The toxins have no observable effect on the fish, but when humans catch and consume them, ciguatera poisoning ensues. Although it is rarely fatal, ciguatera poisoning causes a wide variety of debilitating symptoms, including vomiting, diarrhea, abdominal pain, trembling, and paralysis. Symptoms may vary widely, even if individuals have eaten the same fish. There exists no known cure, nor a proven effective and safe treatment. One recent study suggests that poisoned patients may benefit from intravenous infusions of mannitol, but this has not been proven in controlled clinical trials, nor is mannitol available in many remote Pacific locations.
Individuals become sensitized to the toxin.
Subsequent attacks tend to be more severe than the first attack, and eating certain foods, notably nontoxic fish, alcohol, or chicken, may induce a recurrence of ciguatera symptoms, as may the onset of another illness. Attacks of the disease during pregnancy may result in miscarriage or poisoning of the fetus, and ciguatera can be transmitted from an affected mother to her infant by breast milk. An outbreak of ciguatera poisoning often occurs after a coral reef is damaged. Not every reef disturbance produces an outbreak, but a number of outbreaks can be traced to specific reef damage. Some of the bloodiest battles of the war were at Kwajalein and Eniwetok, where nearly 5,000 Micronesians died.