http://www.fpnotebook.com/

Ciguatera PoisoningAka: Ciguatera Toxin, Ciguatoxin

Epidemiology
1. Reaction occurs in up to 90% of ciguatoxin ingestions
2. Most common outbreaks
  1. Florida
  2. Hawaii
  3. West Indies
  4. Puerto Rico
  5. U.S. Virgin Islands
Pathophysiology
1. Gambierdiscus toxicus bioaccumulates in reef fish
2. Reef fish ingestion results in reaction
  1. Amberjack
  2. Grouper
  3. Snapper
  4. Sturgeon
  5. King Mackerel
  6. Barracuda
  7. Moray eel
Symptoms: Anticholinergic reaction
1. Gastrointestinal
  1. Nausea or Vomiting
  2. Voluminous, watery Diarrhea
  3. Abdominal Pain
2. Neurologic
  1. Cold-hot sensation reversal
    1. Occurs in 80% of cases
    2. Pathognomonic for Ciguatera toxin
  2. Numbness or Paresthesias
  3. Vertigo or ataxia
  4. Weakness
  5. Myalgias
3. Cardiopulmonary changes
  1. Bradycardia
  2. Hypotension
Course
1. Anticholinergic Symptoms 3-6 hours after ingestion
  1. Reactions delayed up to 24 hours in some cases
2. Symptom duration: 7 to 14 days
3. More severe cases with prior ciguatoxin reactions
Management
1. Supportive care
2. May require pressors for hypotension
3. May require Bradycardia management
4. Mannitol does not appear effective in shortening course
  1. Schnorf (2002) Neurology 58:873
Prevention
1. Avoid ingestion of large warm-water reef fish
2. Limit intakes to small quantities
3. Avoid ingesting internal organs of fish
4. No food preparation method deactivate ciguatoxin
References
1. Perkins (2004) Am Fam Physician 69(4):885

Ciguatera Poisoning (C0008775)
Definition (MSH)	Poisoning caused by ingestion of SEAFOOD containing microgram levels of CIGUATOXINS. The poisoning is characterized by gastrointestinal, neurological and cardiovascular disturbances.
Concepts	Injury or Poisoning (T037)
English	Ciguatera, ciguatera fish poisoning, Ciguatera Poisoning, Ciguatera Poisonings, Ciguatoxin causing toxic effect, Fish poisoning, Ichthyosarcotoxism, Poisoning by eating contaminated fish, Toxic effect of ciguatera fish poisoning
Spanish	ciguatera, ciguatoxina que causa efectos tÃ³xicos, ciguatoxina que causa efectos toxicos, ictiosarcotoxicosis, intoxicaciÃ³n por ingestiÃ³n de pescado contaminado, intoxicaciÃ³n por pescado, intoxicacion por ingestion de pescado contaminado, intoxicacion por pescado
Credits	Derived from the NIH UMLS (Unified Medical Language System)

Ciguatoxins (C0008776)
Definition (MSH)	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.
Concepts	Biologically Active Substance (T123) , Hazardous or Poisonous Substance (T131)
English	Ciguatoxin, Ciguatoxins
Spanish	ciguatoxina
Credits	Derived from the NIH UMLS (Unified Medical Language System)