Seafood Related Toxins and Scombrotoxin - US Cases

FDA released its updated table on Seafood-Related Toxin and Scombrotoxin Fish Poisoning Illnesses. The table shows "natural toxin illness and outbreak incidents that are no longer active. These incidents have been reported to and managed by the FDA."

What a great opportunity to review these toxins and introduce a new one (at least for me) Haff disease.

Ciguatera Fish Poisoning (CFP)

• Commonly related to the consumption of subtropical and tropical reef fish which can accumulate naturally occurring ciguatoxins through their diet  Fish can include - barracuda; grouper; snapper; jacks and trevally; wrasse; mackerel; tang; moray eels; and parrotfish
• The onset of symptoms typically occurs within 6 hours after consuming toxic fish and may persist from several days to weeks. In severe cases, some neurological symptoms may persist for months and can recur for years.
• The neurological symptoms are what sets this apart as foodborne illness - Numbness and tingling of the lips and extremities; Itching of the hands and feet; Joint pain; Muscle pain; Muscle weakness; 
• Reversal and sensitivity to temperature; Dizziness; and Vertigo;

Scombrotoxin Fish Poisoning (SFP)

• Caused by histamine formation as a result of time and temperature abuse such as improper storage/refrigeration of certain types of fish can cause consumer illness. 
• Primarily associated with the consumption of tuna, mahi-mahi, marlin, and bluefish, among other species when those species have been temperature abused somewhere in the supply chain (from the point of catch to the point of cooking.
• Symptoms usually occur within a few minutes to a few hours of consumption and last from 12 hours to a few days. Symptoms of SFP include: Tingling or burning in or around the mouth or throat; Rash or hives on the upper body; Drop in blood pressure; Headache; Dizziness; Itching of the skin; Nausea; Vomiting; Diarrhea; Asthmatic-like constriction of the air passage; Heart palpitations; and Respiratory distress  (basically a allergic-type response)

Puffer Fish Poisoning (PFP)

• Caused by naturally occurring tetrodotoxin is associated with the consumption of puffer fish from waters of the Indo-Pacific Ocean Regions, Gulf of Mexico, Gulf of California, and specific areas on the Atlantic coast of Florida
• Symptoms usually develop within 3 hours after consumption of contaminated fish and may last from 24 – 48 hours. Death commonly occurs due to muscle paralysis resulting in respiratory failure when ventilatory support is not accessible.

Seafood-associated Rhabdomyolysis or Haff disease  (HAFF)

• Linked to the consumption of buffalo fish in the United States although other fish species such as burbot, crayfish, eel, pike and salmon have been associated with the disease worldwide.  Buffalo fish are these carp like fish that can be easily confused with carp.
• Results in the breakdown of skeletal muscle (rhabdomyolysis), with a risk of acute kidney failure that develops within 24 hours after consuming certain fish. Initial symptoms include muscle tenderness and weakness, sometimes with tea-colored urine.
• It is suspected that it is  caused by a bioaccumulation of a new, heat-stable freshwater and/or brackish/saltwater algal toxin, similar to palytoxin but primarily myotoxic and not neurotoxic.

Table continues - How to Report Seafood-Related Toxin and Scombrotoxin Fish Poisoning Illnesses | FDA