An Updated Review of Ciguatera Fish Poisoning: Clinical, Epidemiological, Environmental, and Public Health Management

Abstract

Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs), diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future directions, and recommendations for clinicians and patients. It updates and expands upon the previous review of CFP published by Friedman et al. (2008) and addresses new insights and relevant emerging global themes such as climate and environmental change, international market issues, and socioeconomic impacts of CFP. It also provides a proposed universal case definition for CFP designed to account for the variability in symptom presentation across different geographic regions. Information that is important but unchanged since the previous review has been reiterated. This article is intended for a broad audience, including resource and fishery managers, commercial and recreational fishers, public health officials, medical professionals, and other interested parties.

Species‐specific PCR assays for Gambierdiscus excentricus and Gambierdiscus silvae (Gonyaulacales, Dinophyceae)

“…, Friedman et al. ). Ciguatera fish poisoning can cause a variety of gastrointestinal (vomiting/diarrhea), cardiovascular (bradycardia and hypotension) or neurological (asthenia/myalgia, paresthesias/dysesthesias/cold allodynia) disorders, as well as non‐specific symptoms like burning/tingling sensation of the mouth and throat (Lewis , Gatti et al.…”

“…Key index words: Caribbean; ciguatera; ciguatoxin; dinoflagellate; harmful algae; ribosomal; species-specific molecular assay Abbreviations: CFP, ciguatera fish poisoning; CTX, ciguatoxin; ITS, internal transcribed spacer; LSU, large subunit; PCR, polymerase chain reaction Benthic dinoflagellates in the genera Gambierdiscus and Fukuyoa (Dinophyceae) produce ciguatoxins (CTXs), potent neurotoxins that bioaccumulate in food webs. Consumption of invertebrates or more commonly fish that have accumulated sufficient CTXs can result in ciguatera fish poisoning (CFP; Litaker et al 2010, Darius et al 2017, Friedman et al 2017. Ciguatera fish poisoning can cause a variety of gastrointestinal (vomiting/diarrhea), cardiovascular (bradycardia and hypotension) or neurological (asthenia/myalgia, paresthesias/dysesthesias/cold allodynia) disorders, as well as non-specific symptoms like burning/tingling sensation of the mouth and throat (Lewis 2001, Gatti et al 2015, Lewis and Vetter 2016, Darius et al 2017, Friedman et al 2017).…”

“…Consumption of invertebrates or more commonly fish that have accumulated sufficient CTXs can result in ciguatera fish poisoning (CFP; Litaker et al 2010, Darius et al 2017, Friedman et al 2017. Ciguatera fish poisoning can cause a variety of gastrointestinal (vomiting/diarrhea), cardiovascular (bradycardia and hypotension) or neurological (asthenia/myalgia, paresthesias/dysesthesias/cold allodynia) disorders, as well as non-specific symptoms like burning/tingling sensation of the mouth and throat (Lewis 2001, Gatti et al 2015, Lewis and Vetter 2016, Darius et al 2017, Friedman et al 2017). On rare occasions, the intoxication is fatal.…”

Design of experiments for the optimization of electrospray ionization in the LC‐MS/MS analysis of ciguatoxins

“…Modifications of these toxins are observed in both termini of the molecules, mostly by oxidation processes. The consumption of fish containing CTX‐group toxins might cause ciguatera fish poisoning, which is the most commonly reported intoxication related to marine toxins in seafood . This type of fish poisoning has been described in endemic tropical and subtropical regions of the world for centuries .…”

“…The consumption of fish containing CTXgroup toxins might cause ciguatera fish poisoning, which is the most commonly reported intoxication related to marine toxins in seafood. 11 This type of fish poisoning has been described in endemic tropical and subtropical regions of the world for centuries. 12 Currently, its incidence is increased in non-endemic regions due to several factors, such as the spread of dinoflagellates as a result of global warming and changes in marine ecosystems, 13 in addition to an increase of tourism, fisheries activity, and consumption of imported toxic fish.…”