Characteristic Features and Contributory Factors in Fatal Ciguatera Fish Poisoning—Implications for Prevention and Public Education

Abstract

Abstract. In this review, the main objective was to describe the characteristic features of fatal ciguatera fish poisoning and identify contributory factors, with a view to promote prevention and public education. Ciguatera-related deaths, although rare, have been reported from the Pacific, Caribbean, and Indian Ocean regions. The clinical features were generally dominated by convulsions and coma, with various focal neurological signs. Several contributory factors could be identified, including consumption of ciguatoxin (CTX)-rich fish parts (viscera and head) in larger amounts, the most ciguatoxic fish species (e.g., Gymnothorax flavimarginatus) and reef fish collected after storms and individuals' susceptibility. Mass ciguatera fish poisoning with mortalities also occurred when G. flavimarginatus and other ciguatoxic fish species were shared in gatherings and parties. The characteristic features of fatal ciguatera fish poisoning must be recognized early. The public should be repeatedly reminded to avoid eating the most ciguatoxic fish species and the CTX-rich parts of reef fish. To prevent mass poisoning in gatherings and parties, the most ciguatoxic fish species and potentially toxic fish species must be avoided. Particularly after hits by disastrous storms, it is important to monitor the toxicity of reef fish and the incidence rates of ciguatera.

An Updated Review of Ciguatera Fish Poisoning: Clinical, Epidemiological, Environmental, and Public Health Management

“…CFP is rarely fatal [83]. Death may occur in severe cases due to dehydration, cardiovascular shock, or (very rarely) respiratory failure resulting from paralysis of the respiratory musculature [55,84], especially in areas where ventilatory support and emergency medical care are unavailable.…”

“…Death may occur in severe cases due to dehydration, cardiovascular shock, or (very rarely) respiratory failure resulting from paralysis of the respiratory musculature [55,84], especially in areas where ventilatory support and emergency medical care are unavailable. When fatal, the illness is often characterized by convulsions, coma, and focal neurological deficits (see Chan, 2016 [83], for review). Anecdotally, in some of these authors’ experiences primarily with Caribbean cases, critical complications are generally readily apparent upon initial clinical evaluation (Written communication, K. Schrank, J. Bernstein, D. Blythe, L.E.…”

Regional Variations in the Risk and Severity of Ciguatera Caused by Eating Moray Eels

“…The ingestion of a large quantity and CTX-rich parts (head, skin, and viscera) and concomitant alcohol consumption will result in more severe poisoning and prolonged illness [ 2 , 3 ]. Ciguatera-related deaths are rare, but preventable, through public education and an early recognition of the warning features (e.g., coma and seizures) with immediate treatment [ 4 ].…”

Ciguatera oder wieso bei der Kälteallodynie nach dem Fischverzehr gefragt werden sollte

“…Auch in Deutschland gab es schon schwere Ciguatera-Fälle [18], in der ICD-10-Todesursachenstatistik wurde 2012 ein Todesfall registriert. Bei letal verlaufenden Ciguatera-Fällen beherrschten schwere neurologische Komplikationen wie generalisierte epileptische Anfälle und progrediente Bewusstseinsstörungen den klinischen Verlauf [4], möglicherweise in Zusammenhang mit einem Hirnödem. In diesen Fällen blieben die Symptome nicht auf das periphere Nervensystem beschränkt.…”

“…Große Exemplare und die besonders toxinhaltigen Teile (Leber, Gonaden, Kopf, Haut) sollten überhaupt nicht verzehrt werden. Ebenso sollte der Fischkonsum nach schweren Unwettern über mehrere Wochen vermieden werden [3,4]. Diese Vorsichtsmaßnahme war einem deutschen Ehepaar, das im September 2016 auf Kuba Urlaub machte, leider nicht bekannt [5].…”