Ciguatera Fish Poisoning: Ciguatera Toxin Symptoms & Treatment Ciguatera Toxin Detection Ciguatera Fish Poisoning (Toxin) Definition Ciguatera is a foodborn illness (food poisoning ) caused by eating fish that is contaminated by ciguatera toxin. Ciguatera toxin is a heat-stable lipid soluble compound, produced by dinoflagellates and concentrated in fish organs, that can cause nausea , pain , cardiac, and neurological symptoms in humans when ingested. The toxin may be found concentrated in large reef fish, most commonly barracuda, grouper, red snapper, eel, amberjack, sea bass, and Spanish mackerel. These fish live in coral reef waters and accumulate the toxin when they eat smaller reef fish which feed on the dinoflagellates. The area of concern include the Caribbean Sea, Hawaii, and coastal Central America. With fish from ciguatera endemic areas being shipped nationwide, poisonings can potentially occur in any areas in the United States.

Ciguatera toxin tends to accumulate in large predator fish (weight over 2 Kg or about 4.5 lbs), such as the barracuda and other carnivorous reef fish, because they eat other fish that consume toxin-producing algae (dinoflagellates), which live in coral reef waters. The toxin has highest concentrations in fish visceral and sex organs. Ciguatera toxin is harmless to fish, but poisonous to humans. The toxin is odorless and tasteless, and cooking does not destroy the toxin. Eating ciguatera-contaminated tropical or subtropical fish is the main way that humans are exposed to the toxin. The toxin activates voltage-dependent sodium channels causing symptoms in human (and other mammals) gastrointestinal , cardiac, and nerve tissues. There are about 50,000 reported poisonings worldwide per year, but rarely cause death; children have more severe symptoms (see below). Medically Reviewed by a Doctor on 9/30/2016 Medical Author: Ciguatera - Travel.gc.ca Ciguatera None What is ciguatera? Ciguatera is a food-borne illness caused by eating reef fish contaminated with a toxin called “ciguatoxin”.

Ciguatoxin is tasteless and odourless. Fish contaminated with ciguatoxin cannot be identified by appearance. Ciguatoxin is not destroyed by cooking, smoking, freezing, canning, salting or drying. What is my risk? Travellers who consume large reef fish, such as barracuda or moray eel, are at risk. Ciguatera occurs in very localized outbreaks, so it is very difficult to predict risk. One fish on one day may be safe to eat and the same species of fish on another day may not be safe to eat. The risk of ciguatera is higher after events that disturb coral reefs, like tsunamis. The risk is higher among those who: sport fish and eat their catch eat fish that weigh more than 3 kg eat the heads, viscera (organs and intestines) and roe (eggs) of reef fish How is it transmitted? Ciguatera toxins are produced by small sea algae that live around coral reefs in tropical and sub-tropical oceans. The algae are eaten by smaller fish which are then eaten by bigger fish.

The toxins become more concentrated as they move up the food chain and they remain harmless to the fish but act as a poison in humans. What are the symptoms? Symptoms can occur within minutes, but generally develop within 24 hours of eating contaminated fish. Most people recover completely within a few days or weeks, but in very rare cases, ciguatera can be fatal. Initial gastrointestinal symptoms include nausea, vomiting, diarrhea and abdominal pain. These symptoms may last several days. Neurological symptoms develop after the initial symptoms, and include: tingling and numbness around the mouth, lips, throat, arms and legs sore muscles and tooth pain temperature reversal (hot things feel cold and cold things feel hot) feeling tired, headaches and itchy skin In rare, severe cases of ciguatera, neurological symptoms can last months or longer. Can ciguatera be treated? There is no cure for ciguatera, but it usually resolves on its own. There are treatments that may provide relief from some symptoms of ciguatera. Where is ciguatera a concern?

Ciguatera occurs in tropical and sub-tropical areas of the: Caribbean Sea Indian Ocean Pacific Ocean New areas continue to be identified, including the Canary Islands, the eastern Mediterranean and the western Gulf of Mexico. Ciguatera can also occur after eating fish imported from tropical or sub-tropical areas. Recommendations Consult a health care provider or visit a travel health clinic preferably six weeks before you travel. Avoid eating reef fish. Some examples of reef fish include barracuda, moray eel, amberjack, snapper, grouper, sea bass and sturgeon fish. If you cannot avoid eating reef fish: Avoid eating large reef fish (fish that weigh more than 3 kg), although keep in mind that small fish may also cause ciguatera. Avoid eating the heads, viscera (organs and intestines) and roe (eggs) of reef fish. Remember, ciguatoxin is tasteless and odourless. Fish contaminated with ciguatoxin cannot be identified by appearance. Ciguatoxin is not destroyed by cooking, smoking, freezing, canning, salting or drying.

If you are sport fishing, find out if there have been any cases of ciguatera associated with fish caught in the area you are fishing in. Avoid eating any fish that is considered dangerous by the local population. Related links Ciguatera fish poisoning: Fish and shellfish poisoning at The Medical Dictionary From Gale Encyclopedia of Medicine, 4/6/01 by Larry I. Lutwick Definition Fish and shellfish poisoning is a common but often unrecognized group of illnesses related to food. Three of these illnesses include ciguatera, scombroid, and paralytic shellfish poisoning. Ciguatera Definition Ciguatera (from the Spanish word for a poisonous snail) is a food-related illness that causes abdominal and neurological symptoms. Causes & symptoms Ciguatera is caused by eating fish that have a toxin called ciguatoxin. Scientists believe this toxin is acquired by the fish through the food chain, and is originally produced by small algae microorganisms (dinoflagellates). The fish most likely contaminated with ciguatoxin are those that feed close to tropical reefs, including red snapper, grouper, and barracuda. Larger fish are more likely to contain the toxin.

Although not as common in the United States, ciguatera is commonly diagnosed on many of the islands in the Pacific Ocean. Illness from ciguatera can occur in just a few minutes to about 30 hours after eating. Most cases occur one to six hours after eating the contaminated fish. Initial symptoms are abdominal cramps, nausea, vomiting, or watery diarrhea. The most characteristic symptoms of the illness are those involving the nervous system. These include numbness and tingling around the lips, tongue, and mouth; itching; dry mouth; metallic taste in the mouth; and blurry vision. In more prominent cases, patients may complain of temporary blindness, a slow pulse, and a feeling that their teeth are loose. Patients may also have the strange symptom of reversal of hot and cold sensations on the skin, where cold things feel very hot or painful to the touch. In very severe cases, there may be difficulties in breathing or low blood pressure. Diagnosis Ciguatera diagnosis is based on the typical combination of symptoms after eating fish. There are no readily available blood or urine tests to detect the poisoning, but some researchers have developed a test for the toxin left on any remaining fish.

A person does not have to be in a tropical area to get ciguatera. Fish can be caught from one of these distant areas, and can then be shipped and eaten locally. It is important to report suspected cases to local public health officials because more cases may occur from other contaminated fish. Treatment The treatment for this illness is general. Patients are given fluids (by mouth or through a vein) and medications to decrease the itching or to treat vomiting and/or diarrhea. The neurological symptoms can cause discomfort and treatment with amitriptyline (a medicine that has been used for depression) may be useful. Other medications may also be given. Prognosis Although death can occur, almost all patients diagnosed with ciguatera will recover. Recovery, however, can be slow and some symptoms can last for weeks or even months. Symptoms can also be aggravated by other illnesses or alcohol. Prevention Knowing the kinds of fish linked to ciguatera can help a person avoid eating high-risk fish. However, over 400 different kinds of fish have been linked to the disease, even salmon. A particular fish in a given area may be more likely to cause ciguatera than other fish.

For example, red snapper is most often the source of ciguatera in the Pacific, while barracuda is more likely to contain the toxin in Florida. This is why it is illegal to sell barracuda in Florida for human consumption. Cooking the fish does not prevent ciguatera. Scombroid Definition Scombroid is a fish-associated illness caused by eating improperly handled fish. Fish linked to this disease are usually in the Scombridae family, which includes yellowfin tuna, skipjack, bonito, and mackerel. Causes & symptoms Scombroid occurs after eating fish that has not been properly refrigerated after capture. Unlike ciguatera, the toxins linked with scombroid are not contracted by the fish from its surroundings. Bacteria that are normally found in fish act directly on a chemical (called histidine) in the flesh of fish that are not properly cooled when stored. This interaction produces histamine and other chemicals that cause the illness when the fish is eaten. Symptoms of scombroid occur quickly after eating the fish, as soon as 10 minutes. Since histamine is released by certain cells in the body during an allergic reaction, scombroid can be confused with a fish allergy.

Scombroid causes flushing of the face, sweating, a burning feeling in the mouth or throat, vomiting, diarrhea, and headaches. A rash that looks like a sunburn may occur, and a small number of patients have hives. Some patients have a metallic or peppery taste in their mouths. In more severe cases, rapid pulse, blurred vision, and difficulty breathing can occur. Symptoms usually last about four hours. Diagnosis Like ciguatera, scombroid poisoning is diagnosed based on typical symptoms occurring after eating fish. There are usually no available tests for the patient. Experimentally, however, elevated levels of histamine-related products have been found in the urine. It may be possible for public health officials to test any remaining fish flesh for histamine levels. Improperly refrigerated fish caught in both temperate and tropical waters have been linked to the illness. An outbreak of similar cases may be helpful in correctly diagnosing the problem. Treatment The treatment for scombroid is usually general. Antihistamines like diphenhydramine (Benadryl) may shorten the duration of the illness, but the illness will go away on its own.

Some doctors have found that cimetidine (Tagamet) given through a vein may be helpful as well. In rare, more severe cases, epinephrine (adrenaline) may be used. Prognosis Although sometimes dramatic and alarming symptoms can occur, scombroid is usually not serious. The patient should be reassured that scombroid is not a fish allergy. Prevention Adequate storage of the target fish will always prevent scombroid. Since the fish does not appear spoiled or smell bad, the consumer cannot detect the risk of the illness before eating the fish. Cooking the fish does not prevent scombroid. Suspected cases should be reported to public health officials. Paralytic shellfish poisoning Definition Paralytic shellfish poisoning (PSP) is a nervous system disease caused by eating cooked or raw shellfish that contain environmental toxins. These toxins are produced by a group of algae (dinoflagellates). It is unclear whether these toxins are related to the "blooming" of the algae, also called red tide because the algae can turn the water reddish brown. PSP occurs mostly in May through November.

Causes & symptoms PSP develops usually within minutes after eating a contaminated shellfish, most commonly a mussel, clam, or oyster. Symptoms include headache, a floating feeling, dizziness, lack of coordination, and tingling of the mouth, arms, or legs. Muscle weakness causing difficulty swallowing or speaking may occur. Abdominal symptoms such as nausea, vomiting, and diarrhea can also occur. Unlike ciguatera and scombroid, PSP may have a much more serious outcome. PSP may cause difficulty breathing related to weakness or paralysis of the breathing muscle. The symptoms may last for 6-12 hours, but a patient may continue to feel weak for a week or more. Diagnosis PSP diagnosis is based on symptoms after eating shellfish, even if the shellfish are adequately cooked. No blood or urine test is available to diagnose the illness, but tests in mice to detect the toxin from the eaten fish can be done by public health officials. Treatment The treatment of PSP is mostly supportive. If early symptoms are recognized, the doctor will try to flush the toxin from the gastrointestinal tract with medications that create diarrhea. Vomiting may be induced if the patient has no signs of weakness.

In cases where the muscles of breathing are weakened, the patient may be placed on a respirator until the weakness goes away. However, this measure is not usually needed. Likewise, the use of a machine to clean the blood (dialysis) has been used in severe cases. Prognosis The prognosis for PSP is quite good, especially if the patient has passed the initial 12 hours of illness without needing breathing support. Most deaths occur during this period if breathing help is not available. Prevention Measures to control PSP require detecting rising numbers of algae in coastal waters by periodic microscopic examination. By law, shellfish beds are closed when levels of the toxin-producing organisms are above acceptable standards. Cooking the shellfish does not prevent this disease. Suspected cases should be reported to public health officials. Key Terms Food Poisoning from Marine Toxins - Chapter 2 - 2016 Yellow Book | Travelers' Health | CDC Food Poisoning from Marine Toxins Food Poisoning from Marine Toxins Vernon E. Ansdell Seafood poisoning from marine toxins is an under-recognized hazard for travelers, particularly in the tropics and subtropics.

Furthermore, the risk is increasing because of factors such as climate change, coral reef damage, and spread of toxic algal blooms. CIGUATERA FISH POISONING Ciguatera fish poisoning occurs after eating reef fish contaminated with toxins such as ciguatoxin or maitotoxin. These potent toxins originate from Gambierdiscus toxicus, a small marine organism (dinoflagellate) that grows on and around coral reefs. Dinoflagellates are ingested by herbivorous fish. The toxins produced by G. toxicus (gambiertoxins) are then modified and concentrated as they pass up the food chain to carnivorous fish and finally to humans. Ciguatoxins are concentrated in fish liver, intestines, roe, and heads. G. toxicus may proliferate on dead coral reefs more effectively than other dinoflagellates. The risk of ciguatera is likely to increase as more coral reefs deteriorate because of climate change, ocean acidification, construction, and nutrient runoff. Risk for Travelers More than 50,000 cases of ciguatera poisoning occur globally every year.

The incidence in travelers to highly endemic areas has been estimated as high as 3 per 100. Ciguatera is widespread in tropical and subtropical waters, usually between the latitudes of 35°N and 35°S; it is particularly common in the Pacific and Indian Oceans and the Caribbean Sea. The incidence and geographic distribution of ciguatera poisoning are increasing. Newly recognized areas of risk include the Canary Islands, the eastern Mediterranean, and the western Gulf of Mexico. Fish that are most likely to cause ciguatera poisoning are carnivorous reef fish, including barracuda, grouper, moray eel, amberjack, sea bass, or sturgeon. Omnivorous and herbivorous fish such as parrot fish, surgeonfish, and red snapper can also be a risk. Clinical Presentation Typical ciguatera poisoning results in a gastrointestinal illness and may also cause neurologic symptoms. Although very rare, cardiovascular collapse may result.

The first symptoms generally include nausea, vomiting, diarrhea, and abdominal pain, followed by neurologic symptoms such as paresthesias, pain in the teeth or the sensation that the teeth are loose, itching, metallic taste, blurred vision, or even transient blindness. Cold allodynia (abnormal sensation when touching cold water or objects) has historically been reported as characteristic, though new studies have found that there can be acute sensitivity to both hot and cold. Neurologic symptoms usually last a few days to several weeks. The overall death rate from ciguatera poisoning is <0.1% but varies according to the toxin dose and availability of medical care to deal with complications. The diagnosis of ciguatera poisoning is based on the clinical signs and symptoms and a history of eating species of fish that are known to carry ciguatera toxin. Fish testing can be done by the Food and Drug Administration (FDA) in their laboratory at Dauphin Island. There is no easily available test for ciguatera toxins in human clinical specimens. Prevention Travelers can take the following precautions to prevent ciguatera fish poisoning: Avoid or limit consumption of the reef fish listed above, especially if the fish weighed >6 lb (2.7 kg).

Never eat high-risk fish such as barracuda or moray eel Avoid the parts of the fish that concentrate ciguatera toxin: liver, intestines, roe, and head Remember that ciguatera toxins do not affect the texture, taste, or smell of fish, and they are not destroyed by gastric acid, cooking, smoking, freezing, canning, salting, or pickling. Treatment There is no specific antidote for ciguatoxin or maitotoxin poisonings. Treatment is generally for specific symptoms and includes supportive care. Intravenous mannitol has been reported in uncontrolled studies to reduce the severity and duration of neurologic symptoms, particularly if given within 48 hours of the appearance of symptoms. SCOMBROID Scombroid, one of the most common fish poisonings, occurs worldwide in both temperate and tropical waters. The illness occurs after eating improperly refrigerated or preserved fish containing high levels of histamine, and often resembles a moderate to severe allergic reaction.

Fish typically associated with scombroid have naturally high levels of histidine in the flesh and include tuna, mackerel, mahimahi (dolphin fish), sardine, anchovy, herring, bluefish, amberjack, and marlin. Histidine is converted to histamine by bacterial overgrowth in fish that has been improperly stored after capture. Histamine and other scombrotoxins are resistant to cooking, smoking, canning, or freezing. Clinical Presentation Symptoms of scombroid poisoning resemble an acute allergic reaction and usually appear 10–60 minutes after eating contaminated fish. They include flushing of the face and upper body (resembling sunburn), severe headache, palpitations, itching, blurred vision, abdominal cramps, and diarrhea. Untreated, symptoms usually resolve within 12 hours. Rarely, there may be respiratory compromise, malignant arrhythmias, and hypotension requiring hospitalization. Diagnosis is usually clinical. A clustering of cases helps exclude the possibility of true fish allergy. Prevention Fish contaminated with histamine may have a peppery, sharp, salty, taste or “bubbly” feel but may also look, smell, and taste normal.

The key to prevention is to make sure that the fish is properly iced or refrigerated at temperatures <38°F (<3.3°C), or immediately frozen after it is caught. Cooking, smoking, canning, or freezing will not destroy histamine in contaminated fish. Treatment Scombroid poisoning usually responds well to antihistamines (H1-receptor blockers, although H2-receptor blockers may also be of benefit). SHELLFISH POISONING Several forms of shellfish poisoning may occur after ingesting filter-feeding bivalve mollusks (such as mussels, oysters, clams, scallops, and cockles) that contain potent toxins. The toxins originate in small marine organisms (dinoflagellates or diatoms) that are ingested and are concentrated by shellfish. Risk for Travelers Contaminated shellfish may be found in temperate and tropical waters, typically during or after dinoflagellate blooms called harmful algal blooms (HABs). One example of a HAB is the Florida red tide caused by Karenia brevis. Clinical Presentation Poisoning results in gastrointestinal and neurologic illness of varying severity.

Symptoms typically appear 30–60 minutes after ingesting toxic shellfish but can be delayed for several hours. Diagnosis is usually one of exclusion and is usually made clinically in patients who recently ate shellfish. Paralytic Shellfish Poisoning Paralytic shellfish poisoning (PSP) is the most common and most severe form of shellfish poisoning. PSP is caused by eating shellfish contaminated with saxitoxins produced by dinoflagellates from Aelxandrium, Pyrodinium, and Gymnodinium genera. Symptoms usually appear 30–60 minutes after eating toxic shellfish and include numbness and tingling of the face, lips, tongue, arms, and legs. There may be headache, nausea, vomiting, and diarrhea. Severe cases are associated with ingestion of large doses of toxin and clinical features such as ataxia, dysphagia, mental status changes, flaccid paralysis, and respiratory failure. The case-fatality ratio is dependent on the availability of modern medical care, including mechanical ventilation. The death rate may be particularly high in children.

Neurotoxic Shellfish Poisoning Neurotoxin shellfish poisoning is caused by eating shellfish contaminated with brevetoxins produced by the dinoflagellate K. brevis. Neurotoxic shellfish poisoning usually presents as gastroenteritis accompanied by minor neurologic symptoms resembling mild ciguatera poisoning or mild paralytic shellfish poisoning. Inhalation of aerosolized toxin in the sea spray associated with a Florida red tide (K. brevis bloom) can induce bronchoconstriction and may cause acute, temporary respiratory discomfort in healthy people. People with asthma may experience more severe and prolonged respiratory effects. Diarrheic Shellfish Poisoning Diarrheic shellfish poisoning (DSP) is caused by eating shellfish contaminated with a group of toxins that include polyether molecules (such as okadaic acid) produced by dinoflagellates from the genera Dinophysis and Prorocentrum lima. DSP produces chills, nausea, vomiting, abdominal cramps, and diarrhea. No deaths have been reported.

Amnesic Shellfish Poisoning Amnesic shellfish poisoning (ASP) is a rare form of shellfish poisoning caused by eating shellfish, particularly blue mussels, contaminated with domoic acid produced by the diatom Nitzchia pungens. The first cases of ASP were reported after an outbreak associated with eating contaminated cultivated mussels. These cases were reported to have severe gastroenteric and neurologic symptoms. More recently, domoic acid exposure via the food web was implicated in die-off of marine mammals along the US Pacific Coast. Prevention Shellfish poisoning can be prevented by avoiding potentially contaminated bivalve mollusks. This is particularly important in areas during or shortly after algal blooms, which may be locally referred to as “red tides” or “brown tides.” Travelers to developing countries should avoid eating all shellfish, because they carry a high risk of viral and bacterial infections. Marine shellfish toxins cannot be destroyed by cooking or freezing. Treatment Treatment is symptomatic and supportive. Severe cases of paralytic shellfish poisoning may require mechanical ventilation. BIBLIOGRAPHY Ansdell V. Food-borne illness.

In: Keystone JS, Freedman DO, Kozarsky PE, Connor BA, Nothdurft HD, editors. Travel Medicine. 3rd ed. Philadelphia: Saunders Elsevier; 2013. p. 425–32. Backer L, Fleming L, Rowan A, Baden D. Epidemiology and public health of human illnesses associated with harmful marine algae. In: Hallegraeff GM, Anderson DM, Cembella A, editors. Manual on Harmful Marine Microalgae. Paris: UNESCO; 2003. p. 723–49. Backer LC, Schurz-Rogers H, Fleming LE, Kirkpatrick B, Benson J. Marine phycotoxins in seafood. In: Dąbrowski WM, Sikorski ZE, editors. Toxins in Food. Boca Raton, FL: CRC Press; 2005. p. 144–74. Hungerford JM. Scombroid poisoning: a review. Toxicon. 2010 Aug 15;56(2):231–43.

Isbister GK, Kiernan MC. Neurotoxic marine poisoning. Lancet Neurol. 2005 Apr;4(4):219–28. Palafox NA, Buenoconsejo-Lum LE. Ciguatera fish poisoning: review of clinical manifestations. J Toxicol Toxin Rev. 2001;20(2):141–60. Perl TM, Bedard L, Kosatsky T, Hockin JC, Todd EC, Remis RS. An outbreak of toxic encephalopathy caused by eating mussels contaminated with domoic acid. N Engl J Med. 1990 Jun 21;322(25):1775–80. Schnorf H, Taurarii M, Cundy T. Ciguatera fish poisoning: a double-blind randomized trial of mannitol therapy. Neurology. 2002 Mar 26;58(6):873–80. Sobel J, Painter J. Illnesses caused by marine toxins. Clin Infect Dis.

2005 Nov 1;41(9):1290–6. Stewart I, Lewis RJ, Eaglesham GK, Graham GC, Poole S, Craig SB. Emerging tropical diseases in Australia. Part 2. Ciguatera fish poisoning. Ann Trop Med Parasitol. 2010 Oct;104(7):557–71. Ciguatera Fish Poisoning: Read About Symptoms & Tests Medical Author: John P. Cunha, DO, FACOEP John P. Cunha, DO, FACOEP John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey. Medical Editor: Melissa Conrad Stöppler, MD Melissa Conrad Stöppler, MD Melissa Conrad Stöppler, MD, is a U.S.

board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology. Share Your Story Ciguatera is a type of food poisoning . The ciguatera toxin may be found in large reef fish, most commonly barracuda, grouper, red snapper, eel, amberjack, sea bass, and Spanish mackerel. These fish live in coral reef waters between latitudes of 35 degrees south to 35 degrees north, corresponding to the area located between the Tropic of Cancer and the Tropic of Capricorn. These geographic lines ring the earth north and south of the equator and make up the tropics. These areas include the Caribbean Sea, Hawaii, and coastal Central America.

Ciguatera toxin tends to accumulate in predator fish, such as the barracuda and other carnivorous reef fish, because they eat other fish that consume toxin-producing algae (dinoflagellates) that live in coral reef waters. Ciguatera toxin is harmless to fish but poisonous to humans. The toxin is odorless and tasteless, and it is heat-resistant, so cooking does not destroy the toxin. Eating ciguatera-contaminated tropical or subtropical fish poisons the person who eats it. What are the symptoms of ciguatera poisoning? Disease Outbreak Control Division | Ciguatera Disease Outbreak Control Division Ciguatera What is ciguatera fish poisoning? Ciguatera fish poisoning is an illness caused by eating tropical reef fish that have accumulated a poison called ciguatoxin. Ciguatoxin is produced by microscopic organisms that grow on the surface of marine algae, seaweed, or coral. The poison gets into plant-eating fish when they feed on the algae or seaweed. The poison can then build up in larger predator fish near the top of the food chain, such as snapper, amberjacks, and groupers. How do you get it?

You get ciguatera fish poisoning by eating fish contaminated with ciguatoxin. What are the symptoms of ciguatera fish poisoning? numbness, tingling, or a burning sensation around mouth, hands, or feet; joint or muscle pains with weakness or cramps; vomiting, diarrhea, chills, itching, headache, sweating, and dizziness; reversal of temperature sensation in the mouth, where cold things feel hot and hot things feel cold; unusual taste sensations; nightmares; or hallucinations. When do symptoms start? Symptoms usually begin within a few minutes to 6 hours after eating fish containing ciguatoxin. Individuals can become more sensitive to the effects of ciguatoxin if they are exposed repeatedly. The symptoms can appear sooner and be more severe with repeated exposures. For how long do the symptoms of ciguatera fish poisoning last? The symptoms may last for a week or so in mild cases, but may continue for several months or longer in some people. Ciguatera is rarely fatal. What is the treatment for ciguatera fish poisoning? The treatment is mainly supportive care. Certain medicines have been reported to be helpful when started early in the illness.

It is recommended that a person suffering from ciguatera fish poisoning avoid eating fish, fish sauces, shellfish, alcohol, and nuts for several months after the incident. How can you keep from getting it? Clean fish as soon as possible after they are caught or purchased. Do not eat the head, guts, liver or roe (eggs) of any reef fish, especially those of sharks and eels. Avoid eating fish caught at sites known to have a ciguatoxic algae problem. Ciguatoxin is not destroyed by heat, cooking, drying, salting, or freezing the fish. Also, ciguatoxin has no smell and will not change the taste or appearance of the fish. So it is impossible to easily identify a fish that may contain the toxin. For more information, see the CDC’s website. About Us Ciguatera poisoning Symptoms, Diagnosis, Treatments and Causes - RightDiagnosis.com Article Excerpts about Ciguatera poisoning FDA Bad Bug Book (Excerpt) Ciguatera is a form of human poisoning caused by the consumption of subtropical and tropical marine finfish which have accumulated naturally occurring toxins through their diet.

The toxins are known to originate from several dinoflagellate (algae) species that are common to ciguatera endemic regions in the lower latitudes. (Source: FDA Bad Bug Book) Marine Toxins: DBMD (Excerpt) Ciguatera poisoning or ciguatera is caused by eating contaminated tropical reef fish. Ciguatoxins that cause ciguatera poisoning are actually produced by microscopic sea plants called dinoflagellates. These toxins become progressively concentrated as they move up the food chain from small fish to large fish that eat them, and reach particularly high concentrations in large predatory tropical reef fish. (Source: excerpt from Marine Toxins: DBMD ) Definitions of Ciguatera poisoning: Polycyclic ethers produced by Gambierdiscus (DINOFLAGELLATES) from gambiertoxins, which are ingested by fish which in turn may be ingested by humans who are susceptible to the CIGUATERA POISONING. - (Source - Diseases Database) Ciguatera poisoning is listed as a " rare disease " by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH).

This means that Ciguatera poisoning, or a subtype of Ciguatera poisoning, affects less than 200,000 people in the US population. Food Poisoning from Fish: Ciguatera and Scombroid Food Poisoning from Fish: Ciguatera and Scombroid What You Can't Smell, Can Hurt The Bottom Line Scombroid poisoning is caused by eating spoiled fish. Ciguatera fish poisoning is caused by eating fish which have themselves eaten fish contaminated with ciguatera. Neither type of fish poisoning can be detected by taste or appearance or prevented by cooking or freezing the fish. Treatment is available but symptoms may last for months or years. The Full Story What you can't smell can't hurt you, right? Wrong! Eating some kinds of spoiled fish can cause dramatic symptoms. Common types of poisoning from spoiled fish include scombroid and ciguatera. Neither type of fish poisoning can be detected by taste or appearance. Neither can be prevented by cooking or freezing the fish. Fish can also be contaminated with chemicals or heavy metals. Scombroid poisoning is caused by fish which have not been refrigerated properly from the time they were caught until the time they were served.

Bacteria act on compounds in the fish, releasing histamine. This accounts for the allergic-type symptoms and also explains why antihistamines help control the symptoms. The fish most often responsible include tuna, mahi-mahi, mackerel, marlin, bluefish, amberjack, and abalone, though many others have caused scombroid poisoning. A person who catches his or her own fish must be careful to keep the fish refrigerated at all times, at a temperature no higher than 40 degrees F. There is no other reliable way to prevent scombroid poisoning. In a restaurant or store, it is impossible to know for sure if a fish has been properly stored during its entire journey from the water. Scombroid generally is not detectable in fish, but if fish taste peppery or burning, do not eat them. If anyone develops symptoms of scombroid from fish from a store or restaurant, be sure to let the facility and the health department know. That might prevent someone else from becoming ill from eating the same fish. Symptoms of scombroid fish poisoning begin quickly, within about 15 minutes to 2 hours.

Most people experience some combination of flushing and rash on the face and upper body, sweating, diarrhea, and abdominal cramps. Sometimes, there is a burning, peppery taste in the mouth. Most people recover quickly without treatment. More serious symptoms of breathing trouble, swelling of the tongue and mouth, and blurred vision, require treatment in an emergency room with antihistamines, such as diphenhydramine (Benadryl®) and perhaps other drugs. Ciguatera fish poisoning causes nausea, vomiting, diarrhea, muscle weakness, joint aches, headache, dizziness, and low blood pressure. A characteristic symptom is "hot-cold reversal"; hot items feel cold and cold items feel hot. Symptoms may begin within 15 minutes to 24 hours after eating affected fish. Most people are better in a few days, but in some cases symptoms have lasted for months or even years. Ciguatera is produced by a type of algae associated with coral reefs. Small plant-eating fish eat the algae, are eaten by larger fish, again by yet larger fish, and on up the food chain.

More than 400 species of fish are known to have caused ciguatera poisoning, but the most common are older, larger fish which have been eating contaminated fish during their life spans: grouper, barracuda, snapper, jack, mackerel, triggerfish, and others. Even though contaminated fish are from tropical and sub-tropical fish, ciguatera poisoning occurs anywhere these fish are shipped for food. There is no specific prevention except to eat fish smaller than about 4-6 pounds. Treatment is based on symptoms. Spoiled fish, the result of poor food handling practices, can also cause dramatic gastrointestinal symptoms – nausea, vomiting, diarrhea, and abdominal pain. As with any other perishable food, fish need to be handled safely: keep uncooked fish cold, keep cooked fish hot, wash hands, utensils, and cutting boards before and after handling raw fish. For questions about fish poisons, or if you think someone is having a reaction to fish, call Poison Control. Poison specialists are available 24 hours a day at 1-800-222-1222.

Rose Ann Gould Soloway, RN, BSN, MSEd, DABAT emerita Clinical Toxicologist CALL 1-800-222-1222 Prevention Tips Avoid scombroid fish poisoning by keeping fish refrigerated from the time it's caught until it's cooked and eaten. Avoid eating large fish, at or near the top of the food chain, as they are most likely to cause ciguatera poisoning. The Freeport News Read Comments (0) Food For Thought Since moving back to the Bahamas six years ago, I have heard the whispers in closed circles about fish poisoning. Now recently, quite a few friends of mine have contracted the disease. What I don't understand is why so little is done locally to inform the public as to the species to avoid or ways to protect oneself from getting this horrible fate. So, by request of some of my friends who are currently suffering from this, here are some facts about ciguatera. Ciguatera is a foodborne illness caused by eating certain reef fish whose flesh is contaminated with toxins originally produced by dinoflagellates such as Gambierdiscus toxicus which live in tropical and subtropical waters.

These dinoflagellates adhere to coral, algae and seaweed, where they are eaten by herbivorous fish whom in turn are eaten by larger carnivorous fish. In this way, the toxins move up the food chain and bioaccumulate. Gambierdiscus toxicus is the primary dinoflagellate responsible for the production of a number of similar toxins that cause ciguatera. These toxins include ciguatoxin, maitotoxin, scaritoxin and palytoxin. Predator species near the top of the food chain in tropical and subtropical waters, such as barracudas, reef snappers, moray eels, parrotfishes, groupers, triggerfishes (turbot) and amberjacks, are most likely to cause ciguatera poisoning, although many other species cause occasional outbreaks of toxicity. Ciguatoxin is odourless, tasteless and very heat-resistant, so ciguatoxin-laden fish cannot be detoxified by conventional cooking. Hallmark symptoms of ciguatera in humans include gastrointestinal and neurological effects.

Gastrointestinal symptoms include nausea, vomiting, and diarrhea, usually followed by neurological symptoms such as headaches, muscle aches, paresthesia, numbness, ataxia, vertigo, and hallucinations. Severe cases of ciguatera can also result in cold allodynia, which is a burning sensation on contact with cold. Neurological symptoms can persist and ciguatera poisoning is occasionally misdiagnosed as multiple sclerosis. Dyspareunia (painful sexual intercourse) and other ciguatera symptoms have developed in otherwise healthy males and females following sexual intercourse with partners suffering ciguatera poisoning, signifying that the toxin may be sexually transmitted. Diarrhea and facial rashes have been reported in breastfed infants of poisoned mothers, suggesting that ciguatera toxins migrate into breast milk. The symptoms can last from weeks to years, and in extreme cases as long as 20 years, often leading to long-term disability. Most people do recover slowly over time. Often patients recover, but symptoms then reappear.

Such relapses can be triggered by consumption of nuts, seeds, alcohol, fish or fish-containing products, chicken or eggs, or by exposure to fumes such as those of bleach and other chemicals. Exercise is also a possible trigger. Scientific detection Currently, multiple laboratory methods are available to detect ciguatoxins, including liquid chromatography-mass spectrometry (LCMS), receptor binding assays, and neuroblastoma assays). Although testing is possible, in most cases, LCMS is insufficient to detect clinically relevant concentrations of ciguatoxin in crude extracts of fish. ' Folk'  detection In Northern Australia, where ciguatera is a common problem, two different folk science methods are widely believed to detect whether fish harbor significant ciguatoxin. The first method is that flies will not land on contaminated fish. The second is that cats display symptoms after eating contaminated fish. A third, less common testing method involves putting a silver coin under the scales of the suspect fish. Only if the coin turns black, is it contaminated. It is not known whether any of these tests produce accurate results. On Grand Cayman Island the locals will test barracuda by placing a piece of the fish on the ground and allowing ants to crawl on it.

If the ants continue to move then the fish is safe to eat. I do not recommend any of these tests as being accurate or safe. There is no effective treatment or antidote for ciguatera poisoning. The mainstay of treatment is supportive care. There is some evidence that calcium channel blocker type drugs such as Nifedipine and Verapamil are effective in treating some of the symptoms that remain after the initial sickness passes, such as poor circulation and shooting pains through the chest. These symptoms are due to the cramping of arterial walls caused by maitotoxin. Ciguatoxin lowers the threshold for opening voltage-gated sodium channels in synapses of the nervous system. Opening a sodium channel causes depolarization, which could sequentially cause paralysis, heart contraction, and changing the senses of hearing and cold. Nifedipine is a calcium channel blocker. Some medications such as Amitriptyline may reduce some symptoms, such as fatigue and paresthesia, although benefit does not occur in every case. Steroids and vitamin supplements support the body's recovery rather than directly reducing toxin effects. Mannitol was once used for poisoning after one study reported symptom reversal.

Follow-up studies in animals and case reports in humans also found benefit from mannitol. However, a randomized, double-blind clinical trial found no difference between mannitol and normal saline, and based on this result, mannitol is no longer recommended. Due to the limited habitats of ciguatoxin-producing microorganisms, ciguatera is common in only subtropical and tropical waters, particularly the Pacific and Caribbean, and usually is associated with fish caught in tropical reef waters. Ciguatoxin is found in over 400 species of reef fish. Avoiding consumption of all reef fish (any fish living in warm tropical waters) is the only sure way to avoid exposure. Imported fish served in restaurants may contain the toxin and produce illness that often goes unexplained by physicians unfamiliar with the symptoms of a tropical toxin. Ciguatoxin can also occur in farm-raised salmon. Furthermore, species substitution, labeling a reef fish as a non-reef fish at restaurants and retail, can complicate efforts by consumers to avoid ciguatera. I have seen the worst this poisoning can give. It's a horrible disease that I wouldn't wish on anyone.

It would be beneficial for the Ministry of Health to release information to people on the dangers of this disease. However, we face a double-edged sword. Most of the fish species that carry the toxins are the traditional fish species of the Bahamian diet and are the only source of income for some families as fishing the reef is a way of life here. Since there is no way to know in advance, your best way to stay safe is to avoid reef fish. However, if you don't want to do that, I suggest staying away from boiling or 'stewing'  the bones and heads of reef fish as the toxins would be housed in the spinal system and bones as well as the digestive system that usually gets thrown away. I for one will continue to eat Pelagic species instead. Remember, there's more to food than cooking and eating. Current Issue 3rd Annual Conch Festival hosted by Rotary Club of Grand Bahama Sunrise. Spring Break Bahamas 3 days of excitement with Youth Explosion: Basketball Tournament and worship church service. Special celebrity Quest Kel Mitchell of Nickelodeon, 6 basketball teams from the waver runner sports program and many more. Grand Bahama Chamber of Commerce Grand Bahama Chamber of Commerce Monthly Business Luncheon meeting.

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Question: In humans, citguatera is an illness caused by eating contaminated what?
Answer: Fish