Ciguatera
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
- Toxins
- Ciguatera
- Scombroid
- Tetrodotoxin (e.g. pufferfish)
- Shellfish poisoning
- Amnesic shellfish poisoning
- Diarrheal shellfish poisoning
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Stingers
- Venomous fish
- Cone shell
- Lionfish
- Sea urchins
- Crown-of-Thorns Starfish
- Stonefish
- Other: Catfish, zebrafish, scorpion fish
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
Treatment
- Symptomatic
- Mannitol
- Neuropathic pain
- Amitriptyline reported effective in several case series[3] [4]
- Gabapentin[5] and Pregabalin [6] also reported to control neurologic symptoms
- Antiemetics and IVF for hypotension
- Atropine for bradycardia
- 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
- ↑ Friedman MA et al. Ciguatera Fish Poisoning: Treatment, Prevention, and Management. Marine Drugs 2008; 6:456-479
- ↑ Schnorf H et al. Ciguatera Fish Poisoning. A double-blind randomized trial of mannitol therapy. Neurology 2002; 58(6):873
- ↑ Lange W et al. Travel and ciguatera fish poisoning. Arch. Int. Med. 1992; 152:2049-2052
- ↑ Davis RT and Villar LA. Symptomatic improvement with amitriptyline in ciguatera fish poisoning. N Engl J Med 1986; 315:65
- ↑ Perez CM et al. Treatment of ciguatera poisoning with gabapentin. N Engl J Med 2001; 344:692
- ↑ Brett J and Murnion B. Pregabalin to treat ciguatera fish poisoning. Clinical toxicology 2015; 53(6):588.