Read on Twitter
1/
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
2/
What do you think is cause of their sxs? #IDTwitter #IDMedEd #MedTwitter #FOAMed
Pic credits:
https://bit.ly/39Nvx1O
https://bit.ly/339lKSj
What do you think is cause of their sxs? #IDTwitter #IDMedEd #MedTwitter #FOAMed
Pic credits:
https://bit.ly/39Nvx1O
https://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 allergyUsu 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 aminestoxic 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 aminestoxic levels in as short as 2-3hToxins not broken down by cooking, freezing, or refrigeration Fish seems fresh but tastes "peppery/spicy"
5/
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/neckErythematous/urticarial rashDiarrheaHARarely severe bronchospasm/cardiac/shock in those with predisposing conditionsCan use H1/H2 blockers. Tx anaphylaxis if necessary
6/
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)
7/
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 nlCooking/marinating/freezing does not destroy toxinSxs:Gastroenteritis w/i 3-6h (but can be delayed)Neuro w/i 3-72h: peri-oral paresthesias, pruritis (w/o rash), HACV: brady, heart block w/i hrs
8/
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
9/
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 allergyAlpha-gal (galactose-alpha-1,3-galactose) = carb in all mammal meat except humans/apes/Old World monkeysIn 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
https://jamanetwork.com/journals/jama/fullarticle/2670238
https://pubmed.ncbi.nlm.nih.gov/23743512/
Typically allergic rxn with 5-30min of eatingMost 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
https://jamanetwork.com/journals/jama/fullarticle/2670238
https://pubmed.ncbi.nlm.nih.gov/23743512/
11/
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
