Ciguatera: Ecological, clinical, and socioeconomic perspectives

Abstract

Ciguatera fish poisoning, found throughout the world in warm waters, is the most common type of marine biotoxin ingestion. A polymorphous disease caused by toxins produced by coral reef dinoflagellate(s) and which concentrate up the food chain, ciguatera poses important health, nutritional, economic, and social problems for inhabitants of endemic areas. Despite considerable recent study and progress, the ecology and pathophysiology of the disease remain relatively little understood. Areas in which progress has been made include identification of the causative organisms and toxins and, to a lesser extent, treatment of affected persons. It has become clear that a variety of disturbances of the ecology of coral reefs may be associated with outbreaks of ciguatera. This paper reviews broadly the current knowledge of ciguatera, particularly the ecological, clinical, and socioeconomic aspects.

Ciguatera Incidence in the US Virgin Islands Has Not Increased over a 30-Year Time Period Despite Rising Seawater Temperatures

“…However, the threshold suggested in the past is approximately 30 C, which St. Thomas does not typically exceed; the average Table 4 Demographics of US Virgin Islands, 1980 and 2000 16,20 Our findings support the idea that other factors, including demographic and behavioral, are associated with changes in ciguatera incidence over time, with lower socioeconomic status (particularly education), fish consumption three times a week or more, being born in the Caribbean (outside the US Virgin Islands), and previous ciguatera episodes associated with illness. [21][22][23] Lower socioeconomic status presumably increases risk of ciguatera, because lower income individuals may have few affordable protein alternatives to locally caught fish. 21 Persons born on another Caribbean Islands may not have had as much experience with ciguatera (and fish at high risk of being toxic, such as barracuda) as persons born in the Virgin Islands; this finding may also serve as a proxy for differences in socioeconomic status.…”

“…[21][22][23] Lower socioeconomic status presumably increases risk of ciguatera, because lower income individuals may have few affordable protein alternatives to locally caught fish. 21 Persons born on another Caribbean Islands may not have had as much experience with ciguatera (and fish at high risk of being toxic, such as barracuda) as persons born in the Virgin Islands; this finding may also serve as a proxy for differences in socioeconomic status. Lastly, a change in incidence may be driven further by the corresponding change in the number of people at higher risk because of previous ciguatera episodes.…”

Ciguatera poisoning: a global issue with common management problems

“…28 Isolated and small group common source outbreaks are frequently encountered in Australia 1,8,14,17 but less often in Europe 2 and North America. 4,5 With imported contaminated fish becoming increasingly available to consumers in non-endemic areas, 1 ciguatera poisoning will become a greater public health issue.…”

“…Although promising, these agents have no proven efficacy in humans. 16 Non-proven therapies also include calcium gluconate, nifedipine, amitryptyline, 6,15,28 and vitamin B . 8 Symptomatic treatment 12 includes analgesics for musculoskeletal symptoms, antihistamines for pruritus 3,15 as well as antiemetics and antidiarrhoeals.…”

Epidemiology of Ciguatera in Florida

“…2 It results from the consumption of reef fish containing toxins produced by benthic dinoflagellates of the genus Gambierdiscus. 3 Numerous ciguatoxins have been identified and are described elsewhere. 4 Ciguatera is endemic to many tropical and subtropical areas worldwide, 5,6 with a range of latitudes from 35°N to 35°S.…”