In July 1987, state and local public health officials in New
Mexico
investigated two cases of scombroid fish poisoning (histamine
poisoning)
in persons living in Albuquerque. The New Mexico Health and
Environment
Department was initially consulted by an Albuquerque physician
regarding
two patients, a husband and wife, who had become ill within 45
minutes
after eating dinner. Their symptoms included nausea, vomiting,
diarrhea,
headache, fever, flushing, and rapid pulse rate. An investigation
by the
Albuquerque Environmental Health Department found that the couple
had
shared a meal of grilled mahi mahi, pasta, salad, water, and wine.
Their
dog had eaten some of the fish and had vomited; however, their
daughter,
who had eaten no fish, did not become ill. Both of the patients had
been
treated with Benadryl, activated charcoal, and ipecac in a hospital
emergency room. Their symptoms resolved within 36 hours of onset of
illness.
Samples of the remaining mahi mahi were sent to the Food and
Drug
Administration laboratory in Seattle. Histamine was detected in the
samples at a ratio of 20 mg/100 g, a level sufficient to cause
symptoms
(1). Samples from a different shipment of fish were obtained from
the
store in Albuquerque where the mahi mahi was purchased. These
samples
yielded histamine levels of 3 mg/100 g of sample and were negative
for
ciguatera toxin.
The fish had been imported from Taiwan through California and
shipped frozen to the Albuquerque distributor, where it was thawed
and
sold from iced refrigerator cases. The patients had frozen the fish
after they bought it. Later, they thawed it for 3 hours at room
temperature and then grilled the still icy fish.
Reported by: NB Rieder, MD; NI Goertz, RS, JD Hall, DrPH,
Albuquerque
Environmental Health Dept; M Eidson, DVM, HF Hull, MD, State
Epidemiologist, New Mexico Health and Environment Dept. Albuquerque
Resident Post, Food and Drug Administration. Enteric Diseases Br,
Div of
Bacterial Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: Of all varieties of fish, the scombroid species
(tuna,
bonito, and mackerel) and certain other dark-meat fish, such as
mahi
mahi, are the most likely to develop high levels of histamine. When
fresh scombroid fish are not continuously iced or refrigerated,
bacteria
may convert the amino acid histidine, which occurs naturally in the
muscle of the fish, to histamine. Since histamine is resistant to
heat,
cooking the fish generally will not prevent illness. Histamine
levels
may not be correlated with any obvious signs of decomposition of
the
fish. Thus, prompt and proper refrigeration or icing from the time
the
fish is caught until it is preserved, processed, or cooked is
essential
to prevent scombroid fish poisoning. Antihistamines may be useful
for
symptomatic treatment.
Because histamine is metabolized by intestinal flora, even
large
doses of ingested pure histamine usually do not cause symptoms.
Thus,
although histamine is a marker for fish that could cause scombroid
fish
poisoning, the actual mechanism for the poisoning must depend on an
additional cofactor. Experimental evidence indicates that other
substances produced in fish by putrefactive bacteria inhibit the
metabolism of histamine and permit its absorption and circulation
(2).
References
Bartholomew BA, Berry PR, Rodhouse JC, Gilbert RJ, Murray CK.
Scombrotoxic fish poisoning in Britain: features of over 250
suspected
incidents from 1976 to 1986. Epidemiol Infect 1987;99:775-82.
Taylor SL. Histamine food poisoning: toxicology and clinical
aspects.
CRC Crit Rev Toxicol 1986;17:91-128.
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