by Kimberly Allen, RN
I must admit I had never heard of ciguatera until I was researching a story about a man that donated his organs and was found to have rabies. The health officials stated they believed he was suffering from ciguatera. This made me curious not only about the disease, but just how common is it that health officials believed that it was ciguatera they were dealing with?
I was quite surprised to learn that ciguatera poisoning is the most common non-bacterial, fish-borne poisoning in the US. Because of the global marketing of tropical fish, there have been cases reported throughout the US, although it’s normally found primarily in Floridan and Hawaii. The World Health Organization reports that approximately 50,000 cases of ciguatera poisoning are reported every year worldwide. However, most experts believe ciguatera poisoning is under reported and under diagnosed making it difficult to keep track of. Ciguatera poisoning is endemic in some areas including Australia, and the Caribbean as well as the South Pacific islands, all of which are popular vacation spots for many trying to escape the winter cold. Many experts also site tourism as a reason for seeing sporadic cases throughout the US. Many of the tourists that contract ciguatera poisoning don’t begin showing symptoms until they have returned home.
Scientists have identified at least 5 different types of ciguatoxin. Ciguatoxin is a lipid soluble compound that remains stable even when subjected to high heat. In other words, cooking will not kill the toxin. The toxin is also odorless and tasteless making it difficult to detect. The ciguatoxin is usually found in large reef fish like barracuda, eel, sea bass, red snapper, grouper, amberjack and Spanish mackerel. Now, with fish from endemic areas like the Caribbean and Coastal Central America as well as Hawaii being shipped all over the US, the concern is that ciguatera poisoning can develop anywhere.
Symptoms of ciguatera poisoning can manifest as early as 15 minutes after consuming the toxin or as late as 24 hours after consumption. However, most people start experiencing symptoms between 6 to 12 hours after ingesting the toxin. Although there is a wide variety of symptoms reported the 3 major systems most commonly affected are the gastrointestinal, cardiovascular, and neurologic systems. The gastrointestinal symptoms usually appear first and usually last a day or two. They include abdominal pain with nausea and vomiting as well as diarrhea. Neurological symptoms can appear anywhere from a few hours after ingestion to 3 days after. The neurological symptoms can last from weeks to months and can include numbness and tingling as well as a painful “pins and needles” sensation around the face and mouth as well as the extremities. Some people complain of their teeth feeling loose and an intense itching sensation around their mouth. Many also experience dizziness and weakness and if the poisoning is severe they may experience respiratory paralysis and coma. Though less common cardiac symptoms can be severe.
There is no antitoxin specific for ciguatera toxin currently available. If a person is known to have ingested the ciguatoxin with in 3 to 4 hours after ingestion some doctor’s recommend using activated charcoal to decontaminate the gastrointestinal tract. Maintaining hydration is crucial therefore most people diagnosed with ciguatera poisoning are given intravenous fluids. Some doctor’s will also prescribe medications like Amitriptyline to help decrease neural pain, benadryl or vistaril can be used to help the itching and acetaminophen or NSAID’s can be used for any other pain you might be experiencing.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.