Ciguatera fish poisoning
| Ciguatera fish poisoning | |
|---|---|
| Other names | Ciguatera, ciguatera food poisoning |
| Chemical structure of one of the ciguatoxins | |
| Specialty | Toxicology |
| Symptoms | Diarrhea, vomiting, numbness, itchiness, sensitivity to hot and cold, dizziness, weakness[1][2] |
| Usual onset | 30 min to 2 days[3] |
| Duration | Few weeks to months[3] |
| Causes | exposure to polyether toxins found within certain reef fish[2] |
| Risk factors | Barracuda, grouper, moray eel, amberjack, sea bass, fish[2] |
| Diagnostic method | Based on symptoms and recently eating fish[1] |
| Differential diagnosis | Paralytic shellfish poisoning, neurotoxic shellfish poisoning, scombroid food poisoning, pufferfish poisoning[1] |
| Treatment | Mannitol, gabapentin, amitriptyline[1][2] |
| Prognosis | Risk of death ~ 0.1%[2] |
| Frequency | c. 50,000 per year[2] |
Ciguatera fish poisoning (CFP), also known as ciguatera, is a foodborne illness caused by eating tropical reef fish contaminated with ciguatoxins.[4][2] Such individual fish are said to be ciguatoxic. Symptoms may include diarrhea, vomiting, numbness, itchiness, dysesthesia, sensitivity to hot and cold, dizziness, and weakness with lethargy.[1][2] The onset of symptoms varies with the amount of toxin absorbed. If a large quantity of toxins are consumed symptoms may appear within half an hour. If a low amount of toxins are consumed symptoms may take a few days to appear.[3] Diarrhea may last up to four days.[1] Symptoms may last a few weeks to a few months.[3] Heart problems such as slow heart rate and low blood pressure may occur.[2]
The specific toxins involved are the ciguatoxins and maitotoxin.[2] They are originally made by a small marine organism, Gambierdiscus toxicus, that grows on and around coral reefs in tropical and subtropical waters.[2] These are eaten by herbivorous fish which in turn are eaten by larger carnivorous fish.[2] The toxins become more concentrated as they move up the food chain.[3] The fish most often implicated include barracuda, grouper, moray eel, amberjack, sea bass, and sturgeon.[2] Diagnosis is based on a person's symptoms together with having recently eaten fish.[1] If a number of those who eat the same fish develop symptoms the diagnosis becomes more likely.[1] If some of the fish they had previously eaten is available this can also be tested to confirm the diagnosis.[1]
Preventive efforts include not eating reef fish, not eating high-risk fish such as barracuda, and not eating fish liver, roe, or fish heads.[2] Ciguatoxin has no taste or smell, and cannot be destroyed by conventional cooking.[2] There is no specific treatment for ciguatera fish poisoning once it occurs.[2] Mannitol may be considered, but the evidence supporting its use is not very strong.[1] Gabapentin or amitriptyline may be used to treat some of the symptoms.[2]
In 2017, the United States Centers for Disease Control (CDC) estimated that around 50,000 cases occur globally each year.[2] Other estimates suggest up to 500,000 cases per year.[1] The risk of death from poisoning is less than 1 in 1,000 according to the CDC.[2] It is the most frequent seafood poisoning.[3] It occurs most commonly in the Pacific Ocean, Indian Ocean, and the Caribbean Sea between the latitudes of 35°N and 35°S.[2] The risk of the condition appears to be increasing due to coral reef deterioration and increasing trade in seafood.[2] Descriptions of the condition date back to at least 1511.[3] The current name, introduced in 1787, is of Cuban Spanish origin and originally referred to the gastropod Cittarium pica.[3]
- ^ a b c d e f g h i j k Friedman, MA; Fernandez, M; Backer, LC; Dickey, RW; Bernstein, J; Schrank, K; Kibler, S; Stephan, W; Gribble, MO; Bienfang, P; Bowen, RE; Degrasse, S; Flores Quintana, HA; Loeffler, CR; Weisman, R; Blythe, D; Berdalet, E; Ayyar, R; Clarkson-Townsend, D; Swajian, K; Benner, R; Brewer, T; Fleming, LE (14 March 2017). "An Updated Review of Ciguatera Fish Poisoning: Clinical, Epidemiological, Environmental, and Public Health Management". Marine Drugs. 15 (3): 72. doi:10.3390/md15030072. PMC 5367029. PMID 28335428.
- ^ a b c d e f g h i j k l m n o p q r s t u "Food Poisoning from Marine Toxins - Chapter 2 - 2018 Yellow Book". CDC. 2017. Retrieved 1 June 2018. This article incorporates text from this source, which is in the public domain.
- ^ a b c d e f g h "Ciguatera Fish Poisoning (CFP)". Marine biotoxins. Food and Agriculture Organization. 2004. p. Chapter 7. ISBN 978-92-5-105129-0.
- ^ Robertson, Alison; Garcia, Ana C.; Quintana, Harold A. Flores; Smith, Tyler B.; Ii, Bernard F. Castillo; Reale-Munroe, Kynoch; Gulli, Joseph A.; Olsen, David A.; Hooe-Rollman, Jennifer I.; Jester, Edward L. E.; Klimek, Brian J.; Plakas, Steven M. (January 2014). "Invasive Lionfish (Pterois volitans): A Potential Human Health Threat for Ciguatera Fish Poisoning in Tropical Waters". Marine Drugs. 12 (1): 88–97. doi:10.3390/md12010088. ISSN 1660-3397. PMC 3917262. PMID 24378919.