Ciguatera

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Background

  • Most cases tropics and subtropics, between 35 degrees north and south latitudes
  • Most common fish are barracuda, moray eel, amberjack, and certain types of grouper, mackerel, parrotfish, and red snapper
  • Caused by fish eating dinoflagellates that grow on and around coral reefs and contain a heat-stable toxin

Diagnosis

  • GI symptoms
    • vomiting, diarrhea, and abdominal cramping
    • 3-30hrs after eating contaminated fish
  • Neurologic symptoms
    • Paresthesias, painful teeth, painful urination, blurred vision, nerve palsies, and hot/cold temperature reversal
  • Cardiovascular symptoms
    • Bradycardia, heart block, and hypotension.
  • Suspected cases should be reported to local department of health

^Diagnosis based on history and physical only

Differential Diagnosis

Marine toxins, envenomations, and bites

Treatment

  • Symptomatic
    • Mannitol
      • Recommended by several experts for neurologic symptoms if given within 24-48 hours of onset [1]. However, no benefit over normal saline in RCT[2]
      • Caution that many patients may be hypovolemic 2/2 GI symptoms and should be appropriately volume resuscitated prior to considering mannitol
  • Prevent recurrances
    • Do not ingest alcohol, caffeine, nuts or fish for 6 months

Prognosis

  • Neurologic symptoms typically persist from a few days to several weeks
  • ~20% of patients have symptoms that persist for months
  • <2% have symptoms that last for years

See Also

Source

UpToDate

  1. ↑ Friedman MA et al. Ciguatera Fish Poisoning: Treatment, Prevention, and Management. Marine Drugs 2008; 6:456-479
  2. ↑ Schnorf H et al. Ciguatera Fish Poisoning. A double-blind randomized trial of mannitol therapy. Neurology 2002; 58(6):873
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