ciguatoxin

Introduction

Neurotoxin contaminating marine fish.

The syndrome of toxicity is ciguatera.

Epidemiology

• ciguatera toxins occur naturally in coral reef fish (mackeral, grouper, snapper, barracuda, amberjack, surgeonfish) that consume microalgae containing toxin precursors
• food storage & preparation do NOT affect the toxin
• 80%-90% of people who eat contaminated fish become ill

Adverse effects

• gastrointestinal effects 1st to appear 6-12 hours after ingestion
  • abdominal pain, nausea, vomiting, diarrhea
  • duration of symptoms 1-2 days
• neurologic symptoms appear a few hours to 3 days after ingestion
  • paresthesias, headaches, dysarthria, feeling of loose teeth, pruritus, arthralgia, myalgia, muscle weakness, dysphagia generalized hyporeflexia, ataxia, vertigo, visual impairment, respiratory depression due to paralysis, coma
  • cold allodynia or hot-cold-reversal* (burning sensation on exposure to cold)
  • worsening of symptoms with alcohol ingestion*
  • symptoms persist weeks to months
• cardiovascular less common
  • bradycardia, hypotension
  • symptoms persist 3-5 days
• other
  • dyspnea, perspiration, chills, salivation, neck stiffness
• some symptoms may persist up to 5 months

* highly suggestive of ciguatoxin poisoning

Laboratory

• CSF analysis shows normal cell count

More general terms

• toxin (hazardous material, poison)