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Current Issues -- Escolar
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Scombroid and Gastroenteritis Associated with Consumption of Escolar (posted 12/16/04)Within a one-week period in November 2004, two local health jurisdictions reported separate clusters of illness associated with eating escolar. The Washington State Department of Health Communicable Disease Epidemiology Section (CDES) assisted the local health jurisdictions in investigating these two clusters. Escolar is a large ocean fish increasingly popular in Pacific Northwest groceries, restaurants, and other food outlets. It has been reported to be associated with both scombroid and a unique gastroenteritis marked by oily diarrhea. Scombroid results when histamine produced by bacterial decomposition of fish causes an allergic-like reaction. The symptoms of scombroid are like those from an allergic reaction: facial flushing, tingling or numbness, rash or hives, abdominal pain, diarrhea, headache, hypotension, and/or palpitations. Onset of symptoms occurs within 1 to 2 hours of ingestion. The contaminated fish are frequently described as having a "peppery" or "metallic" taste. Scombroid is rarely life-threatening, and most individuals recover within hours without residual problems. Over-the-counter antihistamines such as diphenhydramine are usually sufficient for treatment. Diarrhea associated with consumption of escolar is caused by an indigestible waxy ester (gempylotoxin) that is naturally present in the fish; the diarrhea is often described as oily and/or unusually colored, and may be accompanied by abdominal discomfort and fecal incontinence. One group of patients, a family of three, developed scombroid after eating escolar. In the other group, a cooking class, 21 of 24 students were affected. Thirteen had scombroid like features, while 8 had diarrhea and abdominal cramping. Symptoms started within 1 to 2 hours of eating, and most patients were better within 12 hours. A common fish wholesaler was identified, with the fish coming from the same lot. An effort to retrieve fish from the same lot was initiated. As escolar and related species appear on the menus of consumers and food professionals alike, it is important that healthcare providers and consumers are aware of the potential short-term consequences associated with these fish. |
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