Good fish, bad fish: a cautionary tale

This fish is in trouble

I've learned something about fish food poisoning these past few weeks. Perhaps I knew about it  in medical school, but that was a long time ago. We love fish, consider it a treat, eat it several times a week and, once in a while, partake of other marine creatures. I like mussels as long as they're cooked,  and will eat sushi, but never raw oysters.

So four people we know have had apparent fish-related food poisoning recently. They didn't eat at the same place or the same fish. That got me curious and I started to hunt down types of food poisoning related to eating fish and other marine critters. I found two that aren't the usual bacterial- or viral-caused forms (I'll write about those another time).

So what happened in the first instance was at a play when a close friend got suddenly and violently ill. He collapsed, was "out of it" for perhaps thirty seconds (I thought cardiac arrest or major stroke), then sat up and vomited copiously over himself and his spouse. Then he seemed weak, but otherwise normal. I went with hin to the ER where he was monitored for cardiac rhythm changes for four hours, got blood work and had a brain scan. All those were essentially normal, but he vomited four more times in the ER and once more as I was driving him home.

Over the next two weeks he had a cardiac workup with an echocardiogram, a stress test and a 24-hour Holter monitor for rhythm disturbances. All those were negative. He was previously reasonably healthy for his age of 72 and had no history of any seizure disorder.

A few other tests are pending, but then I spoke to a friend who had suffered a similar illness and heard of two others in the community. I went hunting for odd forms of food poisoning as none of these folk had diarrhea and none had sequelae of their short-term illness.

I finally heard the term scromboid fish food poisoning. All four had eaten fish and several had eaten shellfish.

Scromboid turns out to fit better than other diagnoses. It's typically associated with the consumption of fish, especially Scombridae fish like tuna or mackerel. It has a rapid onset, is marked by abdominal symptoms and or prostration, headache, palpitations, or flushing., sometimes tachycardia (rapid heart beat) and low or high BP and usually is self limited. It is caused by a toxin which is not inactivated by cooking and may be associated with spoiled meat.

The CDC says it's the most common chemically-related food poisoning in the United States., but at that only causes 5% of the food-related illness reported. It's much less nasty than ciguatera, the other fish related illlness I found. That one is also toxin-related, heat-resistent, can cause somewhat similar symptoms, but can lead to months ort even years of problems.

After reading of these I'll still go back to our favorite fish restaurant; they had no other patrons with similar symptoms. Scromboid seems to be relatively uncommon & mild in retrospect. On the other hand some speculate that ciguatera caused the migration of the Polynesians between 1,000 and 1,400 CE.

One Response to “Good fish, bad fish: a cautionary tale”

  1. Yikes - migration? Think I'll pay more attention to my food choices from the sea, but I 'm not packing my bags just yet.

Leave a Reply