An Outbreak of Histamine Poisoning after Ingestion of the Ground Saury Paste in Eight Patients Taking Isoniazid in Tuberculous Ward

Abstract

To determine the cause of outbreak mimicking food poisoning, we studied the toxic polyamine contents of the food and analyzed the clinical characteristics of the affected eight patients. Eight cases of histamine poisoning which occurred in tuberculous patients after dinner in our hospital were analyzed by clinical and biochemical methods. We examined the contents of four representative toxic polyamines, histamine, putrescine, cadaverine and tyramine, of the each food of the dinner and their serum concentrations of the monoamine oxidase (MAO), one of histaminases, using radioimmunoassay. The allergy-like symptoms such as flushing, headache, palpitation, itching, wheezing, dyspnea and diarrhea appeared from 20 minutes to two hours after ingestion in those eight patients taking isoniazid (INH), although the other 378 inpatients had no symptom. The histamine content of the ground saury paste was increased to 32 mg/100 g of food, however, the toxic level of food poisoning is less than 50 mg/100 g of food. All eight patients were taking INH, and their serum concentrations of MAO were decreased. We concluded that this accident was the histamine fish poisoning. We speculated that those allergy-like symptoms were due to both the increased histamine in the food made with the saury under poor storage conditions and the patients' reduced histaminase activities due to INH. We should perceive possible adverse effects depending on the interactions between certain drugs and food.