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A 40F and her 10 yo son present with flushing of neck/face, headache, and diarrhea about 45 min after eating mackerel, rice, and some fruit (mango, cantaloupe).
#IDTwitter #IDMedEd #MedTwitter #FOAMed
A 40F and her 10 yo son present with flushing of neck/face, headache, and diarrhea about 45 min after eating mackerel, rice, and some fruit (mango, cantaloupe).
#IDTwitter #IDMedEd #MedTwitter #FOAMed
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What do you think is cause of their sxs? #IDTwitter #IDMedEd #MedTwitter #FOAMed
Pic credits:
bit.ly/39Nvx1O
bit.ly/339lKSj
What do you think is cause of their sxs? #IDTwitter #IDMedEd #MedTwitter #FOAMed
Pic credits:
bit.ly/39Nvx1O
bit.ly/339lKSj
3/Dx: Scombroid (histamine) poisoning
🍽️After ingestion of contaminated 🐟(tuna, mackerel, bonito, swordfish, mahi-mahi, and more)
🧀Did you know it can occur after w/contaminated cheese too?
📌Freq misdiagnosed as seafood allergy
🎣Usu fresh fish but can occur with canned fish
🍽️After ingestion of contaminated 🐟(tuna, mackerel, bonito, swordfish, mahi-mahi, and more)
🧀Did you know it can occur after w/contaminated cheese too?
📌Freq misdiagnosed as seafood allergy
🎣Usu fresh fish but can occur with canned fish
4/
Improperly stored 🐟➡️bactl overgrowth (ex: E.coli, Vibrio, Proteus, etc)➡️histidine in fish converted to histamine/other amines➡️toxic levels in as short as 2-3h
🧨Toxins not broken down by cooking, freezing, or refrigeration
🎣 Fish seems fresh but tastes "peppery/spicy"
Improperly stored 🐟➡️bactl overgrowth (ex: E.coli, Vibrio, Proteus, etc)➡️histidine in fish converted to histamine/other amines➡️toxic levels in as short as 2-3h
🧨Toxins not broken down by cooking, freezing, or refrigeration
🎣 Fish seems fresh but tastes "peppery/spicy"
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⬆️hist sxs w/i 1 hr of eating:
🔻Rapid-onset flushing face/neck
🔻Erythematous/urticarial rash
🔻Diarrhea
🔻HA
🔻Rarely severe bronchospasm/cardiac/shock in those with predisposing conditions
▪️Can use H1/H2 blockers. Tx anaphylaxis if necessary
⬆️hist sxs w/i 1 hr of eating:
🔻Rapid-onset flushing face/neck
🔻Erythematous/urticarial rash
🔻Diarrhea
🔻HA
🔻Rarely severe bronchospasm/cardiac/shock in those with predisposing conditions
▪️Can use H1/H2 blockers. Tx anaphylaxis if necessary
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Next, let's cover Ciguatera poisoning
🌊Ingest reeffish (barracuda, amberjack, moray eel, 400+ diff 🐟spp)
🦠Contaminated w/toxins fr dinoflagellates (Gambierdiscus toxicus, single cell orgs on coral reefs)
🐠Fish consume, concentrate toxin in organs/flesh (but not affected)
Next, let's cover Ciguatera poisoning
🌊Ingest reeffish (barracuda, amberjack, moray eel, 400+ diff 🐟spp)
🦠Contaminated w/toxins fr dinoflagellates (Gambierdiscus toxicus, single cell orgs on coral reefs)
🐠Fish consume, concentrate toxin in organs/flesh (but not affected)
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🎣 Fish taste/smell nl
🥘Cooking/marinating/freezing does not destroy toxin
🤮Sxs:
🔸Gastroenteritis w/i 3-6h (but can be delayed)
🔸Neuro w/i 3-72h: peri-oral paresthesias, pruritis (w/o rash), HA
🔸CV: brady, heart block w/i hrs
🎣 Fish taste/smell nl
🥘Cooking/marinating/freezing does not destroy toxin
🤮Sxs:
🔸Gastroenteritis w/i 3-6h (but can be delayed)
🔸Neuro w/i 3-72h: peri-oral paresthesias, pruritis (w/o rash), HA
🔸CV: brady, heart block w/i hrs
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🌎Types of sxs vary according to geography (likely due to diff in toxins + local food habits)
🌎Pacific Ocean regions: early neuro+GI+CV sxs with neuro sxs/AMS predominant ➡️Caribbean: usu gastroenteritis 1st, then neuro (but no AMS), not life threatening
🌎Types of sxs vary according to geography (likely due to diff in toxins + local food habits)
🌎Pacific Ocean regions: early neuro+GI+CV sxs with neuro sxs/AMS predominant ➡️Caribbean: usu gastroenteritis 1st, then neuro (but no AMS), not life threatening
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⭐️One more ID+food association: Alpha-gal allergy or red meat allergy
🥩Alpha-gal (galactose-alpha-1,3-galactose) = carb in all mammal meat except humans/apes/Old World monkeys
💥In susceptible indls, mult tick bites resulted in IgE Ab to alpha-gal and recurrent anaphylaxis
⭐️One more ID+food association: Alpha-gal allergy or red meat allergy
🥩Alpha-gal (galactose-alpha-1,3-galactose) = carb in all mammal meat except humans/apes/Old World monkeys
💥In susceptible indls, mult tick bites resulted in IgE Ab to alpha-gal and recurrent anaphylaxis
10/
🤕Typically allergic rxn with 5-30min of eating
📒Most often implicated is Amblyomma americanum (lone star tick), mostly in SE US (but alpha-gal meat allergy reported in other parts of world)
Ref: CDC
jamanetwork.com/journals/jama/…
pubmed.ncbi.nlm.nih.gov/23743512/
🤕Typically allergic rxn with 5-30min of eating
📒Most often implicated is Amblyomma americanum (lone star tick), mostly in SE US (but alpha-gal meat allergy reported in other parts of world)
Ref: CDC
jamanetwork.com/journals/jama/…
pubmed.ncbi.nlm.nih.gov/23743512/
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Three useful illnesses (ciguatera poisoning, scombroid poisoning, alpha-gal meat allergy) to be aware of that are commonly misdiagnosed! (also might be used in various test/board exams 🤓) #IdMedEd
Three useful illnesses (ciguatera poisoning, scombroid poisoning, alpha-gal meat allergy) to be aware of that are commonly misdiagnosed! (also might be used in various test/board exams 🤓) #IdMedEd
