An Australian woman and her teenage daughter who became ill and died within hours of each other in Bali were probably killed by a form of food poisoning.
Hospital nurse manager Noelene Bischoff, 54, and her 14-year-old daughter, Yvana, from the Sunshine Coast in Queensland state, died last month less than a day after eating fish at a restaurant on the Indonesian island.
It starts with a peppery, metallic taste in the mouth, dizziness and flushing on the upper body.
But to die from scombroid food poisoning, believed to have killed Noelene Bischoff, 54, and her daughter Yvana, 14, in Bali last month, is rare, NSW Health says.
Autopsy results suggest the pair died from a combination of scombroid food poisoning after eating fish in a Bali restaurant, and existing medical conditions.
Jennie Musto, manager of enterics at NSW Health, said there have been only seven reported outbreaks of scombroid poisoning in NSW since 2005.
The outbreaks have been small, with an average of three people affected each time. There were no fatalities.
"We expect there is a lot more of it than is reported," Ms Musto said. "Most people with scombroid probably have very mild symptoms, so wouldn't present to a medical centre or emergency."
She said that, to her knowledge, nobody had died from scombroid food poisoning in Australia.
"It is extremely rare," she said.
Scombroid food poisoning is caused by eating fish with toxic levels of histamine, which are triggered by inadequate refrigeration and cannot be reversed by cooking.
"The spoilage of the fish happens straight after the fish has been caught if it's not refrigerated properly," Ms Musto said.
"It's more common when fish is caught by recreational fishermen or when refrigeration isn't available."
Fish that smells old or off should not be consumed, as it could present a risk of scombroid poisoning.
Scombroid poisoning can be differentiated from other types of food poisoning by its rapid onset; diners usually feel ill 30 minutes after eating spoiled fish.
Symptoms include flushing of the upper body, dizziness, a peppery or metallic taste in the mouth, diarrhoea, and tingling and numbness in fingers, toes and around the mouth.
The most common types of food poisoning in Australia are bacterial, caused by bacteria such as salmonella, campylobacter, E.coli and listeria.
The number of salmonella cases reported in Australia have almost doubled in the past 10 years, with almost 13,000 cases last year, compared with 6990 in 2003. There were 180 cases of E.coli reported in 2013, compared with 95 in 2011.
The executive director of the Food Safety Information Council, Juliana Madden, said eggs were the most common cause of food-related disease outbreaks.
"Keeping eggs refrigerated and making sure they are not left in the car for a long period is very important," she says.
"Proper food handling, stopping cross contamination, washing your hands and making sure meat is cooked properly can all lower the risk of food poisoning."
Further testing is yet to take place to confirm scombroid food poisoning as the cause of death of Noelene and Yvana Bischoff.
"There are some more tests that still have to be done, but they more than likely won't change the result," Ms Bischoff's brother, Malcolm Bischoff, said.
- AP, Sydney Morning Herald