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18 Feb 2014

A Queensland mother and daughter who died of food poisoning while on holiday in Bali were the victims of a “one in millions” confluence of circumstances, according to health experts.

An autopsy carried out by Queensland authorities has found it is likely Noeline Bischoff, 54, and her 14-year-old daughter Yvana suffered scombroid food poisoning after eating fish, possibly mahi mahi, at a resort restaurant.

The poisoning is caused by elevated levels of histamine in the fish, and would usually cause mild symptoms such as dizziness, rashes and diarrhoea.

But it can trigger a much more severe reaction in people with asthma – a condition that that both Ms Bischoff and her daughter suffered from.

Ms Bischoff’s brother Malcolm, said it was “just one in millions of chance that that could all come together for that to happen with two people at the same time”.

AMA President Dr Steve Hambleton told ABC radio scombroid poisoning, while unusual, could be dangerous for asthmatics.

“This is a very rare form of food poisoning that, whilst rare, cause serious illness,” Dr Hambleton said. “What happens is that histamine levels rise in the fish - and histamine is what causes allergic reactions - people with asthma of course are more sensitive to histamine and that's why probably in this case two people with mild asthma showed a very, very severe reaction.”

Food Safety Information Council Executive Officer Juliana Madden told the Courier Mail it could be difficult to detect spoiled fish.

“It can look ok, smell ok and taste ok,” Ms Madden said. “It’s one of those horrible perfect storm situations where they were the wrong people at the wrong time.”

Scombroid food poisoning can occur when certain types of fish, including tuna, mackerel and mahi mahi, are kept in temperatures above 5 degrees Celsius after they are caught and killed. After the fish has died, naturally occurring bacteria convert the amino acid histidine into histamine

Dr Hambleton said how the fish was stored and handled after it was caught was a critical factor.

“Handling of the fish has got a lot to do with how much histamine builds up in that fish. So if it's improperly cooled, if it's left to thaw for too long, that's when the risk starts to rise,” he said, warning that this meant it was more likely to be an issue in areas where refrigeration was intermittent.

Dr Hambleton said common anti-histamine medications may have made a difference, but only if the pair were diagnosed early enough.

Mr Bischoff said that “more than likely it wouldn't have been diagnosed here anyway, so more than likely the same result would have happened”.

Adrian Rollins

Published: 18 Feb 2014