Ciguatera fish poisoning causes diarrhea, vomiting, abdominal pain, paresthesias, bradycardia, and pain and weakness in the lower extremities. The toxin is most commonly found in large reef fish (grouper, red snapper, amberjack, and barracuda).
CASES/YEAR
500 (US); 50,000 (Global)
OTHER NAMES
Ciguatoxin poisoning;
INCUBATION
GI symptoms: 2-6 hrs; Neuro: 3 hrs; Heart: 2-5 days; [Foodborne Illnesses. MMWR. April 16, 2004] Usually within 24 hours; [CCDM]
INITIAL SYMPTOMS
Diarrhea, vomiting, abdominal pain, paresthesias, bradycardia, and pain and weakness in the lower extremities; [CCDM]
COMMENTS
Symptoms of ciguatera fish poisoning begin within an hour of eating and include diarrhea, vomiting, abdominal pain, paresthesias, pain and weakness of the lower extremities, and bradycardia. Distortion of temperature sensation and "aching teeth" are frequently reported. Complete recovery within a few weeks is the usual course. Severe cases with coma and respiratory arrest within 24 hours of ingestion have been reported. [CCDM, p. 223] Other symptoms may include pruritus, headache, myalgia, reversal of hot/cold sensations, and facial pain. [Merck Manual, p. 3064] Heart abnormalities include bradycardia, hypotension, and T wave abnormalities on EKG. Toxin is most commonly found in large reef fish (grouper, red snapper, amberjack, and barracuda). [Foodborne Illnesses. MMWR. 4/16/04] Poisoning has also been reported after eating parrotfish, surgeon fish, moray eel, sea bass, and sturgeon. [CDC Travel, p. 111]
DIAGNOSTIC
Clinical; Confirmed by presence of ciguatoxin in implicated fish; [CCDM]
SCOPE
Where large reef fish are eaten; Very localized and time-limited outbreaks occur; [CCDM, p. 224]
SIGNS & SYMPTOMS
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>arthralgia
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>fatigue, weakness
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>myalgia
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E dysphagia
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G abdominal pain
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G diarrhea
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G nausea, vomiting
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N headache
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N muscle weakness
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N paresthesia
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N seizure
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N stiff neck
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O conjunctivitis, acute
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R dyspnea
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S rash (exanthem)
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S skin blister or vesicles
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*cranial neuropathy
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*paralysis
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*stupor, coma
SOURCE
Animal Tissue, Eating Contaminated Food, Eating Infected or Toxin-Containing Fish
RESERVOIR
Fish and Shellfish
RISK FACTORS
- Ingest toxins in food or water
- Travel to endemic area
TREATMENT
Intravenous mannitol has been used, but its effectiveness has not been confirmed in double-blind studies. [CCDM]
REFERENCES FOR CASES/YEAR
1. (US) Guesstimate: 500 cases per year;
2. (Global) Estimated 20,000 cases/year; [Whittle2000: PMID 10885118] Estimated 50,000 cases per year; In South Pacific, estimated 500 cases per 100,000 with 50 times higher rates in some island groups;; [CCDM, p. 224]