Ciguatera


Ciguatera
Ciguatera fish poisoning
Classification and external resources

Chemical structure of the ciguatoxin-CTX1B
ICD-10 T61.0
ICD-9 988.0
DiseasesDB 31122
MedlinePlus 002851
eMedicine emerg/100 ped/403

Ciguatera is a foodborne illness caused by eating certain reef fishes whose flesh is contaminated with toxins originally produced by dinoflagellates such as Gambierdiscus toxicus which lives in tropical and subtropical waters. These dinoflagellates adhere to coral, algae and seaweed, where they are eaten by herbivorous fish who in turn are eaten by larger carnivorous fish. In this way the toxins move up the food chain and bioaccumulate. Gambierdiscus toxicus is the primary dinoflagellate responsible for the production of a number of similar toxins that cause ciguatera. These toxins include ciguatoxin, maitotoxin, scaritoxin and palytoxin. Predator species near the top of the food chain in tropical and subtropical waters, such as barracudas, snapper, moray eels, parrotfishes, groupers, triggerfishes and amberjacks, are most likely to cause ciguatera poisoning, although many other species cause occasional outbreaks of toxicity. Ciguatoxin is very heat-resistant, so ciguatoxin-laden fish cannot be detoxified by conventional cooking.[1][2]

Researchers suggest that ciguatera outbreaks caused by cooling climatic conditions propelled the migratory voyages of Polynesians between 1000 and 1400.[3][4]

Contents

Symptoms

Hallmark symptoms of ciguatera in Humans include gastrointestinal and neurological effects.[5][6] Gastrointestinal symptoms include nausea, vomiting, and diarrhea, usually followed by neurological symptoms such as headaches, muscle aches, paresthesia, numbness, ataxia, and hallucinations.[1][6] Severe cases of ciguatera can also result in cold allodynia, which is a burning sensation on contact with cold (commonly incorrectly referred to as reversal of hot/cold temperature sensation).[5] Doctors are often at a loss to explain these symptoms and ciguatera poisoning is frequently misdiagnosed as multiple sclerosis.[7]

Dyspareunia and other ciguatera symptoms have developed in otherwise healthy males and females following sexual intercourse with partners suffering ciguatera poisoning, signifying that the toxin may be sexually transmitted.[8] Diarrhea and facial rashes have been reported in breastfed infants of poisoned mothers, it is likely that ciguatera toxins migrate into breast milk.[9]

The symptoms can last from weeks to years, and in extreme cases as long as 20 years, often leading to long-term disability.[10] Most people do recover slowly over time.[11] Often patients recover, but symptoms then reappear. Such relapses can be triggered by consumption of nuts, alcohol, fish or fish-containing products, chicken or eggs, or by exposure to fumes such as those of bleach and other chemicals. Exercise is also a possible trigger.[1] Filipino and Chinese people may possibly be more susceptible.[1]

Detection methods

Scientific detection

Currently, multiple laboratory methods are available to detect ciguatoxins, including liquid chromatography-mass spectrometry (LCMS), receptor binding assays (RBA), and neuroblastoma assays (N2A). Although testing is possible, in most cases liquid chromatography-mass spectrometry is insufficient to detect clinically relevant concentrations of ciguatoxin in crude extracts of fish.

Folk detection

In Northern Australia, where ciguatera is a common problem, two different folk science methods are widely believed to detect whether fish harbor significant ciguatoxin. The first method is that flies will not land on contaminated fish. The second is that cats display symptoms after eating contaminated fish. A third, less common testing method involves putting a silver coin under the scales of the suspect fish. Only if the coin turns black, is it contaminated. It is not known whether any of these tests produce accurate results.

Folk remedies

Various Caribbean naturopathic and ritualistic treatments originated in Cuba and nearby islands. The most common old-time remedy involves bed rest subsequent to a guanabana juice enema.[citation needed] Other folk treatments range from directly porting and bleeding the gastrointestinal tract to "cleansing" the diseased with a dove during a Santería ritual[citation needed]. In Puerto Rico, natives drink a tea made from mangrove buttons, purportedly high in B Vitamins, to flush the toxic symptoms from the system[citation needed]. The efficacy of these treatments has never been studied or substantiated.

An account of ciguatera poisoning from a linguistics researcher living on Malakula island, Vanuatu, indicates the local treatment: "We had to go with what local people told us: avoid salt and any seafood. Eat sugary foods. And they gave us a tea made from the roots of ferns growing on tree trunks. I don't know if any of that helped, but after a few weeks, the symptoms faded away."[12]

Treatment

There is no effective treatment or antidote for ciguatera poisoning. The mainstay of treatment is supportive care. There is some evidence that calcium channel blocker type drugs such as Nifedipine and Verapamil are effective in treating some of the symptoms that remain after the initial sickness passes, such as poor circulation and shooting pains through the chest. These symptoms are due to the cramping of arterial walls caused by maitotoxin[6][13][14][15] Ciguatoxin lowers the threshold for opening voltage-gated sodium channels in synapses of the nervous system. Opening a sodium channel causes depolarization, which could sequentially cause paralysis, heart contraction, and changing the senses of hearing and cold. Nifedipine is a calcium channel blocker.[6] Some medications such as Amitriptyline may reduce some symptoms, such as fatigue and paresthesia,[16] although benefit does not occur in every case.[17] Steroids and vitamin supplements support the body's recovery rather than directly reducing toxin effects.

Mannitol was once used for poisoning after one study reported symptom reversal.[6][18] Followup studies in animals[19] and case reports in humans[20] also found benefit from mannitol. However, a randomized, double-blind clinical trial found no difference between mannitol and normal saline,[21] and based on this result, mannitol is no longer recommended.[5]

Epidemiology

Due to the limited habitats of ciguatoxin-producing microorganisms, ciguatera is common in only subtropical and tropical waters, particularly the Pacific and Caribbean, and usually is associated with fish caught in tropical reef waters.[5] Ciguatoxin is found in over 400 species of reef fish. Avoiding consumption of all reef fish (any fish living in warm tropical waters) is the only sure way to avoid exposure.[2] Imported fish served in restaurants may contain the toxin and to produce illness which often goes unexplained by physicians unfamiliar with the symptoms of a tropical toxin.[2][22] Ciguatoxin can also occur in farm-raised salmon.[23]

In 2007, ten people in St. Louis, Missouri developed the disease after eating imported fish.[24]

In February 2008, the U.S. Food and Drug Administration (FDA) traced several outbreaks to the Flower Garden Banks National Marine Sanctuary in the northern Gulf of Mexico, near the TexasLouisiana shoreline. The FDA advised seafood processors that ciguatera poisoning was "reasonably likely" to occur from eating several species of fish caught as far as 50 miles (80 km) from the sanctuary.[25]

History

Ciguatera was first described by one of the surgeon's mates, William Anderson, on the crew of edit] See also

Footnotes

  1. ^ a b c d Swift A, Swift T (1993). "Ciguatera". J. Toxicol. Clin. Toxicol. 31 (1): 1–29. doi:10.3109/15563659309000371. PMID 8433404. 
  2. ^ a b c Schep LJ, Slaughter RJ, Temple WA, Beasley DM (2010). "Ciguatera poisoning: an increasing occurrence in New Zealand". N. Z. Med. J. 123 (1308): 100–2. PMID 20173810. 
  3. ^ Abstract at Wiley Online Library
  4. ^ Article at MongaBay.com
  5. ^ a b c d Isbister G, Kiernan M (2005). "Neurotoxic marine poisoning". Lancet. Neurol. 4 (4): 219–28. doi:10.1016/S1474-4422(05)70041-7. PMID 15778101. 
  6. ^ a b c d e Clark RF, Williams SR, Nordt SP, Manoguerra AS (1999). "A review of selected seafood poisonings". Undersea Hyperb Med 26 (3): 175–84. PMID 10485519. http://archive.rubicon-foundation.org/2314. Retrieved 2008-08-12. 
  7. ^ Ting J, Brown A (2001). "Ciguatera poisoning: a global issue with common management problems". Eur. J. Emerg. Med. 8 (4): 295–300. doi:10.1097/00063110-200112000-00009. PMID 11785597. 
  8. ^ Lange W, Lipkin K, Yang G (1989). "Can ciguatera be a sexually transmitted disease?". J. Toxicol. Clin. Toxicol. 27 (3): 193–7. doi:10.3109/15563658909038583. PMID 2810444. 
  9. ^ Blythe D, de Sylva D (1990). "Mother's milk turns toxic following fish feast". JAMA 264 (16): 2074. doi:10.1001/jama.264.16.2074b. PMID 2214071. 
  10. ^ Gillespie N, Lewis R, Pearn J, Bourke A, Holmes M, Bourke J, Shields W (1986). "Ciguatera in Australia. Occurrence, clinical features, pathophysiology and management". Med. J. Aust. 145 (11–12): 584–90. PMID 2432386. 
  11. ^ Pearn J (2001). "Neurology of ciguatera". J. Neurol. Neurosurg. Psychiatr. 70 (1): 4–8. doi:10.1136/jnnp.70.1.4. PMC 1763481. PMID 11118239. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1763481. 
  12. ^ Dimock, L (2010). "Rescue mission for fading tongue". New Zealand Education Review. ([3]): 3. 
  13. ^ Attaway D, Zaborsky O (1993). Marine Biotechnology. pp. 8. 
  14. ^ Fleming L. "Ciguatera Fish Poisoning |[1]". 
  15. ^ Schlossberg D (1999). Infections of leisure. p. 13. ISBN 3540940693. 
  16. ^ Davis R, Villar L (1986). "Symptomatic improvement with amitriptyline in ciguatera fish poisoning". N. Engl. J. Med. 315 (1): 65. doi:10.1056/NEJM198607033150115. PMID 3713788. 
  17. ^ Hampton M, Hampton A (1989). "Ciguatera fish poisoning". J. Am. Acad. Dermatol. 20 (3): 510–1. doi:10.1016/S0190-9622(89)80094-5. PMID 2918120. 
  18. ^ Palafox N, Jain L, Pinano A, Gulick T, Williams R, Schatz I (1988). "Successful treatment of ciguatera fish poisoning with intravenous mannitol". JAMA 259 (18): 2740–2. doi:10.1001/jama.259.18.2740. PMID 3128666. 
  19. ^ Mattei C, Molgó J, Marquais M, Vernoux J, Benoit E (1999). "Hyperosmolar D-mannitol reverses the increased membrane excitability and the nodal swelling caused by Caribbean ciguatoxin-1 in single frog myelinated axons". Brain Res. 847 (1): 50–8. doi:10.1016/S0006-8993(99)02032-6. PMID 10564735. 
  20. ^ Williamson J (1990). "Ciguatera and mannitol: a successful treatment". Med. J. Aust. 153 (5): 306–7. PMID 2118229. 
  21. ^ Schnorf H, Taurarii M, Cundy T (2002). "Ciguatera fish poisoning: a double-blind randomized trial of mannitol therapy". Neurology 58 (6): 873–80. PMID 11914401. 
  22. ^ Geller R, Olson K, Senécal P (1991). "Ciguatera fish poisoning in San Francisco, California, caused by imported barracuda". West. J. Med. 155 (6): 639–42. PMC 1003121. PMID 1812639. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1003121. 
  23. ^ DiNubile M, Hokama Y (1995). "The ciguatera poisoning syndrome from farm-raised salmon". Ann. Intern. Med. 122 (2): 113–4. PMID 7992985. 
  24. ^ Bizarre fish poisoning sparks alarm
  25. ^ "FDA Advises Seafood Processors About Ciguatera Fish Poisoning in the Northern Gulf of Mexico Near the Flower Garden Banks National Marine Sanctuary" (Press release). U.S. Food and Drug Administration. 2008-02-05. http://www.fda.gov/bbs/topics/NEWS/2008/NEW01790.html. Retrieved 2008-02-07. 
  26. ^ Sanders, Lisa (April 5, 2010). "Fish Tale". New York Times. http://www.nytimes.com/2010/04/11/magazine/11FOB-diagnosis-t.html?ref=magazine. Retrieved 2010-04-10. "The illness was first described in 1774 by a surgeon's mate on the crew of Captain Cook's South Pacific exploration aboard the HMS Resolution. The crewman, John Anderson, documented the symptoms described by several shipmates who had eaten a large fish caught in the tropical waters." 

References

  • Ciguatera fish poisoning CDC
  • Ciguatera fish poisoning—Florida, 1991. MMWR June 4, 1993;42(21):417-8
  • Ciguatera fish poisoning—Texas, 1997. MMWR August 28, 1998;47(33):692-4
  • Epidemiologic notes and reports ciguatera fish poisoning—Bahamas, Miami. MMWR July 23, 1982;31(28):391-2
  • Epidemiologic notes and reports ciguatera fish poisoning—Vermont. MMWR April 25, 1986;35(16):263-4
  • Ciguatera fish poisoning

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Look at other dictionaries:

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  • ciguatera — n. f. Intoxication alimentaire due à la consommation de poissons de lagon ayant mangé une algue toxique. La ciguatera provoque de violentes réactions allergiques. Syn. (Pacifique, Polynésie fr.) gratte …   Encyclopédie Universelle

  • ciguatera — f. Enfermedad que suelen contraer los peces y crustáceos de las costas del golfo de México y que produce perniciosos efectos a las personas que los comen …   Diccionario de la lengua española

  • ciguatera — [sig΄wə ter′ə, sig΄wətir′ə] n. [AmSp < cigua, a marine snail] a type of food poisoning with severe gastrointestinal and neurological symptoms, caused by eating contaminated fish …   English World dictionary

  • Ciguatera — La ciguatera es una forma común de intoxicación alimentaria por ingesta de peces que se alimentan o habitan en los arrecifes coralinos y es endémica de los trópicos y sub trópicos debido al consumo de peces ciguatos. Contenido 1 Características 2 …   Wikipedia Español

  • Ciguatera — Klassifikation nach ICD 10 T61 Toxische Wirkung schädlicher Substanzen, die mit essbaren Meerestieren aufgenommen wurden T61.0 Ciguatera Fischvergiftung …   Deutsch Wikipedia

  • Ciguatera — ► sustantivo femenino MEDICINA, ZOOLOGÍA Enfermedad de los peces y crustáceos del golfo de México, que afecta también a las personas que los consumen. * * * ciguatera f. Cierta *enfermedad que padecen a veces algunos *peces y crustáceos de las… …   Enciclopedia Universal

  • ciguatera — {{#}}{{LM C08686}}{{〓}} {{[}}ciguatera{{]}} ‹ci·gua·te·ra› {{《}}▍ s.f.{{》}} Enfermedad por envenenamiento producida por ciertos peces y crustáceos tropicales: • Enfermó de ciguatera en Veracruz.{{○}} …   Diccionario de uso del español actual con sinónimos y antónimos

  • ciguatera — noun Etymology: American Spanish, from ciguato person ill with ciguatera, perhaps from cigua sea snail Date: 1862 poisoning caused by the ingestion of various normally edible tropical fish in whose flesh a toxic substance (as one produced by some …   New Collegiate Dictionary

  • ciguatera — /see gweuh ter euh, sig weuh /, n. a tropical disease caused by ingesting a poison found in certain marine fishes. [1860 65; AmerSp < cigua sea snail] * * * …   Universalium


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