Ciguatera fish poisoning

Foodborne illness

Ciguatera fish poisoning
Synonyms	Ciguatera, ciguatera food poisoning
Pronounce	N/A
Field	N/A
Symptoms	Diarrhea, vomiting, numbness, itchiness, sensitivity to hot and cold, dizziness, weakness
Complications
Onset	30 minutes to 2 days
Duration	Few weeks to months
Types	N/A
Causes	Ciguatoxin and maitotoxin within certain reef fish
Risks	Barracuda, grouper, moray eel, amberjack, sea bass, surgeonfish
Diagnosis	Based on symptoms and recently eating fish
Differential diagnosis	Paralytic shellfish poisoning, neurotoxic shellfish poisoning, scombroid food poisoning, pufferfish poisoning
Prevention	Avoiding reef fish and high-risk species
Treatment	Mannitol, gabapentin, amitriptyline
Medication
Prognosis	Risk of death < 0.1%
Frequency	≈50,000 per year
Deaths	N/A

Ciguatera fish poisoning (CFP), also known as ciguatera, is a foodborne illness caused by consuming certain reef fish contaminated with ciguatoxin or maitotoxin. Symptoms typically include diarrhea, vomiting, numbness, sensitivity to hot and cold, and neurological disturbances such as dizziness and weakness. Symptoms may appear within 30 minutes to two days after ingestion and can last for weeks to months. Severe cases may include cardiovascular symptoms like bradycardia or hypotension.

Causes

The primary toxins involved, ciguatoxin and maitotoxin, originate from the marine dinoflagellate Gambierdiscus toxicus, which thrives in coral reef environments. These toxins bioaccumulate as they move up the food chain from herbivorous fish to larger carnivorous species like barracuda, grouper, and moray eel. Cooking does not neutralize ciguatoxin, and it has no discernible taste or odor, making it challenging to detect.

Symptoms

Symptoms of CFP are diverse and include:

• Gastrointestinal: Nausea, vomiting, diarrhea
• Neurological: Headache, muscle aches, numbness, paresthesia, and allodynia (burning sensation on contact with cold)
• Cardiovascular: Bradycardia, tachycardia, hypotension

In rare cases, neurological symptoms such as hallucinations and ataxia may persist for years.

Diagnosis

Diagnosis is based on a combination of recent consumption of reef fish and the presence of typical symptoms. Differential diagnosis includes conditions like paralytic shellfish poisoning and scombroid poisoning. Testing fish samples can confirm the presence of toxins.

Treatment

There is no specific cure for CFP. Treatment is symptomatic and may include:

• Medications: Mannitol for acute symptoms, gabapentin or amitriptyline for neurological discomfort.
• Supportive care: Management of dehydration and monitoring of cardiovascular health.

Prevention

Preventive measures include:

• Avoiding high-risk reef fish such as barracuda and amberjack
• Avoiding consumption of fish liver, roe, and heads, which may contain higher toxin concentrations

Epidemiology

Ciguatera is the most common seafood poisoning worldwide, with approximately 50,000 cases reported annually. It is prevalent in tropical and subtropical regions, particularly the Pacific Ocean, Indian Ocean, and the Caribbean Sea.

Historical Context

Ciguatera has been recognized since at least the 18th century, with the term first used in 1787. It has been a known health concern for indigenous populations in tropical regions and remains a challenge due to increased global seafood trade and coral reef degradation.

See Also

• Marine biotoxins
• Reef fish
• Tropical diseases

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