Food poisoning can occur with many different food groups/items, as well as how the food is prepared, handled or stored.
There are three specific “food poisonings” associated with fish consumption can cause serious toxicity/illness beyond GI symptoms: Ciguatera, Scrombroid, tetrodotoxin (puffer fish)
Ciguatera
- Endemic to warm tropical water and bottom reef dwelling large carnivorous fish: grouper, red snapper, barracuda, amberjack, parrot fish, etc. (> 500 species).
- Toxin: ciguatoxin: opens voltage gated Na channel
- Produced by dinoflagellates (gambierdiscus toxicus) and bioaccumulates in large fish through food chain (eating small fish).
Symptoms:
- GI symptoms: n/v/d and abdominal pain
- Hot/cold reversal
- Paresthesia of tongue/lip >> extremities
- Dental pain: “loose teeth”
May progress to develop…
- T wave changes, bradycardia, hypotension
- Respiratory paralysis and pulmonary edema
Treatment: supportive care and mannitol in presence of severe neurologic symptoms (limited evidence).
Scrombroid
- Endemic in (dark meat) fish living in temperate or tropical water: amberjack, skipjack, tuna, mackerel, albacore, mahi mahi, etc.
- Associated with poor refrigeration/storage after catching fish.
- Histidine in tissue is converted to histamine by bacteria on the fish skin.
Symptoms:
- GI symptoms: n/v/d and abdominal pain
- Upper body flushing
- Puritis, urticarial and perioral swelling can occur
- Palpitation and mild hypotension
Tx: H1/H2 blockers and supportive care
Serious reactions: treat like allergic/anaphylactic reaction
Tetrodotoxin
- Ingestion of improperly prepared puffer fish (fugu) sushi (or bite from blue ring octopus)
- Toxin: tetrodotoxin: blocks voltage gated Na channel.
- Highest concentration in liver and ovary.
Symptoms:
- GI: n/v/d
- Progressive paresthesia and weakness (bulbar-> extremities), ataxia
- Ascending paralysis and respiratory distress/paralysis
- Dysrythmia and hypotension
- Mental status preserved.
Treatment: supportive care and intubated if needed.