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A patient presents to your office after lunch at one of the better restaurants in town. She is complaining of dizziness, flushing, diarrhea, tachycardia, and a severe headache. This started about 30 minutes after she had a grilled tuna fish steak for lunch. A number of other patrons had the fish as well but did not develop symptoms.
The fish tasted fine although a bit peppery for her liking. She has never had an allergic reaction to seafood before.
The most likely diagnosis is:
A) Staphylococcus food poisoning.
B) Bacillus cereus food poisoning.
C) Ciguatera poisoning.
D) Scombroid poisoning.
E) Seafood allergy.
Scombroid poisoning occurs when bacteria in a dark-meat fish produce histamine. The fish involved include tuna, mackerel, bluefish, mahimahi, etc. The problem is usually improper handling on the ship and not in the restaurant.
The fish may have a metallic or peppery taste. When these fish are eaten, the patient develops a symptom complex suggestive of histamine effects including
flushing, diarrhea, dizziness, wheezing, tachycardia, and severe headache. An occasional patient will become hypotensive. The symptoms occur 20â€“30 minutes after ingesting the suspect fish and are self-limited, generally lasting less than 6 hours. Patients will respond well to antihistamines such as diphenhydramine.
Patients with ciguatera poisoning present with GI symptoms such as cramping,
vomiting, and diarrhea followed by nondermatomal neurologic symptoms such as perioral numbness, a feeling that oneâ€™s teeth are loose or in the sockets
backwards, burning foot pain similar to a neuropathy, ataxia, weakness, and vertigo. The neurologic symptoms can last for up to 1 year. An almost pathognomonic finding for ciguatera poisoning is hot-cold sensory reversal on the face.
very good explanation. thanks for that.
Yes ,i agree with avir .I am also microbiology student so, i studied all these kind of infection in my college.
i feel, Scombroid poisoning is responsible for this symptoms.
My friends that is typical Qs in ( Coronard Fisher diagnosis cards ) very good for ur prepartion excellent for Renal and Cardiology and More than Perfect in CNS too actually my All friends must have it for step 2 and step 3 good for last 48 hours be4 the test .good luck everyone ( Scomorbid Poisoing ) it give Picture like Carcinoid syndrome and ( Mahhalli fish - tuna , .......)
Scombroid poisoning happens once microorganism in a very dark-meat fish turn out amine. The fish concerned embrace tuna, mackerel, bluefish, mahimahi, etc. the matter is typically improper handling on the ship and not within the building.
The fish could have a silver or pungent style. once these fish ar ingested, the patient develops an indication advanced implicative amine effects as well as
flushing, diarrhea, dizziness, wheezing, arrhythmia, and severe headache. associate occasional patient can become hypotensive. The symptoms occur 20â€“30 minutes once ingesting the suspect fish and ar end, usually lasting but half dozen hours. Patients can respond well to antihistamines like antihistamine.
Patients with ciguatera poisoning gift with GI symptoms like cramping,
vomiting, and diarrhoea followed by nondermatomal neurological symptoms like perioral symptom, a sense that oneâ€™s teeth ar loose or within the sockets
backwards, burning foot pain kind of like a pathology, ataxia, weakness, and symptom. The neurological symptoms will last for up to one year. associate nearly pathognomonic finding for ciguatera poisoning is hot-cold sensory reversal on the face.
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