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ciguatoxin
Neurotoxin contaminating marine fish.
The syndrome of toxicity is ciguatera.
Epidemiology:
- ciguatera toxins occur naturally in coral reef fish (mackeral, grouper, snapper, barracuda, amberjack, surgeonfish) that consume microalgae containing toxin precursors
- food storage & preparation do NOT affect the toxin
- 80%-90% of people who eat contaminated fish become ill [2]
Adverse effects:
1) gastrointestinal effects 1st to appear 6-12 hours after ingestion
a) abdominal pain, nausea, vomiting, diarrhea
b) duration of symptoms 1-2 days [3]
2) neurologic symptoms appear a few hours to 3 days after ingestion
- paresthesias, headaches, dysarthria, feeling of loose teeth, pruritus, arthralgia, myalgia, muscle weakness, dysphagia generalized hyporeflexia, ataxia, vertigo, visual impairment, respiratory depression due to paralysis, coma
- cold allodynia or hot-cold-reversal* (burning sensation on exposure to cold)
- worsening of symptoms with alcohol ingestion*
- symptoms persist weeks to months
3) cardiovascular less common
- bradycardia, hypotension
- symptoms persist 3-5 days
4) other
- dyspnea, perspiration, chills, salivation, neck stiffness
5) some symptoms may persist up to 5 months [2]
* highly suggestive of ciguatoxin poisoning [3]
Laboratory:
- CSF analysis shows normal cell count
General
toxin (hazardous material, poison)
References
- Ruprecht K et al
[Ciguatera: clinical relevance of a marine neurotoxin].
Drsch Med Wochenschr 126:821, 2001
PMID: 11499263
- Centers for Disease Control and Prevention
Ciguatera Fish Poisoning - New York City, 2010-2011
MMWR. February 1, 2013 / 62(04);61-65
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6204a1.htm
- Vearrier D
8 Cases of Food Poisoning: Find the Pathogen Responsible.
Medscape. March 22, 2021
https://reference.medscape.com/slideshow/food-poisoning-6009621