The Ministry of Health today recorded in the European rapid alert system on food safety the news of some cases of poisoning from steaks of yellow fin tuna defrosted with added water. (1)
Pending certain news on operators involved and lots at risk, catering operators are recommended, food service e food delivery to suspend the use of this type of product, subject to receiving written guarantees from suppliers.
Poisoning by adulterated tuna, the cases reported by the Poison Control Center of Pavia
The Poison Control Center (CAV) of Pavia has identified, starting from 1.6.21, seven cases of severe nitrite / histamine intoxication related to the consumption of fresh tuna. Clinically ascertained cases occurred at:
- Blackboard (GE), 1.6.21, 1 adult
- Brindisi, 3.6.21, 2 adults and 2 children,
- Benevento, 3.6.21, 2 adults.
Other cases of toxic infection food following the consumption of tuna steaks were also recorded in Tuscany. (2) Despite the severe clinical conditions (methemoglobinemia), immediate administration of the antidote (methylene blue) prevented lethal outcomes. The cases were reported to the competent ASL veterinary offices for inspections and controls.
Tuna poisoning. Symptoms and Diagnosis
The recommendations of the Poison Control Center to the national health system:
- immediately consider the suspicion of intoxication in case of access of pale and / or cyanotic patients with symptoms that are rapidly onset and not related to previous pathologies. There may also be gastrointestinal disorders and alterations in the state of consciousness (e.g. syncope),
- carry out immediate determination of methemoglobinemia (also on venous sampling) by means of blood gas analysis or specific pulse oximeters (if available),
- evaluate each case with syncope for intoxication with methemoglobinemia before starting different diagnostic paths.
Treatment with antidote
The CAV (Anti-poison Center) therefore recommends:
- check the availability of the antidote (methylene blue) in emergency hospital services and equip the territorial emergency vehicles (medical car) with methylene blue vials, (2)
- refer immediately to the CAV for any suspected case, for information on antidotic therapy (dose, methods and times of administration, contraindications), other investigations and therapies,
- collect samples for specific analytical diagnosis (causal agent) in any other cases.
Ittica Zu Pietru, faulty alert
the 4.6.21 the Ministry of Health has published the recall of a single batch of 'tuna steak thawed with added water'produced by Ittica Zu Pietro Srl based in Bisceglie (BA). (4) The recall notice refers to FAO fishing zone 77 (Central Eastern Pacific Ocean) and an unacceptable recall reason, which the authorities should have corrected. Do not 'anoxic syndrome'(the effect) but'histamine contamination', or maybe'adulteration with nitrites' (the cause). (5,6)
the 7.6.21 the ministry itself notified in the RASFF (Rapid Alert System on Food and Feed) the serious risk (serious risk) of food safety on defrosted yellow fin tuna steaks in Italy, 'origin of raw material Spain'. (1) Pending clarification on the actual extent of the crisis - even more so in the face of an untimely recall, which followed rather than preventing dangerous foodborne infections - operators are advised to exercise the utmost caution.
(1) RASFF (Rapid Alert System on Food and Feed). Notification 2021.2933. Foodborne outbreak suspected to be caused by thawed yellowfin tuna steaks (Thunnus albacares) with added water from Italy, with raw material from Spain. 7.6.21, https://webgate.ec.europa.eu/rasff-window/screen/notification/481311
(2) Florence, nine people end up in hospital after eating fresh tuna in two restaurants. ASL investigations. Daily fact. 4.6.21, https://www.ilfattoquotidiano.it/2021/06/04/firenze-nove-persone-finiscono-in-ospedale-dopo-aver-mangiato-tonno-fresco-in-due-ristoranti-indagini-dellasl/6220209/
(3) The emergency services are required to update the data on the availability of methylene blue by accessing the National Antidote Database on the CAV of Pavia website (http://www9.unipv.it/reumatologia-tossicologia/ cav/CAV/index.php?c=2&op=5&cosa=1 ) in order to facilitate its rapid availability where lacking
(4) Manufacturer identification mark IT 2830 CE, lot 2008217/21, expiry date 7.6.21. See https://www.salute.gov.it/imgs/C_17_PubbificazioneRichiami_1224_azione_itemAzione0_files_itemFiles0_fileAzione.pdf
(5) Ittica Zu Pietro Srl on the page dedicated to yellow fin tuna declaims that 'inside the factory, the processing takes place flawlessly!' (https://www.itticazupietro.com/tonno-spada). Without even referring to the recall in progress
(6) For further information, see theebook by Dario Dongo 'Food safety. Mandatory rules and voluntary norms'. https://www.greatitalianfoodtrade.it/libri/sicurezza-alimentare-regole-cogenti-e-norme-volontarie-il-nuovo-libro-di-dario-dongo