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Abstract
On 20 April 2017, an outbreak of histamine food poisoning occurred in a French military unit located near Paris. A total of 40 cases were identified (attack rate: 16.6%). We conducted a case–control study on 31 cases and 63 controls. Multivariate analysis pointed to cooked yellowfin tuna fillet as the very likely source of food poisoning (odds ratio = 156.8; 95% confidence interval: 18.4–1,338.4). The fresh yellowfin tuna was from Reunion Island and was supplied vacuum-sealed and packed with ice at the principal food market of Paris. No cold chain issues could be established in the upstream and downstream supply chains. Histamine concentration was found to be 1,720 mg/kg in leftover raw tuna, and 3,720 mg/kg in control cooked tuna, well above the threshold limit values defined by European regulations (200 mg/kg). The presence of Klebsiella variicola and Pantoea agglomerans, microorganisms of the Enterobacterales order that have been reported to produce histamine, was confirmed in the leftover raw tuna. This type of food poisoning is rarely recognised and confirmed. We describe the outbreak to highlight the specific key points of this type of investigation.
Highlights
Histamine food poisoning (HFP) is an allergy-like reaction caused by consumption of fish or fermented foods containing a high concentration of histamine [1]
Scombroid fish and some non-scombroid fish are commonly implicated in HFP. Their muscles contain a high level of free amino acid histidine, which is preserved as a substrate for bacterial histidine decarboxylase [3]
A total of 40 food poisoning cases were identified among the 241 people who had eaten at the military catering facility on 20 April 2017, leading to an attack rate of 16.6% of those who had eaten lunch and 49.4% of those who had eaten tuna (39/79)
Summary
Histamine food poisoning (HFP) is an allergy-like reaction caused by consumption of fish or fermented foods containing a high concentration of histamine [1]. Scombroid fish (e.g. tuna, mackerel) and some non-scombroid fish (e.g. mahi-mahi, sardines, pilchards, herring) are commonly implicated in HFP. Their muscles contain a high level of free amino acid histidine, which is preserved as a substrate for bacterial histidine decarboxylase [3]. Through this enzyme, certain bacteria can form histamine from histidine. Once formed, histamine—and to some extent other biogenic amines—are not destroyed by cooking, smoking or freezing [7]
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