Find information on thousands of medical conditions and prescription drugs.

Ciguatera fish poisoning

Ciguatera is a foodborne illness poisoning in humans caused by eating marine species whose flesh is contaminated with a toxin known as ciguatoxin, that is present in many micro-organisms (particularly, the micro-algae Gambierdiscus toxicus) living in tropical waters. Like many naturally and artificially occurring toxins, ciguatoxin bioaccumulates, resulting in higher concentrations of the toxin at higher levels of the food chain. Predator species near the top of the food chain in tropical waters, such as barracuda, moray eel, and amberjack, are most likely to cause ciguatera poisoning, although many other species have been found to cause occasional outbreaks of ciguatera. more...

Home
Diseases
A
B
C
Angioedema
C syndrome
Cacophobia
Café au lait spot
Calcinosis cutis
Calculi
Campylobacter
Canavan leukodystrophy
Cancer
Candidiasis
Canga's bead symptom
Canine distemper
Carcinoid syndrome
Carcinoma, squamous cell
Carcinophobia
Cardiac arrest
Cardiofaciocutaneous...
Cardiomyopathy
Cardiophobia
Cardiospasm
Carnitine transporter...
Carnitine-acylcarnitine...
Caroli disease
Carotenemia
Carpal tunnel syndrome
Carpenter syndrome
Cartilage-hair hypoplasia
Castleman's disease
Cat-scratch disease
CATCH 22 syndrome
Causalgia
Cayler syndrome
CCHS
CDG syndrome
CDG syndrome type 1A
Celiac sprue
Cenani Lenz syndactylism
Ceramidase deficiency
Cerebellar ataxia
Cerebellar hypoplasia
Cerebral amyloid angiopathy
Cerebral aneurysm
Cerebral cavernous...
Cerebral gigantism
Cerebral palsy
Cerebral thrombosis
Ceroid lipofuscinois,...
Cervical cancer
Chagas disease
Chalazion
Chancroid
Charcot disease
Charcot-Marie-Tooth disease
CHARGE Association
Chediak-Higashi syndrome
Chemodectoma
Cherubism
Chickenpox
Chikungunya
Childhood disintegrative...
Chionophobia
Chlamydia
Chlamydia trachomatis
Cholangiocarcinoma
Cholecystitis
Cholelithiasis
Cholera
Cholestasis
Cholesterol pneumonia
Chondrocalcinosis
Chondrodystrophy
Chondromalacia
Chondrosarcoma
Chorea (disease)
Chorea acanthocytosis
Choriocarcinoma
Chorioretinitis
Choroid plexus cyst
Christmas disease
Chromhidrosis
Chromophobia
Chromosome 15q, partial...
Chromosome 15q, trisomy
Chromosome 22,...
Chronic fatigue immune...
Chronic fatigue syndrome
Chronic granulomatous...
Chronic lymphocytic leukemia
Chronic myelogenous leukemia
Chronic obstructive...
Chronic renal failure
Churg-Strauss syndrome
Ciguatera fish poisoning
Cinchonism
Citrullinemia
Cleft lip
Cleft palate
Climacophobia
Clinophobia
Cloacal exstrophy
Clubfoot
Cluster headache
Coccidioidomycosis
Cockayne's syndrome
Coffin-Lowry syndrome
Colitis
Color blindness
Colorado tick fever
Combined hyperlipidemia,...
Common cold
Common variable...
Compartment syndrome
Conductive hearing loss
Condyloma
Condyloma acuminatum
Cone dystrophy
Congenital adrenal...
Congenital afibrinogenemia
Congenital diaphragmatic...
Congenital erythropoietic...
Congenital facial diplegia
Congenital hypothyroidism
Congenital ichthyosis
Congenital syphilis
Congenital toxoplasmosis
Congestive heart disease
Conjunctivitis
Conn's syndrome
Constitutional growth delay
Conversion disorder
Coprophobia
Coproporhyria
Cor pulmonale
Cor triatriatum
Cornelia de Lange syndrome
Coronary heart disease
Cortical dysplasia
Corticobasal degeneration
Costello syndrome
Costochondritis
Cowpox
Craniodiaphyseal dysplasia
Craniofacial dysostosis
Craniostenosis
Craniosynostosis
CREST syndrome
Cretinism
Creutzfeldt-Jakob disease
Cri du chat
Cri du chat
Crohn's disease
Croup
Crouzon syndrome
Crouzonodermoskeletal...
Crow-Fukase syndrome
Cryoglobulinemia
Cryophobia
Cryptococcosis
Crystallophobia
Cushing's syndrome
Cutaneous larva migrans
Cutis verticis gyrata
Cyclic neutropenia
Cyclic vomiting syndrome
Cystic fibrosis
Cystinosis
Cystinuria
Cytomegalovirus
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
Medicines

Ciguatoxin is very heat-resistant, so ciguatoxin-laden fish cannot be detoxified by cooking.

Due to the localized nature of the ciguatoxin-producing micro-orgaisms, ciguatera illness is only common in tropical waters, particularly the Caribbean, and usually is associated with fish caught in tropical reef waters.

The symptoms of ciguatera are gastrointestinal distress (nausea, vomiting) followed by neurological symptoms such as headaches, muscle aches, numbness, and hallucinations. Severe cases of ciguatera can also result in hot-cold reversal, in which hot and cold sensations seem reversed.

Read more at Wikipedia.org


[List your site here Free!]


Fish and shellfish poisoning
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

Algae
Plants that have one cell.
Histamine
A chemical found naturally in the body that produces inflammation and increases blood flow; the uncomfortable symptoms of an allergy attack or an allergic reaction are generally caused by the release of histamine.

Toxin
A poisonous substance usually produced by a living thing.

Further Reading

For Your Information

    Periodicals

  • Barton, Erik D., Paula Tanner, Steven G. Turchen, et al. "Ciguatera Fish Poisoning: A Southern California Epidemic." Western Journal of Medicine, 163 (1)(July 1995): 31-35.
  • Eastaugh, Janet, and Suzanne Shepherd. "Infectious and Toxic Syndromes from Fish and Shellfish Consumption." Archives of Internal Medicine, 149 (August 1989): 1735-1740.
  • Gellert, George A., John Ralls, Corwin Brown, et al. "Scombroid Fish Poisoning: Underreporting and Prevention Among Noncommercial Recreational Fishers." Western Journal of Medicine, 157 (6)(December 1992): 645-647.

Gale Encyclopedia of Medicine. Gale Research, 1999.

Return to Ciguatera fish poisoning
Home Contact Resources Exchange Links ebay