Neuro

Ciguatera Poisoning

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Ciguatera Poisoning, 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 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
  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
  • 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
  • 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]
  • Complication
  1. Stocking-Glove distribution neuropathic pain may persist for weeks after onset
  • 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