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📟 8 YO admitted w/ flushing, an urticaria rash on face & torso, and itching
His mom says the rash occurred within an hr of him eating a tuna sandwich. He complained of a spicy taste & had perioral burning causing her to seek medical help
📟 8 YO admitted w/ flushing, an urticaria rash on face & torso, and itching
His mom says the rash occurred within an hr of him eating a tuna sandwich. He complained of a spicy taste & had perioral burning causing her to seek medical help
❓What is the most likely diagnosis?
Answer: Scombroid poisoning
👇🏼
🎙Fish Poisoning Syndromes:
🚨Scombroid:
⚡️commonly misdiagnosed as a seafood allergy so be 👀
Due to the incorrect storage of 🐟 (above 4C) ➡️ bacterial overgrowth & ⬆️ histamine (by bacterial enzyme called histidine decarboxylase)
👇🏼
🦠- Kleb
👇🏼
🎙Fish Poisoning Syndromes:
🚨Scombroid:
⚡️commonly misdiagnosed as a seafood allergy so be 👀
Due to the incorrect storage of 🐟 (above 4C) ➡️ bacterial overgrowth & ⬆️ histamine (by bacterial enzyme called histidine decarboxylase)
👇🏼
🦠- Kleb
E. coli, Proteus, Salmonella, Clostridum, Shigella, Vibrio
🐟- mackerel, skip-jack, tuna, bonito, tilapia, salmon, swordfish, trout, sardines, dolphin fish
⚡️Once histamine ⬆️, it can’t be broken down by 🧊or👩🏻🍳
🔎- within an hr of eating
Cutaneous flushing, urticarial rash
🐟- mackerel, skip-jack, tuna, bonito, tilapia, salmon, swordfish, trout, sardines, dolphin fish
⚡️Once histamine ⬆️, it can’t be broken down by 🧊or👩🏻🍳
🔎- within an hr of eating
Cutaneous flushing, urticarial rash
usually on face & torso, 🤕, 💩, perioral burning, blurry 👁
👇🏼
Fish will have peppery or spicy taste
⚡️👵🏼 who are in MOAIs or INH, which 🚫 breakdown of histamine ➡️ severe & prolonged symptoms
👇🏼
Tachycardia, bronchospasm, hypotension, dizziness, edema
💊- antihistamine
👇🏼
Fish will have peppery or spicy taste
⚡️👵🏼 who are in MOAIs or INH, which 🚫 breakdown of histamine ➡️ severe & prolonged symptoms
👇🏼
Tachycardia, bronchospasm, hypotension, dizziness, edema
💊- antihistamine
🚨Tetrodotoxin:
⚡️ Due to the incorrect storage of 🐟 ➡️ bacterial overgrowth & toxin production ➡️ blocks Na channels
👇🏼
🦠- Pseudoalteromonas, Pseudomonas, Vibrio, Aeromonas, Alteromonas, Shewanella, Roseobacter, Raoultella, Actinomycetes, Microbacterium, & Serratia
⚡️ Due to the incorrect storage of 🐟 ➡️ bacterial overgrowth & toxin production ➡️ blocks Na channels
👇🏼
🦠- Pseudoalteromonas, Pseudomonas, Vibrio, Aeromonas, Alteromonas, Shewanella, Roseobacter, Raoultella, Actinomycetes, Microbacterium, & Serratia
🐟- pufferfish, newts, sea 🐌
⚡️heat stable toxin
🔎- within 30 min of eating
Classic perioral numbness, paresthesias, slurred speech, loss of reflexes, flaccid paralysis
💊- no known antidote. Supportive care for 🫁
ncbi.nlm.nih.gov/books/NBK50771…
⚡️heat stable toxin
🔎- within 30 min of eating
Classic perioral numbness, paresthesias, slurred speech, loss of reflexes, flaccid paralysis
💊- no known antidote. Supportive care for 🫁
ncbi.nlm.nih.gov/books/NBK50771…
🚨Paralytic Shellfish Poisoning:
⚡️ Shellfish ➡️ eat toxic algae ➡️ commercial harvested fishing ➡️ consumption of saxitoxin ➡️ blocks Na channels
👇🏼
🦪, mollusks, clams, mussels
🔎- within 1 hr of eating Perioral numbness, feeling of “floating” (dissociation), 💩,🤢
⚡️ Shellfish ➡️ eat toxic algae ➡️ commercial harvested fishing ➡️ consumption of saxitoxin ➡️ blocks Na channels
👇🏼
🦪, mollusks, clams, mussels
🔎- within 1 hr of eating Perioral numbness, feeling of “floating” (dissociation), 💩,🤢
🚨Ciguatera:
⚡️🐟➡️ eat algae laced w/ ciguatoxin (produced my dinoflagellates that adhere to it) ➡️ consumption of fish allows toxin to ⬇️ opening threshold of Na channel
👇🏼
Barracudas, groupers, moray eels, snappers, amberjacks
⚡️toxin is heat resistant, lipid solvable
⚡️🐟➡️ eat algae laced w/ ciguatoxin (produced my dinoflagellates that adhere to it) ➡️ consumption of fish allows toxin to ⬇️ opening threshold of Na channel
👇🏼
Barracudas, groupers, moray eels, snappers, amberjacks
⚡️toxin is heat resistant, lipid solvable
odorless, & tasteless
🔎- within 3-6 hrs of consumption
🤢,💩, painful 🦷, blurry 👁, hot/cold reversal, 🤕, pruritus, hallucination, metallic taste in mouth, bradycardia
💊- supportive care. Possible neurological reversal with amitriptyline, gabapentin, or pregabalin
🔎- within 3-6 hrs of consumption
🤢,💩, painful 🦷, blurry 👁, hot/cold reversal, 🤕, pruritus, hallucination, metallic taste in mouth, bradycardia
💊- supportive care. Possible neurological reversal with amitriptyline, gabapentin, or pregabalin
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