Ciguatera is a foodborne illness caused by eating certain reef fish whose flesh is contaminated with a toxin made by dinoflagellates such as Gambierdiscus toxicus which live in tropical and subtropical waters. These dinoflagellates adhere to coral, algae and seaweed, where they are eaten by herbivorous fish which in turn are eaten by larger carnivorous fish like barracudas, shark, [1] and even omnivorous fish like basses and other fish like mullet. This is called biomagnification. Affected fish may show no sign of infection or, in more advanced cases, will be weakened and visibly thin, with yellowish eyes. As well, fish may be pale or a different color than usual.

Gambierdiscus toxicus is the primary dinoflagellate responsible for the production of a number of similar polyether toxins, including ciguatoxin, maitotoxin, gambieric acid and scaritoxin, as well as the long-chain alcohol palytoxin. [2] [3] Other dinoflagellates that may cause ciguatera include Prorocentrum spp., Ostreopsis spp., Coolia monotis, Thecadinium spp. and Amphidinium carterae. [4] Predator species near the top of the food chain in tropical and subtropical waters are most likely to cause ciguatera poisoning, although many other species cause occasional outbreaks of toxicity. [5]

Ciguatoxin is odourless, tasteless and cannot be removed by conventional cooking. [6] [7]

Researchers, such as Ross M. Brown with his "New Religion" theory suggest that ciguatera outbreaks caused by warm climatic conditions in part propelled the migratory voyages of Polynesians between 1000 and 1400AD. [8] [9]

In 2017 an updated review of "Clinical, Epidemiological, Environmental, and Public Health Management" was published and is available at the National Institute of Health website.

Signs and symptoms

Hallmark symptoms of ciguatera in humans include gastrointestinal, cardiovascular, and neurological effects. [10] [11] Gastrointestinal symptoms include nausea, vomiting, and diarrhea, usually followed by neurological symptoms such as headaches, muscle aches, paresthesia, numbness of extremities, mouth and lips, reversal of hot and cold sensation, [12] [13] ataxia, vertigo, and hallucinations. [6] [11] Severe cases of ciguatera can also result in cold allodynia, which is a burning sensation on contact with cold. [10] Neurological symptoms can persist and ciguatera poisoning is occasionally misdiagnosed as multiple sclerosis. [14] Cardiovascular symptoms include bradycardia, tachycardia, hypotension, hypertension, orthostatic tachycardia, exercise intolerance, and rhythm disorders. [15] Death from the condition can occur, but is extremely rare. [16]

Dyspareunia and other ciguatera symptoms have developed in otherwise healthy males and females following sexual intercourse with partners suffering ciguatera poisoning, signifying that the toxin may be sexually transmitted. [17] Diarrhea and facial rashes have been reported in breastfed infants of poisoned mothers, suggesting that ciguatera toxins migrate into breast milk. [18]

The symptoms can last from weeks to years, and in extreme cases as long as 20 years, often leading to long-term disability. [19] Most people do recover slowly over time. [20]

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