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Youcefi HE, Abu Saadeh A, Karaca G, Kimiaei A, Safaei S, Kaya A. Exploring Variations in Etiology and Clinical Presentations of Kounis Syndrome Across Pediatric and Adult Populations: A Comprehensive Review. Cureus 2024; 16:e56249. [PMID: 38623099 PMCID: PMC11016985 DOI: 10.7759/cureus.56249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
Kounis syndrome (KS), recognized as a rare yet significant form of acute coronary syndrome precipitated by allergy-mediated mechanisms, poses diagnostic challenges due to its varied clinical presentations and under-recognition. Despite its relevance across diverse populations, comprehensive insights into age-specific characteristics and management remain limited. The analysis of 420 studies yielded a total of 466 case reports of Kounis syndrome, categorized into pediatric (n = 31) and adult (n = 435) populations. After rigorous screening, 330 adult and 20 pediatric case reports were included for further analysis. Triggering factors were identified, with drugs (other) being the most prevalent in both groups. The breakdown of triggering factors, such as drugs (antibiotics), bee/wasp stings, and contrast media, was elucidated. Variations in presenting symptoms, diagnostic investigations, and treatment modalities between pediatric and adult populations were observed. Notably, all pediatric cases were diagnosed with subtype I Kounis syndrome and demonstrated favorable outcomes without any reported fatalities, whereas adult cases exhibited a broader range of Kounis subtypes. Mortality was recorded solely in adult case reports, with no fatalities reported among pediatric cases. These findings underscore the importance of understanding the nuances in the clinical presentation and management of Kounis syndrome across different age groups.
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Affiliation(s)
| | | | | | - Ali Kimiaei
- Cardiology, Bahçeşehir University, Istanbul, TUR
| | | | - Adnan Kaya
- Cardiology, Bahçeşehir University, Istanbul, TUR
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Zhernov YV, Simanduyev MY, Zaostrovtseva OK, Semeniako EE, Kolykhalova KI, Fadeeva IA, Kashutina MI, Vysochanskaya SO, Belova EV, Shcherbakov DV, Sukhov VA, Sidorova EA, Mitrokhin OV. Molecular Mechanisms of Scombroid Food Poisoning. Int J Mol Sci 2023; 24:ijms24010809. [PMID: 36614252 PMCID: PMC9821622 DOI: 10.3390/ijms24010809] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
Abstract
Scombroid food poisoning (SFP) is a foodborne disease that develops after consumption of fresh fish and, rarely, seafood that has fine organoleptic characteristics but contains a large amount of exogenous histamine. SFP, like other food pseudo-allergic reactions (FPA), is a disorder that is clinically identical to allergic reactions type I, but there are many differences in their pathogenesis. To date, SFP has been widespread throughout the world and is an urgent problem, although exact epidemiological data on incidence varies greatly. The need to distinguish SFP from true IgE-associated allergy to fish and seafood is one of the most difficult examples of the differential diagnosis of allergic conditions. The most important difference is the absence of an IgE response in SFP. The pathogenesis of SFP includes a complex system of interactions between the body and chemical triggers such as exogenous histamine, other biogenic amines, cis-urocanic acid, salicylates, and other histamine liberators. Because of the wide range of molecular pathways involved in this process, it is critical to understand their differences. This may help predict and prevent poor outcomes in patients and contribute to the development of adequate hygienic rules and regulations for seafood product safety. Despite the vast and lengthy history of research on SFP mechanisms, there are still many blank spots in our understanding of this condition. The goals of this review are to differentiate various molecular mechanisms of SFP and describe methods of hygienic regulation of some biogenic amines that influence the concentration of histamine in the human body and play an important role in the mechanism of SFP.
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Affiliation(s)
- Yury V. Zhernov
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
- Department of Chemistry, Lomonosov Moscow State University, 119991 Moscow, Russia
- Center of Life Sciences, Skolkovo Institute of Science and Technology, 121205 Moscow, Russia
- Center for Medical Anthropology, N.N. Miklukho-Maclay Institute of Ethnology and Anthropology, Russian Academy of Sciences, 119017 Moscow, Russia
- Department of Medical and Biological Disciplines, Reaviz Medical University, 107564 Moscow, Russia
- Correspondence: ; Tel.: +7-(915)-1552000
| | - Mark Y. Simanduyev
- The Baku Branch, I.M. Sechenov First Moscow State Medical University (Sechenov University), Baku AZ1141, Azerbaijan
| | - Olga K. Zaostrovtseva
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Ekaterina E. Semeniako
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Kseniia I. Kolykhalova
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Inna A. Fadeeva
- Department of Foreign Language, Faculty of World Economy, Diplomatic Academy of the Russian Foreign Ministry, 119034 Moscow, Russia
- Department of Public Administration in Foreign Policy, Diplomatic Academy of the Russian Foreign Ministry, 119034 Moscow, Russia
| | - Maria I. Kashutina
- Loginov Moscow Clinical Scientific and Practical Center, 111123 Moscow, Russia
- Department of Public Health Promotion, National Research Centre for Therapy and Preventive Medicine, 101990 Moscow, Russia
- Department of Therapy, Clinical Pharmacology and Emergency Medicine, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Sonya O. Vysochanskaya
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Elena V. Belova
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Denis V. Shcherbakov
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Vitaly A. Sukhov
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Ekaterina A. Sidorova
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Oleg V. Mitrokhin
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
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Scombroid Poisoning: An Overview for the Emergency Nurse Practitioner. Adv Emerg Nurs J 2023; 45:72-76. [PMID: 36757750 DOI: 10.1097/tme.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Scombroid poisoning is a common fish-borne disease in clinical settings. Fish that has not been adequately stored after catching can allow bacteria to proliferate, which causes the conversion of histidine to histamine. Once histamine has formed, freezing or cooking the fish will not remove the histamine content. Once the fish is consumed, histamine is released, causing toxicity to the patient with symptoms including cutaneous, gastrointestinal, and anaphylactoid. Emergency nurse practitioners should identify, appropriately diagnose, and treat individuals with scombroid poisoning and avoid misdiagnosing it as fish allergy.
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Taylor R, Burg J, Opara N. The Sea Was Angry That Day My Friends: An Inland Case of Acute Scombroid Poisoning With a Twist. Cureus 2021; 13:e18394. [PMID: 34729272 PMCID: PMC8555940 DOI: 10.7759/cureus.18394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/05/2022] Open
Abstract
Scombroid poisoning is a common form of food poisoning related to fresh, canned, or smoked fish ingestion with high histamine content as a result of improper handling and storage. The incubation period for this type of fish poisoning is relatively short (ranges from a few minutes to hours). We present a case of a 53-year-old male who developed severe symptoms of scombroid poisoning minutes after ingesting an ahi tuna salad in a local restaurant.
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Affiliation(s)
- Roger Taylor
- Emergency Medicine, Charleston Area Medical Center, Charleston, USA
| | - Joshua Burg
- Emergency Medicine, Charleston Area Medical Center, Charleston, USA
| | - Nnennaya Opara
- Emergency Medicine, Charleston Area Medical Center Health Education and Research Institute, Charleston Area Medical Center, Charleston, USA
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Katugaha SB, Carter AC, Desai S, Soto P. Severe scombroid poisoning and life-threatening hypotension. BMJ Case Rep 2021; 14:e241507. [PMID: 33906888 PMCID: PMC8076943 DOI: 10.1136/bcr-2020-241507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/04/2022] Open
Abstract
Scombroid fish poisoning (SFP), the most common fish-related illness worldwide, is a histamine response caused by the heat stable toxin histamine. A healthy 48-year-old woman and co-author of this paper developed palpitations, tachycardia and hypotension 10 min after a tuna steak dinner. She subsequently developed numbness of her face, flushing, conjunctival erythema, abdominal pain, nausea, vomiting, diarrhoea, headache and chest pain. Her ECG revealed tachycardia with ST depression. Her hypotension did not respond to fluid resuscitation, and she required phenylephrine. Based on exposure history, clinical syndrome, exclusion of other diseases and consultation with poison control, a diagnosis of scombroid poisoning was established. The state health department was notified. The patient was weaned off vasopressors, dosed famotidine and discharged 43 hours after fish ingestion with no symptoms and normal ECG. SFP is an often misdiagnosed and underreported illness with the potential to cause life-threatening hypotension.
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Affiliation(s)
| | | | - Shashank Desai
- Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Pelayia Soto
- National Capital Poison Center, Washington, DC, USA
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