Mild ciguatera poisoning: Case reports with neurophysiological evaluations

ArticleinMuscle & Nerve 23(10):1598-603 · November 2000with57 Reads
DOI: 10.1002/1097-4598(200010)23:103.0.CO;2-P · Source: PubMed
Abstract
Ciguatera poisoning causes mainly gastrointestinal and neurological effects of variable severity. However, symptoms of peripheral neuropathy with paresthesias and paradoxical disturbance of thermal sensation are the hallmark. Electrophysiological studies are often normal, except in severe cases. We report four people who developed mild ciguatera poisoning after barracuda ingestion. Electrophysiological studies documented normocalcemic latent tetany. These findings are consistent with ciguatoxin's mechanism of toxicity, which involves inactivation of voltage-gated Na(+) channels and eventually increases nerve membrane excitability.
    • "Currently, accepted as the most effective method of abating the neurological symptoms, D-mannitol, nonetheless, has not been consistently beneficial to all patients. Despite this treatment, the management of the chronic neurological symptoms of CFP continues to be problematic, especially when D-mannitol has not been administrated in the acute phase of the disease (Adams, 1993; de Haro et al., 1997; 2003; Butera et al., 2000). None of the case reports or trial series cited above included a randomized placebo-controlled clinical study, until very recently, whereby the effects of D-mannitol to normal saline were compared in a double-blinded trial (Schnorf et al., 2002). "
    [Show abstract] [Hide abstract] ABSTRACT: Ciguatera fish poisoning (CFP) is acquired through consumption of tropical reef fishes, contaminated with potent neurotoxins, ciguatoxins (CTXs), produced by benthic dinoflagellate of the Gambierdiscus genus. Both spatially and temporally unpredictable, a tainted fish is impossible to differentiate from an untainted one by appearance, taste, texture or odour. Given the predominance of reef fish in the diet of insular countries, the risk of CFP is ever-present. In the Pacific where the incidence of CFP is the highest, the consequences on public health and socio-economy can be extremely severe. Multidisciplinary in nature, the present review revisits the phenomenon of CFP, covering certain of its aspects, notably the etiology, toxicology, ecotoxicology, pharmacology, pathology and the treatments administrated. These aspects of CFP have been reviewed in relation to other poisoning syndromes: tetrodotoxin poisoning and other dinoflagellates- or diatoms-associated intoxications such as paralytic (PSP), diarrhetic (DSP), neurotoxic (NSP), amnesic (ASP) and azaspiracid shellfish poisoning (AZP) and palytoxin poisoning. Based on case reports and bibliographic accounts, a list inventorying the western medicines prescribed to patients suffering from CFP has been established. Within the last two decades, several of the herbal remedies have been evaluated for their efficiencies in in vivo and in a number of in vitro tests, which have also been reviewed herein.
    Full-text · Article · Feb 2011
    • "Acute gastrointestinal problems typically resolve within 24–28 h and cardiovascular disorders reverse within 48– 72 h (Butera et al., 2000; Hokama, 1988). Recovery from neurologic symptoms is longer and less predictable, ranging from 1 week to 6 months (Butera et al., 2000; Lange et al., 1992; Morris et al., 1982a, b; Poon-King et al., 2004). Chronic illness may occur in a subset of patients, and is characterized by a vague and poorly defined combination of recurring neurologic and neuropsychological symptoms. "
    [Show abstract] [Hide abstract] ABSTRACT: Ciguatera fish poisoning is a seafood-borne illness caused by consumption of fish that have accumulated lipid-soluble ciguatoxins. In the United States, ciguatera is responsible for the highest reported incidence of food-borne illness outbreaks attributed to finfish, and it is reported to hold this distinction globally. Ciguatoxins traverse the marine food web from primary producers, Gambierdiscus spp., to commonly consumed fish in tropical and subtropical regions of the world. Ciguatoxins comprise 12 known congeners among Caribbean and tropical Atlantic fish and 29 reported congeners among Pacific fish. Expanding trade in fisheries from ciguatera-endemic regions contributes to wider distribution and increasing frequency of disease among seafood consumers in non-endemic regions. Ciguatoxins produce a complex array of gastrointestinal, neurological and cardiological symptoms. Treatment options are very limited and supportive in nature. Information derived from the study of ciguatera outbreaks has improved clinical recognition, confirmation, and timely treatment. Such studies are equally important for the differentiation of ciguatoxin profiles in fish from one region to the next, the determination of toxicity thresholds in humans, and the formulation of safety limits. Analytical information from case and outbreak investigations was used to derive Pacific and Caribbean ciguatoxin threshold contamination rates for adverse effects in seafood consumers. To these threshold estimates 10-fold safety factors were applied to address individual human risk factors; uncertainty in the amount of fish consumed; and analytical accuracy. The studies may serve as the basis for industry and consumer advisory levels of 0.10ppb C-CTX-1 equivalent toxicity in fish from the tropical Atlantic, Gulf of Mexico, Caribbean, and 0.01ppb P-CTX-1 equivalent toxicity in fish from Pacific regions.
    Full-text · Article · Sep 2009
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