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Ciguatera poisoning: a global issue with common management problems.
Eur J Emerg Med. 2001 Dec; 8(4):295-300.EJ

Abstract

Ciguatera poisoning, a toxinological syndrome comprising an enigmatic mixture of gastrointestinal, neurocutaneous and constitutional symptoms, is a common food-borne illness related to contaminated fish consumption. As many as 50000 cases worldwide are reported annually, and the condition is endemic in tropical and subtropical regions of the Pacific Basin, Indian Ocean and Caribbean. Isolated outbreaks occur sporadically but with increasing frequency in temperate areas such as Europe and North America. Increase in travel between temperate countries and endemic areas and importation of susceptible fish has led to its encroachment into regions of the world where ciguatera has previously been rarely encountered. In the developed world, ciguatera poses a public health threat due to delayed or missed diagnosis. Ciguatera is frequently encountered in Australia. Sporadic cases are often misdiagnosed or not medically attended to, leading to persistent or recurrent debilitating symptoms lasting months to years. Without treatment, distinctive neurologic symptoms persist, occasionally being mistaken for multiple sclerosis. Constitutional symptoms may be misdiagnosed as chronic fatigue syndrome. A common source outbreak is easier to recognize and therefore notify to public health organizations. We present a case series of four adult tourists who developed ciguatera poisoning after consuming contaminated fish in Vanuatu. All responded well to intravenous mannitol. This is in contrast to a fifth patient who developed symptoms suggestive of ciguatoxicity in the same week as the index cases but actually had staphylococcal endocarditis with bacteraemia. In addition to a lack of response to mannitol, clinical and laboratory indices of sepsis were present in this patient. Apart from ciguatera, acute gastroenteritis followed by neurological symptoms may be due to paralytic or neurotoxic shellfish poisoning, scombroid and pufferfish toxicity, botulism, enterovirus 71, toxidromes and bacteraemia. Clinical aspects of ciguatera toxicity, its pathophysiology, diagnostic difficulties and epidemiology are discussed.

Authors+Show Affiliations

Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.No affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

11785597

Citation

Ting, J Y., and A F. Brown. "Ciguatera Poisoning: a Global Issue With Common Management Problems." European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine, vol. 8, no. 4, 2001, pp. 295-300.
Ting JY, Brown AF. Ciguatera poisoning: a global issue with common management problems. Eur J Emerg Med. 2001;8(4):295-300.
Ting, J. Y., & Brown, A. F. (2001). Ciguatera poisoning: a global issue with common management problems. European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine, 8(4), 295-300.
Ting JY, Brown AF. Ciguatera Poisoning: a Global Issue With Common Management Problems. Eur J Emerg Med. 2001;8(4):295-300. PubMed PMID: 11785597.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ciguatera poisoning: a global issue with common management problems. AU - Ting,J Y, AU - Brown,A F, PY - 2002/1/12/pubmed PY - 2002/3/16/medline PY - 2002/1/12/entrez SP - 295 EP - 300 JF - European journal of emergency medicine : official journal of the European Society for Emergency Medicine JO - Eur J Emerg Med VL - 8 IS - 4 N2 - Ciguatera poisoning, a toxinological syndrome comprising an enigmatic mixture of gastrointestinal, neurocutaneous and constitutional symptoms, is a common food-borne illness related to contaminated fish consumption. As many as 50000 cases worldwide are reported annually, and the condition is endemic in tropical and subtropical regions of the Pacific Basin, Indian Ocean and Caribbean. Isolated outbreaks occur sporadically but with increasing frequency in temperate areas such as Europe and North America. Increase in travel between temperate countries and endemic areas and importation of susceptible fish has led to its encroachment into regions of the world where ciguatera has previously been rarely encountered. In the developed world, ciguatera poses a public health threat due to delayed or missed diagnosis. Ciguatera is frequently encountered in Australia. Sporadic cases are often misdiagnosed or not medically attended to, leading to persistent or recurrent debilitating symptoms lasting months to years. Without treatment, distinctive neurologic symptoms persist, occasionally being mistaken for multiple sclerosis. Constitutional symptoms may be misdiagnosed as chronic fatigue syndrome. A common source outbreak is easier to recognize and therefore notify to public health organizations. We present a case series of four adult tourists who developed ciguatera poisoning after consuming contaminated fish in Vanuatu. All responded well to intravenous mannitol. This is in contrast to a fifth patient who developed symptoms suggestive of ciguatoxicity in the same week as the index cases but actually had staphylococcal endocarditis with bacteraemia. In addition to a lack of response to mannitol, clinical and laboratory indices of sepsis were present in this patient. Apart from ciguatera, acute gastroenteritis followed by neurological symptoms may be due to paralytic or neurotoxic shellfish poisoning, scombroid and pufferfish toxicity, botulism, enterovirus 71, toxidromes and bacteraemia. Clinical aspects of ciguatera toxicity, its pathophysiology, diagnostic difficulties and epidemiology are discussed. SN - 0969-9546 UR - https://www.unboundmedicine.com/medline/citation/11785597/Ciguatera_poisoning:_a_global_issue_with_common_management_problems_ L2 - https://doi.org/10.1097/00063110-200112000-00009 DB - PRIME DP - Unbound Medicine ER -