//fpnotebook.com/
Ciguatera Poisoning
Aka: Ciguatera Poisoning, Ciguatera Toxin, Ciguatoxin
- See Also
- Biological Toxin
- Foodborne Illness
- Epidemiology
- Reaction occurs in up to 90% of Ciguatoxin ingestions
- Most common outbreaks
- Florida
- Hawaii
- West Indies
- Puerto Rico
- U.S. Virgin Islands
- Pathophysiology
- Gambierdiscus toxicus bioaccumulates in carnivorous reef fish
- Reef fish ingestion results in reaction
- Amberjack
- Grouper
- Snapper
- Sturgeon
- King Mackerel
- Barracuda
- Moray eel
- Toxin
- Tasteless, heat stable toxin
- Symptoms: Anticholinergic Reaction
- Gastrointestinal
- Nausea or Vomiting
- Voluminous, watery Diarrhea
- Abdominal Pain
- Neurologic
- Cold-hot sensation reversal
- Hot feels cold and cold feels hot
- Occurs in 80% of cases
- Pathognomonic for Ciguatera Toxin
- Numbness or Paresthesias of hands and feet
- Vertigo or Ataxia
- Weakness
- Myalgias
- Cardiopulmonary changes
- Bradycardia
- Hypotension
- Course
- Anticholinergic Symptoms 3-6 hours after ingestion
- Reactions delayed up to 24 hours in some cases
- Symptom duration: 7 to 14 days
- More severe cases with prior Ciguatoxin reactions
- Paresthesias may persist for months
- Management
- Supportive care
- May require pressors for Hypotension
- May require Bradycardia management
- Avoid Alcohol
- Mannitol does not appear effective in shortening course
- Schnorf (2002) Neurology 58:873-80 [PubMed]
- Complication
- Stocking-Glove distribution neuropathic pain may persist for weeks after onset
- Prevention
- Avoid ingestion of large warm-water reef fish
- Limit intakes to small quantities
- Avoid ingesting internal organs of fish
- No food preparation method deactivate Ciguatoxin
- References
- Perkins (2004) Am Fam Physician 69(4):885-90 [PubMed]