Emergency Medicine Book

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Ciguatera Poisoning

Aka: Ciguatera Poisoning, Ciguatera Toxin, Ciguatoxin
  1. 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
  2. Pathophysiology
    1. Gambierdiscus toxicus bioaccumulates in carnivorous 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
    3. Toxin
      1. Tasteless, heat stable toxin
  3. Symptoms: Anticholinergic Reaction
    1. Gastrointestinal
      1. Nausea or Vomiting
      2. Voluminous, watery Diarrhea
      3. Abdominal Pain
    2. Neurologic
      1. Cold-hot sensation reversal
        1. Hot feels cold and cold feels hot
        2. Occurs in 80% of cases
        3. Pathognomonic for Ciguatera Toxin
      2. Numbness or Paresthesias of hands and feet
      3. Vertigo or Ataxia
      4. Weakness
      5. Myalgias
    3. Cardiopulmonary changes
      1. Bradycardia
      2. Hypotension
  4. 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
    4. Paresthesias may persist for months
  5. Management
    1. Supportive care
    2. May require pressors for Hypotension
    3. May require Bradycardia management
    4. Avoid Alcohol
    5. Mannitol does not appear effective in shortening course
      1. Schnorf (2002) Neurology 58:873-80 [PubMed]
  6. Complication
    1. Stocking-Glove distribution neuropathic pain may persist for weeks after onset
  7. 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
  8. References
    1. Perkins (2004) Am Fam Physician 69(4):885-90 [PubMed]

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)
MSH D036841
ICD10 T61.0
SnomedCT 212865008, 61614000, 240346005, 241774007
English Ciguatera, Ciguatera fish poisoning, Ciguatoxin causng toxic effect, Toxic eff/ciguatera fish poisn, ciguatera fish poisoning, ciguatera poisoning (diagnosis), ciguatera poisoning, Ciguatera Poisoning [Disease/Finding], Ciguatera Fish Poisoning, Poisoning, Ciguatera Fish, Ciguatera Fish Poisonings, Poisonings, Ciguatera Fish, ciguatera, poisoning fish, fish poisoning, ciguatera poison, Fish poisoning (disorder), Ciguatera (disorder), Fish poisoning, Ciguatoxin causing toxic effect (event), Ciguatera Poisonings, Poisoning, Ciguatera, Poisonings, Ciguatera, Ciguatoxin causing toxic effect, Toxic effect of ciguatera fish poisoning, Ciguatoxin causing toxic effect (disorder), Ciguatera Poisoning, ciguatera fish; ichthyotoxism, ciguatera fish; poisoning, ichthyotoxism; ciguatera fish, poisoning; ciguatera fish, Fish poisoning, NOS, Ichthyosarcotoxism, NOS, Poisoning by eating contaminated fish, Fish poisoning (disorder) [Ambiguous], Ichthyosarcotoxism, Poisoning;ciguatera
Swedish Ciguateraförgiftning
Czech ciguatera
Finnish Ciguatera-myrkytys
Italian Ciguatera, Avvelenamento da ciguatera
Russian TSIGUATOKSINAMI OTRAVLENIE, ЦИГУАТОКСИНАМИ ОТРАВЛЕНИЕ
German Ciguatera-Fischvergiftung, Ciguatera, Ciguatera-Vergiftung
Japanese シグワテラ, 中毒-シガテラ, 食中毒-シガテラ, シガテラ, シガテラ中毒
Korean 시구아테라 물고기 중독
Spanish ciguatoxina que causa efectos tóxicos (trastorno), ciguatoxina que causa efectos tóxicos, efecto tóxico causado por ciguatoxina (trastorno), efecto tóxico causado por ciguatoxina, intoxicación por pescado (trastorno), ciguatera, intoxicación por pescado, ictiosarcotoxicosis, intoxicación por ingestión de pescado contaminado, Envenenamiento por Ciguatera, intoxicación por pescado (concepto no activo), Ciguatera, Intoxicación por Ciguatera
Polish Zatrucie toksyną cigua
Norwegian Ciguatera-forgiftning, Ciguatera
Portuguese Envenenamento Alimentar por Ciguatera, Intoxicação Alimentar por Ciguatera, Envenenamento por Ciguatera, Ciguatera, Intoxicação por Ciguatera
Dutch ciguateravis; ichthyotoxisme, ciguateravis; vergiftiging, ichthyotoxisme; ciguateravis, vergiftiging; ciguateravis, Vergiftiging door ciguateravis, Ciguatera, Ciguateravergiftiging
French Ciguatera, Intoxication à la ciguatoxine
Sources
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)
MSH D002922
SnomedCT 26426004
English Ciguatoxin, ciguatoxin, Ciguatoxins [Chemical/Ingredient], Ciguatoxins, Ciguatoxin (substance)
Swedish Ciguatoxiner
Czech ciguatoxin, ciguatoxiny
Finnish Siguatoksiinit
Russian TSIGUATOKSINY, TSIGUATOKSIN, CIGUATERA, ЦИГУАТОКСИН, ЦИГУАТОКСИНЫ
Japanese シグアトキシン
French Ciguatoxine, Ciguatoxines
Italian Ciguatossina, Ciguatossine
Polish Toksyny cigua
Spanish ciguatoxina (sustancia), ciguatoxina, Ciguatoxina, Ciguatoxinas
German Ciguatoxin, Ciguatoxine
Portuguese Ciguatoxina, Ciguatoxinas
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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