Ciguatera fish poisoning (ciguatera food poisoning or ciguatera poisoning) is a seafood-borne illness caused by consuming contaminated reef fish that contain a toxin called ciguatoxin, which is poisonous to humans. When ingested, the toxin produces numerous gastrointestinal, muscular, neurological and cardiovascular symptoms, which last for days to weeks or even months.
Ciguatera toxin is harmless to fish who often appear healthy when contaminated by it. Hence, it is not possible to know if a fish has ciguatera. The toxin is odorless and tasteless and cannot be destroyed by cooking, smoking, freezing, salting or any other method of food preparation.
Ciguatera food poisoning commonly occurs in tropical and subtropical areas, particularly in the Pacific Ocean, Indian Ocean and the Caribbean Sea. Outbreaks may occur seasonally or occasionally after storms. One of the most common causes of toxicity, consumption of imported fish from the tropical and subtropical regions, as well as tourism, has now made ciguatera fish poisoning a worldwide health concern that has been known for centuries.
What causes ciguatera fish poisoning?
Ciguatera fish poisoning is caused by the consumption of reef fish that contain accumulated ciguatoxins. These toxins are produced by dinoflagellates, which are small marine organisms (microalgae) that belong to the species Gambierdiscus toxicus. Typically, they live in the coral reefs in tropical or subtropical areas.
Small herbivorous fish feed on these dinoflagellates. The ciguatoxins bio-accumulate in the marine food chain and contaminate larger predatory fish, usually weighing over 6 lbs. When humans consume the contaminated fish, it causes ciguatera fish poisoning.
Fish at risk of ciguatera food poisoning
More than 400 different species of fish have been associated as the cause of ciguatera fish poisoning and such fish are said to be ciguatoxic fish. Ciguatera toxin may be found in any large reef fish but is mostly found in barracuda, grouper, red snapper, moray eel amberjack, perch Spanish mackerel, parrotfish, hogfish, sturgeon fish, kingfish, coral trout and sea bass.
What are the signs and symptoms of ciguatera fish poisoning?
Symptoms of ciguatera food poisoning generally begin six to eight hours after eating the contaminated fish, and may include:
- Gastrointestinal symptoms: Characterize the first stage of ciguatera poisoning and appear within 12 hours of consuming the contaminated fish, lasting for a couple of days.
- Neurological symptoms: The next set of symptoms affects the neurological system. These symptoms can appear in a few hours or several days after consumption of the contaminated fish and may continue for several months.
- Cardiovascular symptoms: The third set of symptoms affects the cardiovascular system.
- Orthostatic hypotension
- Cold allodynia: A characteristic symptom of ciguatera food poisoning is cold allodynia, which is a dysesthesia (unpleasant, abnormal sensation) that induces a burning sensation when in contact with cold objects.
Death due to heart or respiratory failure may occur in rare cases within 24 hours.
How is ciguatera fish poisoning treated?
Immediate medical attention is necessary for ciguatera food poisoning since the symptoms can rapidly progress in certain patients, and may include gastric lavage in severe cases.
There is no specific antidote for ciguatera poisoning. However, the mainstay of treatment is supportive care, such as:
- Intravenous administration of fluids: To maintain hydration.
- Diphenhydramine and hydroxyzine: To help relieve itching.
- Amitriptyline and gabapentin: To help reduce neural pain symptoms.
- Non-steroidal anti-inflammatory drugs and acetaminophen: To help reduce pain.
- Verapamil (Calcium channel blockers): To treat some of the symptoms that occur after the initial digestive stage symptoms.
- Vitamin supplements and steroids: To support recovery.
Consumption of alcohol, fish, nuts and nut oils should be avoided after ciguatera poisoning because these may cause recurrent symptoms.
Prevention of ciguatera fish poisoning
Ciguatera food poisoning may be prevented by:
- Avoiding eating reef fish that weighs 6 lbs or more.
- Avoiding eating the liver, intestine, head and roe of smaller reef fish.
Latest Digestion News
Daily Health News
Health Solutions From Our Sponsors
Friedman MA, Fleming LE, Fernandez M, et al. Ciguatera Fish Poisoning: Treatment, Prevention and Management. Mar Drugs. 2008;6(3):456-479. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579736/
Science Direct. Ciguatera. https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/ciguatera
National Organization for Rare Disorders. Ciguatera Fish Poisoning. https://rarediseases.org/rare-diseases/ciguatera-fish-poisoning/
Top Is My Fish Contaminated by Ciguatera Toxin Related Articles
Ciguatera poisoning is a type of food poisoning caused by the ciguatera toxin found in a variety of large reef fish found between the Tropic of Cancer and the Tropic of Capricorn. Symptoms of ciguatera poisoning include diarrhea, nausea, vomiting, abdominal pain, dizziness, vertigo, numbness, tingling, and muscle pain. Ciguatera poisoning requires medical treatment.
Food PoisoningFood poisoning is common but can also be life-threatening. The symptoms of food poisoning are fever, abdominal pain, headache, diarrhea, nausea, and vomiting. Food poisoning has many causes, for example, chemicals (from toxic fish or plants) and bacteria (Staphylococcus aureus or Salmonella). Treatment of food poisoning depends upon the cause.
Food Poisoning QuizWhat causes food poisoning? Can it be prevented? Take this quiz to learn about food safety and how to guard yourself against food poisoning.
How Do You Know It's Food Poisoning?Food poisoning is a common illness that usually resolves within one to two days. Learn the signs of food poisoning, what causes food poisoning, and what you can do to treat food poisoning.
How Do You Store Fish?The best way to store fresh fish is on ice. Ice may need to be placed on top of the fish as well as underneath. The ice isn’t just cold; it’s also dry and allows the meltwater and liquid to run off the fish.
Is It a Stomach Virus or Food Poisoning?A stomach virus is also called stomach flu or gastroenteritis. It is a viral infection that infects the tummy and the gut. Food poisoning is also often called gastroenteritis and may present symptoms like stomach virus/stomach flu. However, food poisoning is caused by consuming food or drinks that may be contaminated with bacteria.
Stomach Flu vs. Food Poisoning
The stomach flu (viral gastroenteritis) and food poisoning are not the same infections. However, they do have a few similar symptoms, for example:
- Abdominal (stomach) pain and cramping.
Symptoms and signs of food poisoning show up earlier (2 hours up to a couple of days) in comparison to the stomach flu in which symptoms may take 4 hours up to 48 hours (2 days) before symptoms begin. Medical treatment for the stomach flu and food poisoning generally is not necessary. A bland diet, drinking plenty of fluids, and rest may be the only treatment necessary.
What Medicine Helps With Food Poisoning?Learn what medical treatments can help ease your food poisoning symptoms and speed up your recovery.