Epidemiologic Notes and Reports Restaurant-Associated
Scombroid Fish Poisoning -- Alabama, Tennessee
Between December 31, 1985, and January 4, 1986, three
restaurants
in Alabama and Tennessee received complaints of illness from nine
customers and one employee who ate Pacific amberjack fish (also
called
yellowtail or kahala). Detailed information was obtained on four
of
the 10 persons. Illness onset occurred 10-90 minutes after eating
(median 23 minutes). Symptoms included red facial rash (4/4), body
rash (2/4), severe headache (2/4), oral paresthesias (1/4),
shortness
of breath (2/4), vomiting (1/4), and diarrhea (3/4). Of the three
persons who sought medical evaluation, one had diastolic
hypotension,
and one had bronchospasm. All three were diagnosed as having food
or
fish allergy and were treated with an antihistamine. Rash
persisted
for 2-5 hours (median 3 hours), and all other symptoms resolved in
3-36 hours (median 14 hours). One restaurant cook, who did not eat
the
fish, reported a transient red rash on the hands shortly after
handling the fish.
Ill persons reported no other menu items in common. The fish
meals were prepared by grilling or frying, and none of the
restaurants
reported using food preservatives or monosodium glutamate (MSG) on
the
fish.
In November 1985, a Florida seafood company procured 1,100
pounds
of fresh amberjack from southern California. A 120-pound portion
was
resold December 30 to a distributor that in turn supplied the fish
to
nine restaurants in Alabama, Kentucky, and Tennessee. After
receiving
complaints from three of the restaurants, the distributor promptly
notified all recipient restaurants and collected 20 pounds of
amberjack. Analysis of the leftover fish by the U.S. Food and
Drug
Administration (FDA) showed 19 of 20 subsamples had markedly
elevated
levels of histamine (257-430 mg%). (Fresh fish normally contains
less
than 1 mg% of histamine.) The remaining fish, which had not been
distributed, was destroyed under FDA supervision.
Reported by JFE Shaw, MPA, Jefferson County Health Dept,
Birmingham,
WE Birch, DVM, State Epidemiologist, Alabama State Dept of Public
Health; RH Hutcheson, MD, State Epidemiologist, Tennessee Dept of
Health and Environment; Investigations Br, Nashville District
Office,
W Staruszkiewicz, Div of Food Technology, Center for Food Safety
and
Applied Nutrition, US Food and Drug Administration; Div of Field
Svcs,
Epidemiology Program Office, Enteric Diseases Br, Div of Bacterial
Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: The symptoms of scombroid fish poisoning resemble
those of a histamine reaction; the illness is characterized by
flushing, headache, dizziness, burning of the mouth and throat,
abdominal cramps, nausea, vomiting, and diarrhea. Urticaria and
generalized pruritus often occur (1). In severe cases,
bronchospasm
and respiratory distress may develop (2). Some victims complain
that
the toxic food has a sharp or peppery taste. Typical incubation
periods are less than 1 hour, although wide variations can occur
among
individuals (1).
Scombroid means mackerel-like; mackerel, tuna, and bonito are
related species that are often implicated in outbreaks of scombroid
poisoning. However, nonscombroid species, such as the amberjack
reported here, have also been implicated in scombroid poisoning
(2,3). Of the 73 outbreaks of scombroid poisoning reported to CDC
during the 5-year period 1978-1982, 31 (42%) implicated mahi-mahi
(dolphin fish), a nonscombroid fish (4).
Poisoning is caused by the ingestion of spoiled fish.
Histamine
and probably other toxic byproducts are produced by bacterial
action
on histidine, a normal muscle constituent of dark-meat fishes (5).
Scombroid poisoning is a response to toxic by-products--not an
allergic reaction to fish. Once formed, the toxins are
heat-stable,
so the best defense against poisoning is prompt storage of freshly
caught fish at 0 C (32 F) or below (6). Laboratory confirmation of
scombroid fish poisoning is based on demonstrating elevated
histamine
levels in incriminated fish (1). Public health authorities should
be
notified when this or other fish-related illness is suspected so
that
the distribution of the implicated food can be determined.
References
Hughes JM, Merson MH. Fish and shellfish poisoning. N Engl J
Med
1976; 295:1117-20.
Halstead BW. Class osteichthyes: poisonous scombrotoxic
fishes.
In: Halstead BW. Poisonous and venomous marine animals of the
world. Princeton: Darwin Press, Inc., 1978:417-35.
CDC. Foodborne and waterborne disease outbreaks, annual
summary
1977.
CDC. Foodborne disease surveillance, annual summary reports,
1978
to 1982.
Arnold SH, Brown WD. Histamine toxicity from fish products.
Adv
in Food Res 1978;23:113-54.
Behling AR, Taylor SL. Bacterial histamine production as a
function of temperature and time of incubation. J Food Sci
1982;47:1311-4.
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