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PubMed1995

Ciguatera Poisoning.

Ciguatera poisoning is a worldwide problem associated with ingestion of certain toxin-containing fish. The disease was named after a turban-shelled snail known as "cigua" in the Spanish Antilles, which was mistakenly thought to be the cause of this disease.1 More than 200 species of fish have been implicated, the most common of which include grouper, red snapper, barracuda, amberjack, and less commonly mackerel, surgeonfish, and sea bass. Toxin-containing fish may be found in tropical areas extending approximately 35 degrees latitude on either side of the equator, but the increase in air travel and the relative ease of shipping fish long distances have meant that both travelers and people living outside those areas may be affected.2 In major endemic areas, including the Caribbean and the South Pacific islands, the incidence of ciguatera poisoning ranges from 50-500 cases annually per 10,000 population, making it one of the more common illnesses in those areas. I report two cases of ciguatera poisoning in a husband and wife following barracuda ingestion and briefly review the clinical manifestations, diagnosis, and treatment of this disease.

Journal Article↗
PubMed1989

Variations in symptomatology of ciguatera poisoning.

Ciguatera poisoning reports were examined for patterns of symptomatology when different types of fishes were consumed. Consumption of surgeon fish (Ctenochaetus strigosus), amberjack (Seriola dumerili) and jack (Caranx sp.) resulted in different symptom profiles with a number of statistically significant differences in the reported frequencies of specific symptoms. The results support the contention that the large variability in symptoms associated with ciguatera poisoning is caused by several closely related but distinct toxins.

Animals↗
PubMed1992

Traditional remedies used in the western Pacific for the treatment of ciguatera poisoning.

Ciguatera is a specific type of food poisoning associated with the ingestion of tropical fish, which, although normally safe for consumption, may at times contain high amounts of ciguatoxin, as well as other chemically related toxins. Widespread in tropical regions where coral reefs are present, ciguatera fish poisoning constitutes a major hindrance for local fishing industries, local economies and foreign trade. Because no symptomatic treatment has been totally satisfactory, folk remedies remain of great interest. In this paper, a list of plants used in treating ciguatera poisoning in the Western Pacific region is presented, with emphasis on species whose exact utilization (part of plant used, preparation, dosage) has been determined.

Animals↗
PubMed2002

Rabbitfish ("aras"): an unusual source of ciguatera poisoning.

BACKGROUND: Ciguatera poisoning is the commonest fish-borne seafood intoxication. It is endemic to warm water tropical areas and is caused by consumption of bottom-dwelling shore reef fish, mostly during spring and summer. The causative agent, ciguatoxin, is a heat-stable ester complex that becomes concentrated in fish feeding on toxic dinoflagellates. The common clinical manifestations are a combination of gastrointestinal and neurologic symptoms. Severe poisoning may be associated with seizures and respiratory paralysis. OBJECTIVE: To describe a series of patients who sustained ciguatera poisoning in an uncommon region and from an unexpected source. PATIENTS: Two families complained of a sensation of "electrical currents," tremors, muscle cramps, nightmares, hallucinations, agitation, anxiety and nausea of varying severity several hours after consuming rabbitfish ("aras"). These symptoms lasted between 12 and 30 hours and resolved completely. The temporal relationship to a summer fish meal, the typical clinical manifestations along with the known feeding pattern of the rabbitfish suggested ciguatera poisoning. CONCLUSIONS: The Eastern Mediterranean basin is an unusual region and the rabbitfish an unusual source for ciguatera poisoning. There are no readily available and reliable means for detecting ciguatoxin in humans. A high index of suspicion is needed for diagnosis and a thorough differential diagnosis is essential to eliminate other poisonings, decompression sickness and encephalitis. Supportive therapy is the mainstay of treatment.

Adult↗
PubMed2001

A brief case report and review of ciguatera poisoning.

Although ciguatera fish poisoning is generally a mild, self-limited disease, both life-threatening acute reactions and troublesome chronic symptoms can occur. Because ciguatera has been largely confined to tropical locations, a relative lack of recognition exists among many US physicians. As access to tropical locations has increased, so has the distribution of ciguatera. Herein, we present a case report and review the current literature on ciguatera.

Adult↗
PubMed2003

Ciguatera poisoning in Vanuatu.

Ciguatera poisoning is endemic in many tropical and subtropical countries. We conducted a retrospective study of admissions to two hospitals on the islands of Vanuatu in the southwestern Pacific region. We estimated the annual hospital admission rate for fish poisoning to be 65 (95% confidence interval [CI] = 55-75)/100,000 population on the island of Santo and 29 (95% CI = 19-43)/100,000 population on the island of Ambae. Hospital admission was more common in males 20-29 years old. Death was a rare complication. In the face of increases in both tourism and in the global trade in tropical and exotic fish, physicians in both endemic and non-endemic areas should be familiar with the epidemiology and clinical features of this important condition.

Adolescent↗
PubMed2003

[Ciguatera poisoning in Spanish travellers].

BACKGROUND AND OBJECTIVE: Ciguatera poisoning appears after ingestion of contaminated fish from tropical coral reefs. Due to the diversity of clinical symptoms and the absence of a specific test in humans, the diagnosis is often difficult. PATIENTS AND METHOD: A retrospective study of 10 patients consulting for a clinical and epidemiological picture compatible with ciguatera poisoning after a trip to tropical countries between 1993 and 2000. RESULTS: Most infections but one were acquired in the Caribbean area and there were 8 females. Clinical manifestations started within the first 24 hours after fish ingestion. Chief symptoms were diarrhea and nausea, followed by neurological symptoms, mainly limbs paresthesias that persisted for several weeks. CONCLUSIONS: The severity of clinical symptoms was variable and not related to age or initial symptoms. Ciguatera poisoning has to be considered in the diagnosis of acute gastroenteritis affecting travellers to tropical areas.

Adolescent↗
PubMed2000

Mild ciguatera poisoning: Case reports with neurophysiological evaluations.

Ciguatera poisoning causes mainly gastrointestinal and neurological effects of variable severity. However, symptoms of peripheral neuropathy with paresthesias and paradoxical disturbance of thermal sensation are the hallmark. Electrophysiological studies are often normal, except in severe cases. We report four people who developed mild ciguatera poisoning after barracuda ingestion. Electrophysiological studies documented normocalcemic latent tetany. These findings are consistent with ciguatoxin's mechanism of toxicity, which involves inactivation of voltage-gated Na(+) channels and eventually increases nerve membrane excitability.

Adult↗
PubMed1983

Preliminary immunologic studies of ciguatera poisoning.

Preliminary immunologic studies of ciguatera poisoning were performed with serum samples from patients and extracts from both toxic and nontoxic fish. Counterimmunoelectrophoresis disclosed precipitin lines with toxic fish extracts and effectively discriminated between samples established as toxic or nontoxic on the basis of human toxic reactions and by an in vivo mouse bioassay. However, it is not currently possible to conclude that affected individuals had specific antibody to ciguatoxin, since putative immune and nonimmune serum samples gave equally clear precipitin reactions with toxic extracts.

Animals↗
PubMed2001

Ciguatera poisoning: a global issue with common management problems.

Ciguatera poisoning, a toxinological syndrome comprising an enigmatic mixture of gastrointestinal, neurocutaneous and constitutional symptoms, is a common food-borne illness related to contaminated fish consumption. As many as 50000 cases worldwide are reported annually, and the condition is endemic in tropical and subtropical regions of the Pacific Basin, Indian Ocean and Caribbean. Isolated outbreaks occur sporadically but with increasing frequency in temperate areas such as Europe and North America. Increase in travel between temperate countries and endemic areas and importation of susceptible fish has led to its encroachment into regions of the world where ciguatera has previously been rarely encountered. In the developed world, ciguatera poses a public health threat due to delayed or missed diagnosis. Ciguatera is frequently encountered in Australia. Sporadic cases are often misdiagnosed or not medically attended to, leading to persistent or recurrent debilitating symptoms lasting months to years. Without treatment, distinctive neurologic symptoms persist, occasionally being mistaken for multiple sclerosis. Constitutional symptoms may be misdiagnosed as chronic fatigue syndrome. A common source outbreak is easier to recognize and therefore notify to public health organizations. We present a case series of four adult tourists who developed ciguatera poisoning after consuming contaminated fish in Vanuatu. All responded well to intravenous mannitol. This is in contrast to a fifth patient who developed symptoms suggestive of ciguatoxicity in the same week as the index cases but actually had staphylococcal endocarditis with bacteraemia. In addition to a lack of response to mannitol, clinical and laboratory indices of sepsis were present in this patient. Apart from ciguatera, acute gastroenteritis followed by neurological symptoms may be due to paralytic or neurotoxic shellfish poisoning, scombroid and pufferfish toxicity, botulism, enterovirus 71, toxidromes and bacteraemia. Clinical aspects of ciguatera toxicity, its pathophysiology, diagnostic difficulties and epidemiology are discussed.

Adult↗
PubMed1986

Ciguatera poisoning: a report of three cases.

Confirmed ciguatera poisoning is reported in three Canadian adults who ingested grouper imported from Florida. Two required hospitalization for management of marked gastrointestinal, neurological, and cardiovascular disturbances. Outside of endemic areas, the recognition of this type of fish poisoning may be inadequate. The pathogenesis, diagnosis, and therapy of the disease are outlined.

Adult↗
PubMed1993

The basis of the paradoxical disturbance of temperature perception in ciguatera poisoning.

The basis of the paradoxical reversal of temperature perception commonly described in ciguatera poisoning has never been defined. The sensations experienced are described as tingling, burning, "dry ice-like", smarting, and "electric". Studies have demonstrated that these types of sensations are generated in C-polymodal nociceptor fibers in skin and deep structures and the intensity of these sensations depends on the intensity of discharge in these fibers. Ciguatoxin causes persistent sodium channel opening in nerve membrane resulting in oscillations in membrane potentials and runs of spontaneous discharges. Studies on ciguatera victims in which their hands were immersed in water baths ranging from 0 degree C to 50 degrees C, suggest the paradoxical sensory discomfort experienced is, most likely, a result of an exaggerated and intense nerve depolarization occurring in peripheral small A-delta myelinated and in particular, C-polymodal nociceptor fibers. Gross temperature perception was found to be intact in ciguatera poisoning and reversal of temperature does not occur.

Abdominal Pain↗
PubMed1991

Electrophysiological studies on ciguatera poisoning in man (Part II).

Fifteen cases of acute ciguatera poisoning were subjected to electrical studies on the sural and common peroneal nerves. Significant slowing of sensory conduction velocity and prolongation of the absolute refractory, relative refractory and supernormal periods were recorded. These findings indirectly suggest that ciguatoxin causes an abnormally prolonged sodium channel opening in nerve membranes.

Australia↗
PubMed1989

Clinical and laboratory findings implicating palytoxin as cause of ciguatera poisoning due to Decapterus macrosoma (mackerel).

A near fatal case of ciguatera-related intoxication following consumption of smoked Decapterus macrosoma is documented. In addition to some of the hallmark symptoms of ciguatera poisoning, the patient exhibited acute respiratory distress and severe muscle spasms. Laboratory results showed large elevations in a number of blood enzymes, indicative of muscle damage. The responsible agent was extracted from corresponding fish samples and identified as palytoxin.

Acrylamides↗
PubMed1995

Ciguatera poisoning after ingestion of imported jellyfish: diagnostic application of serum immunoassay.

Ciguatera fish poisoning is an important public health problem wherever humans consume tropical and subtropical fish. It accounts for over half of fish-related poisonings in the United States but is uncommonly diagnosed and underreported. Produced by dinoflagellates, ciguatoxin accumulates up the food chain in herbivorous and carnivorous fishes. Cnidaria jellyfish and related invertebrates) have not previously been associated with direct ciguatera intoxication in humans. We report the first case of ciguatera fish poisoning associated with cnidarian ingestion. A 12-year-old Tongan female presented to our Emergency Department with mid-abdominal pain, nausea, change in mental status, and new-onset movement disorder after ingestion of jellyfish imported from American Samoa. Clinical diagnosis was confirmed by strongly positive serum identification of ciguatoxin and related polyether toxins (including okadaic acid) with a rapid extraction method (REM) and highly reliable solid-phase immunobead assay (S-PIA) performed by the Food Toxicology Research Group, University of Arizona. Ciguatera pathophysiology, clinical presentation, differential diagnosis (including consideration of palytoxin poisoning), and treatment are briefly reviewed. We emphasize the growing incidence of ciguatera fish poisoning outside "high-risk" areas. In regions with immigrant populations, privately imported exotic fish may be toxin vectors. Marine species other than carnivorous fish are now suspect in human ciguatera intoxication. Reliable tests can aid in premarket fish testing, diagnosis, and follow-up of ciguatera fish poisoning. The global prevalence of marine toxins demands fishermen, consumers, and physicians maintain a high index of suspicion for ciguatera fish poisoning.

Animals↗
PubMed2000

Three clusters of ciguatera poisoning: clinical manifestations and public health implications.

Between July 1997 and August 1998 we investigated three clusters (26 cases) of ciguatera poisoning in the inner Sydney area. Tropical reef fish were implicated in each cluster. Most of those affected had musculoskeletal, neurological and gastrointestinal symptoms. The clusters raise questions about the need for rapid diagnosis and enhanced surveillance mechanisms, the regulation of fish supply, and the lack of testing facilities for ciguatera toxin.

Adolescent↗
PubMed1994

Severe ciguatera poisoning in Madagascar: a case report.

In a single outbreak on the East coast of Madagascar, more than 500 people, 98 of whom died, were poisoned by the flesh of a shark, Carcharhinus amboinensis. From clinical symptoms it can be concluded that this poisoning is due to ciguatera toxins. It is the first case of a severe outbreak caused by a shark, and it is the first case with a mortality rate of 20%.

Animals↗