Nsi Azụ Ciguatera (Ngbanwe Ọkpụkpọ Oyi na-ekpo ọkụ, Bradycardia) vs. Scombroid Histamine Fish Flush and Shellfish Toxins¶

Ịzụlite nhịahụ na mberede n'akụkụ ọnụ, na-ere ọkụ mgbe ọ na-emetụ mmiri oyi aka, ihu na-acha uhie uhie na-egbuke egbuke, nhụsianya, ma ọ bụ ike iku ume obere oge mgbe ị richara azụ azụ, steaks pelagic, ma ọ bụ shellfish bivalve chọrọ mgbanwe ngwa ngwa n'ụlọ ọgwụ n'etiti nnukwu biotoxins mmiri. Kpọọ nọmba mberede mpaghara gị (911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom) ma ọ bụ kpọtụrụ anyị. akwụkwọ ndekọ aha mberede mba ụwa ozugbo ma ọ bụrụ na onye na-eri nri na-egosi ngwa ngwa obi, ọbara mgbali elu, iku ume, mgbagwoju anya, ma ọ bụ adịghị ike. N'ihi na ** nsị azụ Scombroid ** na-eṅomi nnukwu mgbasa ozi IgE mmeghachi omume nfụkasị ma ọ bụ anaphylaxis, mgbe ** Ciguatera ***, ** Domoic Acid **, na ** Brevetoxin *** na-emeju oke anyị. botulism na ahụ mkpọnwụ shellfish neurotoxin ndu ndu, Ndị na-azaghachi aghaghịkwa ịmata ọdịiche ndị a na-ekpo ọkụ na-ekpo ọkụ site na nje bacteria nri nsị na nnukwu gastroenteritis.

Isi nri, esi, frying, sie, ise siga, kefriza, ma ọ bụ igbari azụ n'ime mmiri lime (** ceviche**) ** anaghị emebi ihe ọ bụla n'ime nsị mmiri ndị a. Na mgbakwunye, azụ na-egbu egbu na azụ azụ na-ele anya, na-esi isi, ma na-atọkwa ụtọ nke ọma (ma e wezụga naanị ose na-esi ísì ụtọ ma ọ bụ ata ọla n'ime azụ scombroid). Ndị ụlọ ọgwụ mberede na ndị njem ga-amarịrị ozugbo n'etiti nnukwu ọrịa mmiri anọ: 1. ** Nsi azụ̀ Ciguatera (CFP):** Ihe kpatara ya site na iri nnukwu azụ azụ na-eri anụ nke ebe okpomọkụ / subtropical (** barracuda, grouper, red snapper, amberjack, moray eel, hogfish, Spanish mackerel, coral trout ) nwere ** ciguatoxins (CTX* bioaccumulated sitere na benthic dinoflagellate Gambierdiscus toxicus. Ọ na-enwe nnukwu gastroenteritis (2 to 12 hours), na-eyi ndụ egwu ** sinus bradycardia na hypotension , na pathognomonic ** allodynia oyi (oyi).hot-cold temperature reversal, na-emeso n'ime 48 to 72 hours na eriri afọ ** 20% mannitol (1.0 g/kg** gbakwunyere nri siri ike ** nke ọnwa 6 na-akpalite-ezere. 2. ** ScombroidHistamine) Nsi azụ:** Ọ na-ebute site na iri azụ na-adịghị mma refrigerated nke anụ gbara ọchịchịrị (** tuna, mahi-mahi [dorado], bluefish, mackerel, bonito, marlin, sardines, anchovies ***) nke nje bacteria na-agbanwe akwara L-histidine n'ime nnukwu ọnụọgụ **histamine. Ihe ngosi n'ime 10 to 60 minutes dị ka ihe dị egwu **"ọkụ ọkụ-dị ka" histamine flush *, isi ọwụwa na-akụda mmụọ, palpitations, na bronchospasm, na-agwọ ya ngwa ngwa na H1 na H2 antihistamines (not permanent fish allergy). 3. ** Amnesic Shellfish na-egbu egbu (ASP - Domoic Acid): Ihe kpatara ya bụ Pseudo-nitzschia diatom na-ama ifuru na mọsel, agụba, scallops, na Dungeness crab viscera; overexcites hippocampal AMPA / kainate glutamate receptors **, na-akpata ọnọdụ epipticus na ** na-adịgide adịgide anterograde mkpụmkpụ-oge ncheta ọnwụ *. 4. ** Nsi nke Shellfish Neurotoxic (NSP - Brevetoxin): Nke kpatara * Karenia brevis * ("Florida / Gulf of Mexico red tide") dinoflagellates na oysters na clams; na-eme ka ọwa sodium voltaji na-arụ ọrụ (dị ka ciguatoxin) iji mepụta ** allodynia oyi, paresthesia, na bronchospasm osimiri ikuku ikuku na-enweghị mkpọnwụ.

+-------------------------------------------------------------------------+
|            MARINE SEAFOOD TOXIN RAPID DIFFERENTIATION MATRIX            |
+-------------------------------------------------------------------------+
|  1. CIGUATERA FISH POISONING (Barracuda, Grouper, Snapper, Amberjack)   |
|     * Toxin: Ciguatoxin (Locks open Na+ channels) -> Onset 2 to 12 hrs  |
|     * Hallmarks: Cold Allodynia (Ice feels like burning fire), Tooth    |
|       ache/loose-tooth sensation, Severe Bradycardia (HR < 45) & Low BP |
|     * Treatment: IV Atropine + Fluids; IV 20% Mannitol (1 g/kg over     |
|       30-45m AFTER full rehydration, within 48-72h) + 6-Month Diet      |
+-------------------------------------------------------------------------+
|  2. SCOMBROID HISTAMINE POISONING (Tuna, Mahi-Mahi, Mackerel, Bluefish) |
|     * Toxin: Bacterial Histamine (from warm storage) -> Onset 10-60 min |
|     * Hallmarks: Peppery/metallic taste, Bright Red Face/Neck Flush,    |
|       throbbing headache, tachycardia, diarrhea (NOT a true allergy)    |
|     * Treatment: IV/PO H1 Blocker (Diphenhydramine/Cetirizine) + H2     |
|       Blocker (Famotidine 20 mg IV); Epinephrine only if bronchospasm   |
+-------------------------------------------------------------------------+
|  3. AMNESIC SHELLFISH POISONING (Mussels, Razor Clams, Crab Viscera)    |
|     * Toxin: Domoic Acid (Glutamate excitotoxin) -> Onset 15m to 38 hrs |
|     * Hallmarks: Vomiting -> Confusion, Status Epilepticus, Permanent   |
|       loss of short-term memory (Hippocampal necrosis)                  |
+-------------------------------------------------------------------------+
|  4. NEUROTOXIC vs. PARALYTIC SHELLFISH POISONING (Oysters, Clams)       |
|     * NSP (Brevetoxin): Na+ channel opener -> Cold allodynia, NO apnea  |
|     * PSP (Saxitoxin): Na+ channel blocker -> Rapid respiratory arrest  |
+-------------------------------------------------------------------------+

Mee nke a ugbu a¶

1. ** Nyochaa iku ume, ọ̀tụ̀tụ̀ obi, na ọbara mgbali elu ozugbo, ma kpọọ ndị ọrụ mberede.** Kpọọ 911 (US na Canada), 112 (European Union), 999 (United Kingdom), 000 (Australia), ma ọ bụ 111 (New Zealand).
2. Ọ bụrụ na onye ahụ rie ** tuna ma ọ bụ mahi-mahi** 15 minutes N'oge gara aga ma ugbu a nwere iku ume, njigide akpịrị, ma ọ bụ ọzịza ire (** Scombroid siri ike), na-enye ** epinephrine auto-injector (EpiPen*** banye n'apata mpụta ma ọ bụrụ na ọ dị, ma nye ọnụ ** diphenhydramine (Benadryl, 25 to 50 mg*** ma ọ bụ ** cetirizine (10 mg*** gbakwunyere ** famotidine (Pepcid, 20 mg*** ọ bụrụ na ha nwere ike ilo nke ọma.
3. Ọ bụrụ na onye ahụ riri barracuda, grouper, red snapper, ma ọ bụ amberjack 2 to 8 hours gara aga, ọ na-enwe nkụda mmụọ ma ọ bụ daa mbà n'obi na ** ngwa ngwa pulse (below 50 beats per minute*** (Ciguatera), tọgbọrọ ha n'azụ na-ebuli ụkwụ ha elu 30 centimeters (12 inches) iji mee ka ọbara na-eruba n'ụbụrụ mgbe ị na-echere ndị na-ahụ maka ahụike na ** atropine ** na saline nkịtị.
4. ** Mee "Nnwale Ihe Oyi" n'akụkụ akwa maka Ciguatera ma ọ bụ Brevetoxin.** Mee ka onye ọrịa metụ ike soda oyi, ice cube, ma ọ bụ mmiri mgbata oyi. Ọ bụrụ na ihe oyi na-adị ka ** ọkụ na-egbu mgbu, ice kpọrọ nkụ, ma ọ bụ ọkụ eletrik (cold allodynia / hot-cold temperature reversal, nchoputa bụ ihe fọrọ nke nta ka ọ bụrụ ** Ciguatera Fish Poisoning ** (ọ bụrụ na e riri azụ azụ) ma ọ bụ ** Neurotoxic Shellfish Poisoning (Brevetoxin (ma ọ bụrụ na a na-eri ọwara mmiri nke Mexico / shellfish subtropical). (Gulf of Mexico)
5. Aṅụla mmiri oyi ma ọ bụ ịsa ahụ oyi ma ọ bụrụ na a na-enyo Ciguatera. Ịṅụ ihe ọṅụṅụ oyi na-ebute oké mgbu na akpịrị na akpịrị, na mmiri oyi na akpụkpọ ahụ na-ebute paresthesia na-egbu mgbu. Na-enye naanị ** ọnụ ụlọ-okpomọkụ ma ọ bụ ọkụ ọnụ rehydration mmiri mmiri** na obere sips.
6. ** Gbaa mbọ hụ na a na-eme ka mmiri dị n'ime intravenous zuru ezu tupu inye Mannitol intravenous maka Ciguatera.** Gwa dọkịta mberede na onye ọrịa ahụ nwere nnukwu nsi Ciguatera Fish n'ime ahụ. 48 to 72 hour windo maka ** eriri afọ 20% Mannitol (1.0 gram/kg). Otú ọ dị, n'ihi na mannitol bụ ike osmotic diuretic na Ciguatera na-akpata oké vomiting na afọ ọsịsa n'oge, ** mannitol ga-abụ nanị inye ya mgbe emechara hypovolemia na akpịrị ịkpọ nkụ kpamkpam. 1 to 2 liters nke isotropic intravenous crystalloids (0.9% Saline nkịtị ma ọ bụ Lactated Ringer's).
7. ** Chekwaa na friza nke fọdụrụ azụ ma ọ bụ azụ azụ ma dọọ ndị na-eri nri ndị ọzọ aka na ntị.** Kechie ihe ọ bụla esighị nri ma ọ bụ sie nri n'ime foil ma ọ bụ akpa rọba ma tụba ya maka nyocha biotoxin ngalaba ahụike.FDA / state marine lab liquid chromatography-mass spectrometry). Kpọtụrụ onye ọ bụla kesara azụ̀ ozugbo.

Osisi mkpebi: azụ mmiri na nsi na-egbu egbu¶

flowchart TD
    A["Ọrịa Ọrịa Mgbe Irichara Azụ Mmiri ma ọ bụ Shellfish"] --> B{"Kedu ụdị nri mmiri ka a na-eri?"}
    B -->|"Azụ Pelagic anụ gbara ọchịchịrị (Tuna, Mahi-Mahi, Mackerel, Bluefish, Sardines)"| C{"Malite na nkeji 10-60 na ihu uhie na-egbuke egbuke na tachycardia?"}
    B -->|"Azụ mmiri dị n'ebe okpomọkụ/Southtropical (Barracuda, Grouper, Snapper, Amberjack, Eel)"| D{"Gastroenteritis (2-12h) + Cold Allodynia, eze mgbu ma ọ bụ Bradycardia?"}
    B -->|"Shellfish Bivalve (Mussels, Clams, Oysters, Scallops) ma ọ bụ Crab Viscera"| E{"Chọpụta Ọrịa Shellfish site na akara akwara akwara"}
    C -->|"Ee"| F["SCOMBROID (HISTAMINE) NSI Azụ: Nye IV/PO H1 Blocker (Diphenhydramine 25-50 mg) + H2 Blocker (Famotidine 20 mg IV); Albuterol/Epi ma ọ bụrụ na ọ na-afụ ụfụ"]
    D -->|"Ee"| G["CIGUATERA FISH POISONING (CFP): Mweghachi mbụ na 1-2 L IV 0.9% Saline + IV Atropine (0.5-1 mg) maka Bradycardia/Hypotension"]
    G --> H["Ozugbo Euvolemic (na n'ime 48-72h): Nye 20% IV Mannitol (1.0 g / kg n'elu 30-45 min); Manye usoro ịzere nri ọnwa isii"]
    E -->|"Mgbagwoju anya, mgbakasị ahụ, ihe ọdịdọ, mfu ebe nchekwa dị mkpirikpi"| I["AMNESIC SHELLFISH POISONING (Domoic Acid): Nchekwa ụgbọ elu ICU + IV Benzodiazepines/Phenobarbital maka Ọnọdụ Epilepticus"]
    E -->|"Cold Allodynia + Perioral Tingling + Bronchospasm (Ọ dịghị ahụ mkpọnwụ akpọnwụ)"| J["NEUROTOXIC SHELLFISH POISONING (Brevetoxin - Red Tide): Na-akwado Fluid IV + Albuterol maka Bronchospasm"]
    E -->|"Ihu/Ọdịmma aka na-arịgo ngwa ngwa + ahụ mkpọnwụ nke diaphragmatic"| K["MMỤTA SHELLFISH kpọnwụrụ akpọnwụ (Saxitoxin): Intubation endotracheal ozugbo na ikuku ikuku."]

Ntụle zuru oke nke ọrịa biotoxin mmiri 4¶

Ọrịa 1: Ciguatera Fish nsị (CFP): Pathophysiology, Mannitol Protocol, na nri ọnwa isii¶

Ciguatera Fish Poison bụ ọrịa na-adịghị egbu egbu na-adịghị egbu egbu n'ụwa, na-emetụta ya. 50,000 to 500,000 ndị mmadụ kwa afọ gafee endemic belt mpaghara n'etiti latitudes 35 degrees North na 35 degrees South (** Caribbean, South Florida, Ọwara Mexico, Hawaii, French Polynesia, Great Barrier Reef nke Australia, South Pacific, na Indian Ocean**). N'ihi na ibu ụgbọ elu mba ụwa na-ebuga azụ azụ ọhụrụ zuru ụwa ọnụ, ntiwapụ nke Ciguatera na-ebutekarị n'ọnụ ụlọ mberede na New York, London, Toronto, Paris na Tokyo. (Gulf of Mexico)

1. Food-Chain Bioaccumulation: Ihe kpatara na nnukwu anụ ọhịa na-eri anụ ji dị ize ndụ¶

• Mgbe oké mmiri ozuzo, ịcha ọcha, mmiri na-asọpụta, ma ọ bụ mmiri na-asọpụta n'ụsọ oké osimiri mebiri akuku coral, ihe ndị na-emepụta coral benthic dinoflagellates na-achịkọta ihe ndị dị na mbara igwe **Gambierdiscus *** ( G. toxicus *, * G. polynesiensis *).
• Obere azụ azụ ahịhịa ahịhịa na-ata nri na macroalgae na-ekpuchi coral ma na-eri nri gambiertoxins. Dika azụ na-eri obere azụ̀ na azụ̀ ndị na-eri anụ na-eri ya, na-erikwa azụ̀ ndị na-agba ọsọ ** ndị na-eri anụ ndị na-eri anụ (barracuda, big grouper, red snapper, amberjack, kingfish, moray eel), azu enzymes imeju na-eme ka nsị na-egbu egbu egbu egbu ** ciguatoxins.P-CTX-1, C-CTX-1, I-CTX) wee mee ka agbụ nri dị elu.
• N'ihi na ciguatoxin adịghị emerụ ahụ azụ n'onwe ya, a 10-kilogram (22-pound) Barracuda ma ọ bụ grouper na-ele anya ahụike mgbe ọ na-ebu ọgwụ na-egbu egbu mmadụ n'anụ ahụ na akụkụ ya.

2. Pathophysiology: Gịnị kpatara mmiri oyi ji dị ka ọkụ na-ere ọkụ (Cold Allodynia)¶

+-------------------------------------------------------------------------+
|     MECHANISM OF CIGUATOXIN COLD ALLODYNIA & MANNITOL RESCUE            |
+-------------------------------------------------------------------------+
|  1. Ciguatoxin (CTX) binds Site 5 on Voltage-Gated Sodium Channels      |
|     (Nav1.6 / Nav1.8) in peripheral C-polymodal nociceptors & A-delta   |
|     cold-sensing nerve fibers                                           |
|  2. Shifts activation voltage to resting potential -> Spontaneous,      |
|     repetitive nerve depolarization whenever skin cools below 24-26 C   |
|     -> Brain interprets cold input as intense BURNING HEAT (Allodynia)  |
|  3. Continuous Na+ influx draws water osmotically into axons and        |
|     myelinating Schwann cells -> Acute Paranodal Schwann Cell Edema     |
+-------------------------------------------------------------------------+
|  HOW INTRAVENOUS 20% MANNITOL (1.0 g/kg) REVERSES ACUTE CIGUATERA:      |
|  * Creates an intravascular osmotic gradient that pulls trapped water   |
|    OUT of swollen Schwann cells and nerve axons at the nodes of Ranvier |
|  * Competitively displaces Ciguatoxin from sodium channel membranes     |
|    and scavenges free hydroxyl radicals generated by nerve ischemia     |
+-------------------------------------------------------------------------+

3. The 3 Clinical Systems metụtara Ciguatera¶

1. ** Usoro eriri afọ (Onset 2 to 12 hours, na-adịgide adịgide 24 to 48 hours):** Ọsịsa mmiri mberede, ọgbụgbọ, ọgbụgbọ, ọsụsọ dị ukwuu, na mgbaka afọ.
2. ** Usoro Autonomic Cardiovascular (Onset 2 to 24 hours, na-adịgide adịgide 2 to 5 days** Ciguatoxin na-akpali eriri vagal obi na ọwa sodium autonomic, na-akpata ** sinus bradycardia na-eyi ndụ egwu (heart rate 30 to 45 bpm*, mgbochi obi AV, na ** hypotension siri ike (systolic BP < 70 to 80 mmHg).
3. ** Usoro Ọrịa Ọrịa Neurological (Onset 3 to 72 hours, na-adịgide adịgide weeks to months):**
4. ** Circumoral na Acral Paresthesia:** Ọkpụkpọ ahụ siri ike na ntugharị gburugburu egbugbere ọnụ, ire, akpịrị, mkpịsị aka na mkpịsị ụkwụ.
5. ** Cold AllodyniaHot-Cold Temperature Reversal):** Ahụrụ n'ime 70% to 90% nke ikpe. Imetụ aka ọnụ ụzọ oyi aka, ịbanye n'ala tile dị jụụ, ma ọ bụ ị drinkụ mmiri dị jụụ na-ebute mgbu n'ịkụ, ọkụ, ma ọ bụ ọkụ eletrik.
6. ** Dysesthesia ezeOdontalgia):** Mmetụta mara mma nke ** ezé na-atọhapụ na oghere ha** ma ọ bụ na-egbu mgbu mgbe ha na-ata ahụhụ.
7. ** Pruritus ("La Gratte"):** Itching zuru oke na-agafe n'ọbụ aka, ọbụ ụkwụ, na ogwe nke na-akawanye njọ n'abalị, tinyere ike ọgwụgwụ na-agwụ ike (asthenia), myalgia, ogbu na nkwonkwo, dysuria, na dyspareunia.

4. Usoro iwu ụlọ ọgwụ nzọụkwụ-site-nzọụkwụ: mmiri mmiri, Atropine, na eriri afọ 20% Mannitol¶

1. ** Nzọụkwụ 1: Ezi akpịrị ịkpọ nkụ na Bradycardia nke mbụ (Mandatory Pre-Mannitol Stabilization):**
2. Tinye **1 to 2 liters nke 0.9% Saline nkịtị ma ọ bụ Lactated Ringer's *** na-agbanye n'ime intravenous ruo mgbe mmepụta mmamịrị dị brisk (> 0.5 to 1.0 mL/kg/hour) na akpụkpọ anụ mucous dị mmiri.
3. Maka bradycardia Symptomatic (HR < 50 bpmma ọ bụ hypotension, na-enye ** Atropine intravenous0.5 to 1.0 mg IV kwaba ọ bụla 5 minutes, ruo 3 mg)** ma gbakwunye obere dose dopamine ma ọ bụ ** norepinephrine** infusion ma ọ bụrụ na hypotension na-aga n'ihu ka emechara mmiri.
4. ** Nzọụkwụ 2: Ntinye n'ime 20% MannitolWithin 48 to 72 Hours of Ingestion):**
5. ** Gịnị kpatara oge na hydration okwu: *** Mannitol na-eme n'ime mmiri na-arụ ọrụ nke ọma mgbe enyere ya na nke mbụ 24 to 48 hours (up to 72 hours) nke mgbaàmà mmalite. ** etinyela mannitol n'ime onye ọrịa akpọnwụ akpọnwụ ma ọ bụ hypotensive, n'ihi na osmotic diuresis ga-ebuli nnukwu ujo hypovolemic na nnukwu necrosis tubular.
6. Okwemkwem Usoro Dosing Protocol: Ozugbo onye ọrịa nwere euvolemic na normotensive, nye ya 1.0 gram per kilogram (1.0 g/kg, ma ọ bụ 5 mL/kg nke a 20% Ihe ngwọta Mannitol) n'ime intravenously gafere 30 to 45 minutes .
7. ** Tinyegharịa usoro: *** Ọ bụrụ na enyemaka neurosensory na-esote nlọghachi azụ n'echi ya, nke abụọ. 1.0 g/kg dose nke 20% Enwere ike iji mannitol mee ihe 12 to 24 hours emesia tinyere mmezi crystalloid nnọchi.
8. ** Nzọụkwụ 3: Enyemaka Symptomatic maka Neuropathy Subacute/Ọdịghị AlaWeeks 1 to 12):**
9. Ọ bụrụ na onye ọrịa na-egosi karịa 72 hours Mgbe nri gasịrị, nye iwu ọnụ ** Gabapentin (300 to 600 mg ugboro atọ kwa ụbọchị)**, Pregabalin (75 to 150 mg ugboro abụọ kwa ụbọchị), ma ọ bụ **Amitriptyline (25 to 50 mg n'oge ụra) *** iji belata allodynia oyi na itching.

5. Nri Ciguatera nke ọnwa isii bụ nke a chọrọ n'aka¶

N'ihi na lipophilic ciguatoxin na-anọgide na-edobe n'ime akpụkpọ ahụ akwara na adipose anụ ahụ ruo ọnwa ole na ole, nri na ihe ọṅụṅụ na-eme ka ọbara na-erugharị akpụkpọ ahụ, na-ahapụ histamine, ma ọ bụ na-agbanwe akpụkpọ anụ akwara ga-eme ka nlọghachi azụ nke Ciguatera itching, ọkụ paresthesia na ike ọgwụgwụ. 3 to 6 months mgbe onye ọrịa ahụ gbakere. Onye ọrịa Ciguatera ọ bụla ga-ezere ihe ndị a maka 3 to 6 months: * ** Azụ niile, azụ azụ, na ihe oriri dị n'oké osimiri *** (ọbụlagodi trout mmiri dị oyi, salmon ugbo, ma ọ bụ tuna tuna nwere zero ciguatoxin, iri protein azụ̀ ọ bụla na-akpalite nlọghachi ozugbo mgbaàmà). * Ihe ọṅụṅụ na-aba n'anya niile *** ( biya, mmanya, mmụọ, mmanya bụ otu ihe na-akpalite nnukwu nlọghachi azụ Ciguatera na nnukwu hypotension / bradycardia). * Akụ, ahụekere, na mmanụ mkpụrụ (gụnyere bred ahụekere, almọnd, walnuts, na sesame). * Caffeine na nri nwere histamine dị elu (kọfị, ihe ọṅụṅụ ike, chọkọletị gbara ọchịchịrị, na anụ a gwọchara).

Ọrịa 2: ScombroidHistamine) Nsi azụ̀: Ntụle Anaphylaxis¶

** Nsi azụ nke Scombroid *** (histamine fish poisoning) bụ oké ọgwụ mmanya na-egbu egbu, abụghị ezi ihe nfụkasị azụ ndụ ogologo ndụ, nke sitere na iri azụ̀ na-ata ahụhụ mkpachapụ oge okpomọkụ (stored above 4.4 degrees Celsius [40 degrees Fahrenheit] for more than 3 to 4 hours) n'etiti ijide na isi nri.

Pathophysiology: Bacterial Histidine Decarboxylase¶

Azụ pelagic anụ gbara ọchịchịrị sitere na ezinụlọ * Scombridae * (** tuna, mackerel, bonito, skipjack, albacore**) na Scombresocidae, yana ụdị ndị na-abụghị scombroid (** mahi-mahi / dorado [Coryphaena hippurus], bluefish, amberjack, marlin, swordfish, escolar, sardines, anchovies, and herring), na-enwekarị ọkwa dị elu nke amino acid n'efu L-histidine (> 1,000 mg/100 g) n'ime anụ ahụ ha. * Ọ bụrụ na a na-ahapụ azụ ahụ n'elu ụgbọ mmiri na-ekpo ọkụ, gbazee na ụlọ oriri na ọṅụṅụ, ma ọ bụ chekwaa ya na friji na-ekpo ọkụ, nje bacteria na-adịghị mma na gills na gut (* Morganella morganii *, * Klebsiella pneumoniae *, * Hafnia alvei *, * Photobacterium phosphoreum *) na-amụba ma mepụta enzyme carhistidine. * N'ime awa ole na ole, histidine decarboxylase na-atụgharị akwara L-histidine n'ime nnukwu mkpokọta nke histamine (often > 50 to 500 milligrams per 100 grams nke azụ; nkịtị ọhụrụ azụ nwere < 1 mg/100 g), n'akụkụ biogenic diamines (putrescine na cadaverine) nke na-egbochi histaminases nke eriri afọ mmadụ.diamine oxidase [DAO] na histamine N-methyltransferase) na ịmanye oke nnabata histamine n'ime ọbara. * Ọbụlagodi na ụlọ oriri na ọ restaurantụ restaurantụ ahụ emesịa mee ka azụ ahụ sie ike ma na-agba ma ọ bụ sie ya na oke ọkụ, ** nje bacteria na-anwụ, mana histamine emebere tupu 100% na-adịgide adịgide ma na-arụ ọrụ ***.

+-------------------------------------------------------------------------+
|       SCOMBROID POISONING vs. TRUE IgE SEAFOOD ALLERGY TRIAGE           |
+-------------------------------------------------------------------------+
|  SCOMBROID (HISTAMINE) POISONING:                                       |
|  * Fish had a "peppery," "metallic," or "fizzy" bite on the tongue      |
|  * Multiple diners at the same table eating the tuna/mahi get sick      |
|  * Bright red "sunburn" flush on face, neck, and upper chest (often     |
|    WITHOUT raised wheals/hives) + throbbing histamine headache          |
|  * Patient has eaten the exact same fish species safely in the past     |
|    and CAN safely eat properly refrigerated fish again in the future    |
+-------------------------------------------------------------------------+
|  TRUE IgE-MEDIATED SEAFOOD ALLERGY (ANAPHYLAXIS):                       |
|  * Only the allergic individual reacts; other diners are unaffected     |
|  * Prominent raised pruritic urticaria (hives), angioedema of lips/     |
|    tongue, laryngeal stridor, and hypotensive anaphylactic shock        |
|  * Requires lifelong fish avoidance and an Epinephrine Auto-Injector    |
+-------------------------------------------------------------------------+

Usoro ọgwụgwọ Scombroid Nzọụkwụ-Nzọụkwụ¶

1. ** Mkpuchi H1 + H2 AntihistamineThe Definitive Cure):**
2. Na-elekọta onye na-emegide ndị na-anabata ihe ** H1 : ** Diphenhydramine (Benadryl, 25 to 50 mg IV ma ọ bụ ọnụ; 1 mg/kg n'ime ụmụaka) ma ọ bụ onye na-egbochi ọgbọ nke abụọ H1 (** Cetirizine 10 mg IV/PO**).
3. N'otu oge na-enye onye na-emegide ndị na-anabata ihe na-anabata ** H2 ** Famotidine (Pepcid, 20 mg IV ma ọ bụ ọnụ; 0.5 mg/kg na ụmụaka)** ma ọ bụ Cimetidine (300 mg IV) / Ranitidine. N'ihi na arịa ọbara akpụkpọ anụ na myocardium na-egosipụta ma H1 na H2 ndị na-anabata histamine, ijikọta ihe mgbochi H1 na H2 na-edozi ihu ihu, isi ọwụwa, tachycardia, na abdominal cramps nke ukwuu n'ime 15 to 30 minutes .
4. ** Mgbe ị ga-enye Epinephrine na Bronchodilators: *** Ọtụtụ ikpe scombroid na-egbochi onwe ya (resolving in 6 to 12 hours) na anaghị achọ epinephrine. Otú ọ dị, n'ime ndị ọrịa nwere ihe na-akpata ** asthma , ndị agadi ndị ọrịa nwere ọrịa akwara ọbara, ma ọ bụ ndị ọrịa na-ewere ** Isoniazid (INH* ma ọ bụ ** Monoamine Oxidase InhibitorsMAOIs*** (nke na-egbochi nkwụsị nke histamine endogenous ma na-akpata scombroid ujo), exogenous histamine nwere ike ịkpalite nnukwu bronchospasm (bronchospasm).wheezing*** ma ọ bụ ** hypotension vasoplegic. Na-elekọta nebulized ** albuterol (salbutamol, 2.5 to 5 mg*, mmiri mmiri na-asọ asọ, na ** epinephrine intramuscular (0.3 to 0.5 mg nke 1 mg/mL [1:1,000] banye n'apata anterolateral) ozugbo ma ọ bụrụ na nsogbu iku ume ma ọ bụ hypotension dị.
5. ** Nkụzi onye ọrịa tupu ịwepu ya:** Mee ka obi sie onye ọrịa ahụ obi (ma dezie ya nke ọma na eserese ahụike ha) na ha tara ahụhụ ** Scombroid (histamine) nsị nri ** site na azụ ndị etinyere n'ime friji na-ezighi ezi, ** ọ bụghị nrịanrịa azụ ọhụrụ **, yabụ na a naghị akpọ ha nrịanrịa maka nri mmiri ma ọ bụ ihe dị iche.

Ọrịa 3 & 4: Shellfish Neurotoxins: Amnesic (Domoic Acidvs. Neurotoxic (Brevetoxin) vs. Paralytic (Saxitoxin)¶

1. Amnesic Shellfish nsi (ASP: Domoic Acid)¶

• ** Isi mmalite na usoro: *** Mepụtara site na diatoms mmiri nke genus *** Pseudo-nitzschia *** n'akụkụ Pacific Northwest, California, Atlantic Canada (Prince Edward Island, bụ ebe ntiwapụ mmadụ mbụ mere na 1987), Europe, na New Zealand. ** Domoic acid *** bụ ihe analọgụ arụrụ arụ nke *kainic acid na ihe na-akpali akpali neurotransmitter L-glutamate. Ọ na-ejikọta ya na ndị na-anabata AMPA na kainate glutamate ** gbadoro anya na mpaghara ** CA1 na CA3 nke hippocampus mmadụ ** na amygdala, na-akpata calcium na-adịghị agwụ agwụ.Ca2+) mbubata na neuronal excitotoxic necrosis.
• ** Usoro nlekọta ahụike: *** N'ime 15 minutes to 24 hours nke iri nri e merụrụ emerụ, agụba clams, ma ọ bụ Dungeness crab viscera, ndị ọ metụtara na-amalite ọgbụgbọ, ọgbụgbọ, na ọnya afọ. N'ime 4 to 48 hours (karịsịa na ndị toro eto ma ọ bụ ndị ọrịa na-arịa ọrịa akụrụ na-adịghị ala ala, ebe ọ bụ na a na-ekpochapụ domoic acid n'ụbụrụ), oke nrịanrịa nke akwara ozi na-adaba: ** mgbagwoju anya, mgbakasị ahụ, mutism, ịta / grimacing automatisms, ọbara mgbali elu na-adịghị akwụsi ike, myoclonus, refractory status epilepticus, and coma**. Ndị lanarịrịnụ na-ata ahụhụ ugboro ugboro ** ọnwụ ncheta oge dị mkpirikpi na-adịgide adịgide ** (enweghị ike ịmepụta ihe ncheta ọhụrụ mgbe nrichara nri, nke yiri Korsakoff psychosis ma ọ bụ ngbanwe hippocampal bilateral).
• ** Ọgwụgwọ: ** Enweghị ọgwụ mgbochi. Na-elekọta n'isi ụtụtụ ** unyi na-arụ ọrụ** (within 1 to 2 hours), ike ike ** hydration intravenous *** iji bulie mkpochapụ gbasara akụrụ nke domoic acid mmiri soluble, yana nnukwu dose ** GABA-A agonists (IV lorazepam, midazolam, phenobarbital, na propofol*** iji gbochie ọnọdụ epilepticus nke hippocampal excitotoxic (phenytoin is ineffective against domoic acid seizures).

2. Nsi nke Shellfish Neurotoxic (NSP: Brevetoxin)¶

• ** Isi mmalite na usoro:** Dinoflagellate enweghị ngwa agha mepụtara *** Karenia brevis *** (formerly Gymnodinium breve), akụkụ ahụ na-ahụ maka Florida na Gulf of Mexico "Red Tides" (na okooko osisi ndị yiri ya na New Zealand). ** BrevetoxinsPbTx*** jikọọ na ** saịtị 5 na ọwa sodium voltaji gated **, otu saịtị nnabata dị ka Ciguatoxin.
• ** Ụzọ abụọ nke ngosi: ***
• Iri azụ̀ azụ̀ nke ọnụ: Iri oporo, clams, ma ọ bụ coquinas emetọọ na-akpata igbu egbugbere ọnụ, ire na akpịrị n'ime. 30 minutes to 3 hours, nke na-esote vomiting, afọ ọsịsa, isi ọwụwa, ataxia, ** Cold Allodynia (hot-cold temperature reversal***, ụmụ akwụkwọ gbawara agbawa, na bradycardia dị nro. N'adịghị ka nsị nsị Shellfish Paralytic (Saxitoxin), ** NSP anaghị ebute ahụ mkpọnwụ iku ume **, ndị ọrịa na-agbake kpamkpam n'ime 2 to 3 days ya na mmiri mmiri IV na-akwado.
• ** N'ihi na * Karenia brevis * mkpụrụ ndụ na-emebi emebi ma na-enweghị shei siri ike, ebili mmiri nke oke osimiri na-emebi algae wee malite brevetoxin lipid soluble n'ime ikuku ikuku. Ndị na-aga n'ụsọ osimiri na ndị bi n'ụsọ oké osimiri na-ekuba alụlụ na-etolite ozugbo (within 5 to 15 minutes) ọkụ anya, rhinorrhea, ụkwara hacking na-adịghị arụpụta ihe, yana ** bronchospasm siri ike na ndị nwere ụkwara ume ọkụ ma ọ bụ COPD. Ịkwaga n'ime ụlọ na ** ụlọ nwere ntụ oyi ** ma na-elekọta ** beta-2 agonistsalbuterol*** na-edozi mgbaàmà ngwa ngwa.

Usoro ihe mberede mpaghara na usoro mkpesa mmiri¶

• United States na Canada: Kpọọ 911 maka ihe mberede iku ume, obi, ma ọ bụ akwara ozi, wee kpọtụrụ Control Poison (1-800-222-1222 na US; 1-844-POISON-X na Canada). Na Florida, Ọwara Mexico, Puerto Rico, US Virgin Islands, na Hawaii, ngwaahịa ngalaba mberede (Gulf of Mexico) 20% Mannitol maka infusion Ciguatera ozugbo, yana ngalaba ahụike steeti na-arịọ mgbaghara nri oyi kpọnwụrụ maka FDA Center for Safety Food and Applied Nutrition (CFSAN)***
• United Kingdom na European Union: Kpọọ 999 (UK) ma ọ bụ 112 (EU). Ndị dọkịta na-ahụ maka NPIS / TOXBASE (UK) ma ọ bụ ụlọ ọgwụ EU nke mba (CAPTV na France, nke na-ahazikwa ókèala ndị France na mba ofesi na Caribbean [Guadeloupe, Martinique] na Pacific [French Polynesia, New Caledonia] ebe Ciguatera bụ hyper-endemic). Na mgbakwunye, amberjack (Seriola) ejidere na mpaghara na barracuda na ** Canary Islands, Madeira, na ọwụwa anyanwụ Mediterranean na-akpata ugbu a ntiwapụ nke European Ciguatera.
• Australia, New Zealand, na Pacific Islands: Kpọọ 000 (Australia) ma ọ bụ 111 (New Zealand), wee gaa na ebe ozi ** Poisons Information Center.13 11 26 n'Australia; 0800 764 766 na New Zealand)**. Na Queensland, Northern Territory, Fiji, Samoa, Tonga, na Vanuatu, Ciguatera sitere na coral trout, Spanish mackerel, red bass, na azụ chinaman bụ nnukwu ihe ngosi ụlọ ọgwụ ejiri IV crystalloids, atropine, na mmalite. 20% mannitol (1.0 g/kg).
• ** Asia (Hong Kong, Japan, Philippines, Ndịda Ebe Ọwụwa Anyanwụ Eshia):** Azụ ahịa azụ̀ na-eri coral reef (grouper, humphead wrasse, snapper) na-akpata ụyọkọ Ciguatera ugboro ugboro gafee Hong Kong, ndịda China, na Ndịda Ebe Ọwụwa Anyanwụ Eshia; mpaghara toxicology center na-amanye ndị 48-to-72-hour Window mannitol IV na mgbochi siri ike nke ọnwa 6 nke azụ, mmanya na mkpụrụ.

Ajụjụ a na-ajụkarị¶

Kedu ihe bụ "oyi allodynia" (mgbanwe oyi na-ekpo ọkụ) na kedu ihe oriri na-edozi ahụ na-akpata ya?¶

Cold allodynia (nke a na-akpọkarị mgbanwe ihu igwe na-ekpo ọkụ) bụ ihe mgbaàmà nke ọrịa akwara ozi nke imetụ mmiri oyi aka, ijide ihe ọṅụṅụ na-ekpo ọkụ, ma ọ bụ ịbanye n'ala dị jụụ na-emepụta ọkụ na-egbu mgbu, ọkụ ọkụ, ma ọ bụ ọkụ eletrik na akpụkpọ ahụ na akpịrị. Ọ na-eme n'ihi na Ciguatoxin (nke sitere na azụ azụ mmiri dị ka barracuda, grouper, na snapper) na Brevetoxin (nke sitere na shellfish na-acha uhie uhie) na-emechi ọwa sodium voltaji na-ekpo ọkụ n'ime eriri akwara na-ahụ oyi, na-eme ka ọkụ na-agba ọkụ mgbe ọ bụla jụrụ oyi n'okpuru 24 ruo 26 degrees Celsius.

Kedu ihe kpatara onye ọrịa ga-eji na-anata mmiri saline n'ime intravenous TUPU ị nweta IV Mannitol maka Ciguatera?¶

Mannitol 20% nke intravenous (1.0 g/kg etinyere ihe karịrị nkeji 30 ruo 45 n'ime awa 48 ruo 72) na-arụ ọrụ site n'iwepụta oke mmiri n'ime mkpụrụ ndụ Schwann fụrụ akpụ gbara gburugburu irighiri akwara na-egbu egbu, na-ewepụ ngwa ngwa Ciguatera numbness na mgbu. Otú ọ dị, n'ihi na Ciguatera na-amalite site na vomiting siri ike, afọ ọsịsa mmiri, na ọbara mgbali elu dị ala, na mannitol bụ osmotic diuretic dị ike nke na-adọta mmiri n'ime mmamịrị, na-enye mannitol tupu ị nwetaghachi onye ọrịa ahụ na 1 ruo 2 lita nke saline nkịtị nwere ike ịkpalite ujo hypovolemic dị ize ndụ na mmebi akụrụ.

Kedu ihe kpatara na mmadụ enweghị ike ịgbake na Ciguatera ịṅụ mmanya ma ọ bụ rie azụ ma ọ bụ mkpụrụ maka ọnwa 6?¶

Ciguatoxin na-agbaze nke ukwuu ma na-ejikọta ya na akpụkpọ anụ akwara na abụba anụ ahụ ruo ọnwa ole na ole mgbe ọrịa gastroenteritis mbụ kwụsịrị. Iri mmanya, ụdị azụ ọ bụla ma ọ bụ azụ azụ (ọbụlagodi azụ mmiri dị mma ma ọ bụ salmon mkpọ), ahụekere, mkpụrụ osisi, caffeine, ma ọ bụ chọkọletị n'ime ọnwa 3 ruo 6 na-ebute na mberede, nnukwu nlọghachi azụ nke mgbu akwara na-ere ọkụ, itching siri ike, ọbara mgbali elu, na ike ọgwụgwụ siri ike.

Kedu ka ị ga-esi gwa nsị nsị Scombroid na-abụghị ezigbo ihe nfụkasị nri ogologo ndụ nke mmiri?¶

Ma nsi Scombroid na mmeghachi ahụ nfụkasị ahụ na-eme ka ihu na-egbuke egbuke, hives, palpitations, na swinging n'ime 10 ruo 60 nkeji iri azụ, ha abụọ na-anabata antihistamines (na epinephrine ma ọ bụrụ na ọ dị njọ). Otú ọ dị, Scombroid na-apụta site na iri azụ na-agba ọchịchịrị (tuna, mahi-mahi, mackerel, bluefish) nke a na-ahapụghị na friji, na-enye ohere ka nje bacteria gbanwee muscle histidine ka ọ bụrụ histamine: azụ na-atọkarị ụtọ ose ma ọ bụ ọla, ọtụtụ ndị na-ekesa efere ahụ na-arịa ọrịa ọnụ, na onye ọrịa ahụ enweghị ezi ihe nfụkasị azụ IgE ma nwee ike iri azụ ọhụrụ n'ọdịnihu.

Kedu ihe kpatara ndị ọrịa na-ewere Isoniazid (INH) maka ụkwara nta n'ihe egwu dị ukwuu site na azụ Scombroid?¶

Isoniazid (INH) na monoamine oxidase inhibitors (MAOI) na-egbochi diamine oxidase (DAO, ma ọ bụ histaminase), enzyme eke na mgbidi eriri afọ mmadụ nke na-akụda histamine nri tupu ọ banye n'ọbara. Ọ bụrụ na onye ọrịa na-ewere isoniazid na-eri tuna, mahi-mahi, ma ọ bụ mackerel nwere ọbụna ọkwa histamine na-agafeghị oke, histamine na-enweghị metabolized na-ejupụta n'usoro ha, na-ebute mgbawa mgbawa, isi ọwụwa, bronchospasm siri ike, na ujo hypotensive.

Azụ na-agba oyi ma ọ bụ na-agbanye ya na ihe ọṅụṅụ lime maka ceviche na-egbu Ciguatera ma ọ bụ Scombroid toxins?¶

Mba, ọbụghị Ciguatoxin, Scombroid histamine, ma ọ bụ shellfish biotoxins (Domoic acid, Brevetoxin, Saxitoxin) na-ebibi site na friza, esi, frying, ime achịcha, ise siga, ma ọ bụ marinades lime juice. Ka ị na-edebe tuna ma ọ bụ mahi-mahi ọhụrụ oyi na ice n'okpuru 4.4 degrees Celsius (40 degrees Fahrenheit) site na mgbe a na-ejide ya na-egbochi nje bacteria ịmepụta histamine ọhụrụ, ozugbo histamine ma ọ bụ ciguatoxin dị na fillet, ọ dịghị usoro nri nwere ike ime ka ọ dị mma.

Iji kwadebe maka ihe mberede ahụike nke nri, ihe nfụkasị na njem njem, tụlee ị nweta enyemaka mbụ na usoro CPR site na Red Cross, St John Ambulance, ma ọ bụ onye na-enye ọzụzụ mpaghara.

Ntuziaka emetụtara¶

• Botulism, Ciguatera, Scombroid, na Shellfish Neurotoxin Nleta nsi
• Mmeghachi omume nfụkasị na enyemaka mbụ anaphylaxis
• Anaphylaxis eweghachite, mmeghachi omume nfụkasị ahụ nke Biphasic, na oge EpiPen nke abụọ
• Nsi nri, nnukwu Gastroenteritis, na akpịrị ịkpọ nkụ
• Enyemaka mbụ na-egbu egbu na mkpochapụ

Isi mmalite na nduzi ọchịchị¶

• ** U.S. Ụlọ Ọrụ Maka Nchịkwa na Mgbochi Ọrịa (CDC): *** Akwụkwọ Yellow CDC (ozi ahụike maka njem mba ụwa): Nsi nri sitere na nsị mmiri (Ciguatera, Scombroid, na nsị Shellfish)* (United States).
• ** U.S. Nchịkwa nri na ọgwụ ọjọọ (FDA): *** Akwụkwọ ahụhụ (Foodborne Pathogenic Microorganisms and Natural Toxins, 2^nd Edition): Scombrotoxin (Histamine), Ciguatoxin, Domoic Acid (ASP), Brevetoxin (NSP), na Saxitoxin (PSP)* (United States).
• ** Òtù Ahụ Ike Ụwa (WHO) & Òtù Na-ahụ Maka Nri na Ọrụ Ugbo (FAO):** * Akụkọ banyere nzukọ ndị ọkachamara gbasara nsi Ciguatera na mmiri biotoxins na Bivalve Molluscs* (Rome / Geneva).
• ** UK National Poisons Information Service (NPIS) / TOXBASE:** * Nlekọta ahụike nke Ciguatera Fish Poisoning (Mannitol Protocol), Scombroid Fish Poisoning, na Shellfish Neurotoxins* (United Kingdom).
• **Friedman MA, Fleming LE, Fernandez M, Bienfang P, et al .: *** * Nsi azụ azụ Ciguatera: ọgwụgwọ, mgbochi na njikwa * (Ọgwụ mmiri mmiri / Palafox NA intravenous mannitol ọmụmụ).