Ciguatera fish poisoning

Ciguatera fish poisoning
SynonymsCiguatera, ciguatera food poisoning
Chemical structure of ciguatoxin
SymptomsDiarrhea, vomiting, numbness, itchiness, sensitivity to hot and cold, dizziness, weakness[1][2]
Usual onset30 min to 2 days[3]
DurationFew weeks to months[3]
CausesCiguatoxin and maitotoxin within certain reef fish[2]
Risk factorsBarracuda, grouper, moray eel, amberjack, sea bass, sturgeon.[2]
Diagnostic methodBased on symptoms and recently eating fish[1]
Differential diagnosisParalytic shellfish poisoning, neurotoxic shellfish poisoning, scombroid food poisoning, pufferfish poisoning[1]
TreatmentMannitol, gabapentin, amitriptyline[1][2]
PrognosisRisk of death < 0.1%[2]
Frequency~50,000 per year[2]

Ciguatera fish poisoning, also known simply as ciguatera, is a foodborne illness caused by eating reef fish whose flesh is contaminated with certain toxins.[2] Symptoms may include diarrhea, vomiting, numbness, itchiness, sensitivity to hot and cold, dizziness, and weakness.[1][2] Onset of symptoms vary with the amount of toxin eaten from half an hour to up to two days.[3] The diarrhea may last for up to four days.[1] Some symptoms typically remain for a few weeks to months.[3] Heart difficulties such as a slow heart rate and low blood pressure may occur.[2]

The specific toxins involved are ciguatoxin and maitotoxin.[2] They are originally made by a small marine organism, Gambierdiscus toxicus, that grows on and around coral reefs in tropical and subtropical waters.[2] These are eaten by herbivorous fish which in turn are eaten by larger carnivorous fish.[2] The toxins become more concentrated as they move up the food chain.[3] The fish most often implicated include barracuda, grouper, moray eel, amberjack, sea bass, and sturgeon.[2] Diagnosis is based on a person's symptoms together with having recently eaten fish.[1] If a number of those who eat the same fish develop symptoms the diagnosis becomes more likely.[1] If some of the fish they had previously eaten is avaliable this can also be tested to confirm the diagnosis.[1]

Preventive efforts include not eating reef fish, not eating high risk fish such as barracuda, and not eating fish liver, roe, or fish heads.[2] Ciguatoxin has neither smell nor taste and cannot be removed by conventional cooking.[2] There is no specific treatment for ciguatera fish poisoning once it occurs.[2] Mannitol may be considered but evidence supporting its use is not very good.[1] Gabapentin or amitriptyline may be used to treat some of the symptoms.[2]

The Center for Disease Control estimates that around 50,000 cases occur a year.[2] Other estimates vary up to 500,000 cases per year.[1] It is the most frequent seafood poisoning.[3] It occurs most commonly in the Pacific Ocean, Indian Ocean, and the Caribbean Sea between the latitudes of 35°N and 35°S.[2] The risk of the condition appears to be increasing due to coral reef deterioration and increasing trade in seafood.[2] The risk of death from poisoning is less than 1 in 1,000.[2] Descriptions of the condition date back to at least 1511.[3] The current name came into use in 1787.[3]

Signs and symptoms

Hallmark symptoms of ciguatera in humans include gastrointestinal, cardiovascular, and neurological effects.[4][5] 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,[6][7] ataxia, vertigo, and hallucinations.[8][5] Severe cases of ciguatera can also result in cold allodynia, which is a burning sensation on contact with cold.[4] Neurological symptoms can persist and ciguatera poisoning is occasionally misdiagnosed as multiple sclerosis.[9] Cardiovascular symptoms include bradycardia, tachycardia, hypotension, hypertension, orthostatic tachycardia, exercise intolerance, and rhythm disorders.[10] Death from the condition can occur, but is extremely rare.[11]

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.[12] Diarrhea and facial rashes have been reported in breastfed infants of poisoned mothers, suggesting that ciguatera toxins migrate into breast milk.[13]

The symptoms can last from weeks to years, and in extreme cases as long as 20 years, often leading to long-term disability.[14] Most people do recover slowly over time.[15]

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עברית: סיגואטרה
Nederlands: Ciguatera
日本語: シガテラ
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română: Ciguatera
русский: Сигуатера
svenska: Ciguatera