Three clusters of ciguatera poisoning: clinical manifestations and public health implications

Karalis, T.; Gupta, Leila; Chu, Maoping; Campbell, Bradley A.; Capra, Mike; Maywood, Patrick

doi:10.5694/j.1326-5377.2000.tb125539.x

Cited by 22 publications

(11 citation statements)

References 19 publications

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“…Although not yet tested by double blind trials, most case series report that more than 60% of victims have their symptoms reversed by mannitol infusion4 5 9 18 26 provided that this is administered within 48 hours of the onset of symptoms. No other therapy, other than non-specific supportive management, has been shown to be of benefit.…”

Section: Treatmentmentioning

confidence: 99%

Neurology of ciguatera

Pearn

2001

Journal of Neurology, Neurosurgery &Amp; Psychiatry

203

171

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Ciguatera is a widespread ichthyosarcotoxaemia with dramatic and clinically important neurological features. This severe form of fish poisoning may present with either acute or chronic intoxication syndromes and constitutes a global health problem. Ciguatera poisoning is little known in temperate countries as a potentially global problem associated with human ingestion of large carnivorous fish that harbour the bioaccumulated ciguatoxins of the photosynthetic dinoflagellate Gambierdiscus toxicus. This neurotoxin is stored in the viscera of fish that have eaten the dinoflagellate and concentrated it upwards throughout the food chain towards progressively larger species, including humans. Ciguatoxin accumulates in all fish tissues, especially the liver and viscera, of "at risk" species. Both Pacific (P-CTX-1) and Caribbean (C-CTX-1) ciguatoxins are heat stable polyether toxins and pose a health risk at concentrations above 0.1 ppb. The presenting signs of ciguatera are primarily neurotoxic in more than 80% of cases. Such include the pathognomonic features of postingestion paraesthesiae, dysaesthesiae, and heightened nociperception. Other sensory abnormalities include the subjective features of metallic taste, pruritus, arthralgia, myalgia, and dental pain. Cerebellar dysfunction, sometimes diphasic, and weakness due to both neuropathy and polymyositis may be encountered. Autonomic dysfunction leads to hypotension, bradycardia, and hypersalivation in severe cases. Ciguatoxins are potent, lipophilic sodium channel activator toxins which bind to the voltage sensitive (site 5) sodium channel on the cell membranes of all excitable tissues. Treatment depends on early diagnosis and the early administration of intravenous mannitol. The early identification of the neurological features in sentinel patients has the potential to reduce the number of secondary cases in cluster outbreaks.

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Section: Treatmentmentioning

confidence: 99%

Neurology of ciguatera

Pearn

2001

Journal of Neurology, Neurosurgery &Amp; Psychiatry

203

171

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“…6,10 Because there is no approved human assay for ciguatoxin, the diagnosis is based on clinical findings and by the detection of toxin in samples of fish. 13 As in this outbreak, ciguatera fish poisoning is diagnosed by the characteristic combination of acute gastrointestinal and neurologic symptoms in persons who eat large, predatory barracuda fish. The bioassay for ciguatera toxin is the only available method in Taiwan.…”

Section: Discussionmentioning

confidence: 99%

Persistent Bradycardia Caused by Ciguatoxin Poisoning After Barracuda Fish Eggs Ingestion in Southern Taiwan

Hung¹,

Hung²,

Chou³

et al. 2005

The American Journal of Tropical Medicine and Hygiene

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We report an outbreak of ciguatoxin poisoning after barracuda fish ingestion in southern Taiwan. Three members of a family developed nausea, vomiting, watery diarrhea, and myalgias about 1 hour after eating three to ten eggs of a barracuda fish. Numbness of the lips and extremities followed the gastrointestinal symptoms about 2 hours after ingestion. Other manifestations included hyperthermia, hypotension, bradycardia, and hyperreflexia. Bradycardia persisted for several days, and one patient required a continuous infusion of intravenous atropine totaling 40 mg over 2 days. Further follow-up of the patients disclosed improvement of neurologic sequelae and bradycardia, but sensory abnormalities resolved several months later. In conclusion, ciguatoxin poisoning causes mainly gastrointestinal and neurologic effects of variable severity. In two patients with ciguatoxin poisoning after barracuda fish egg ingestion, persistent bradycardia required prolonged atropine infusion.

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“…commerson), most outbreaks caused by fish from Australian waters are attributable to fish caught in the seas off Queensland and the Northern Territory. Fish sourced from Queensland have been responsible for ciguatera outbreaks in southern Australian states and internationally (Karalis et al, 2000;Ng and Gregory, 2000;Wong et al, 2005), and overseas visitors to Queensland have contracted the illness (Slobbe et al, 2008). Ciguatera clearly has the potential to tarnish the reputation of Queensland's tourism and fish-export industries.…”

Section: Management Of Ciguatera In Queenslandmentioning

confidence: 99%

Emerging tropical diseases in Australia. Part 2. Ciguatera fish poisoning

Stewart

Lewis

Eaglesham

et al. 2010

Annals of Tropical Medicine & Parasitology

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Ciguatera poisoning is a food-borne neuro-intoxication caused by consumption of finfish that have accumulated ciguatoxins in their tissues. Ciguatera is a distressing and sometimes disabling condition that presents with a self-limiting though occasionally severe gastro-intestinal illness, progressing to a suite of aberrant sensory symptoms. Recovery can take from days to years; second and subsequent attacks may manifest in a more severe illness. Ciguatera remains largely a pan-tropical disease, although tourism and export fish markets facilitate increased presentation in temperate latitudes. While ciguatera poisoning in the South Pacific was recognised and eloquently described by seafarers in the 18th Century, it remains a public-health challenge in the 21st Century because there is neither a confirmatory diagnostic test nor a reliable, low-cost screening method to ascertain the safety of suspect fish prior to consumption. A specific antidote is not available, so treatment is largely supportive. The most promising pharmacotherapy of recent decades, intravenous mannitol, has experienced a relative decline in acceptance after a randomized, double-blind trial failed to confirm its efficacy. Some questions remain unanswered, however, and the use of mannitol for the treatment of acute ciguatera poisoning arguably deserves revisiting. The immunotoxicology of ciguatera is poorly understood, and some aspects of the epidemiology and symptomatology of ciguatera warrant further enquiry.

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Three clusters of ciguatera poisoning: clinical manifestations and public health implications

Cited by 22 publications

References 19 publications

Neurology of ciguatera

Neurology of ciguatera

Persistent Bradycardia Caused by Ciguatoxin Poisoning After Barracuda Fish Eggs Ingestion in Southern Taiwan

Emerging tropical diseases in Australia. Part 2. Ciguatera fish poisoning

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