Ciguatera fish poisoning

Ciguatera is a food-borne ailment caused by the consumption of fish contaminated by the ciguatera toxin. It is important to note that the ciguatera toxin is generated by dinoflagellates and builds up extensively in fish organs. It can trigger pain, nausea, heart and neurological symptoms among humans if ingested.

These fish thrive in coral reef waters and accumulate the toxin once they consume smaller reef fish which feed on the dinoflagellates.

What are the indications?

The symptoms essentially start 6-8 hours after consuming the contaminated fish but can be as early as 2 hours or delayed up to 24 hours after ingestion. Consuming the ciguatera toxin in contaminated fish can result to the following symptoms:

  • Nausea
  • Vomiting
  • Muscle pain
    Ciguatera fish poisoning

    The symptoms essentially start 6-8 hours after consuming the contaminated fish but can be as early as 2 hours or delayed up to 24 hours after ingestion.

  • Diarrhea
  • Tingling
  • Numbness
  • Dizziness
  • Abdominal pain
  • Vertigo

There is also a burning sensation upon contact with cold while the teeth might feel loose and itching can be intense.

In severe cases of ciguatera poisoning, it can result to shortness of breath, tearing, salivation, itching, chills, rashes and paralysis. Bradycardia, hypotension and coma can occur.

Management

Even today, there is no specific antitoxin available for the ciguatera toxin.

  • In some studies, it is indicated to induce vomiting if the individual is awake and alert and has consumed the contaminated fish within the last 3-4 hours. At the present, doctors recommend digestive decontamination using activated charcoal which absorbs the toxin if done 3-4 hours after ingestion.
  • Keep the body properly hydrated. Fluids given intravenously might be required if uncontrollable nausea and vomiting occurs.
  • Osmotic diuretics have been utilized to reduce the symptoms.
  • The neural pain symptoms can be managed with gabapentin and amitriptyline.
  • For itchiness, hydroxyzine and diphenhydramine can be used.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) are given to reduce the pain.
  • Avoid fish, alcohol, nuts and nut oils after being exposed to the ciguatera toxin since they can trigger recurrent symptoms.

When to seek medical care

In severe cases, hospitalization is required so that intravenous fluids can be started. Immediate care is vital for all cases since the symptoms can rapidly progress in some individuals.

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