Hallucinatory Fish Poisoning (Ichthyoallyeinotoxism): Two Case Reports From the Western Mediterranean and Literature Review

Abstract

Ichthyoallyeinotoxism is a rare kind of food poisoning contracted following the ingestion of fish. The responsible toxins are unknown, and the clinical feature is characterized by the development of CNS disturbances, especially hallucinations and nightmares. As the implicated fish species may be also related to ciguatera poisoning, there may be possible confusion between the two fish-borne intoxications. In order to clarify this, the literature pertaining to "dreamfish" was reviewed and two cases are presented. A 40-year-old man experienced mild digestive troubles and terrifying visual and auditory hallucinations after eating a specimen of Sarpa salpa in a restaurant. As he had severe behaviour troubles, he was managed in the hospital and recovered 36 h after the meal. He was unable to recall the hallucinatory period. Another man, 90-years-old and previously healthy, had auditory hallucinations 2 h after eating a specimen of Sarpa salpa. The two following nights, he had numerous nightmares and recovered spontaneously after a period of 3 days.

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“…CFP induces some symptoms in common with paralytic shellfish poisoning (PSP), neurotoxic shellfish poisoning (NSP), scombrotoxin fish poisoning, pufferfish poisoning (also referred to as Fugu poisoning), and hallucinatory fish poisoning [92]. Other maladies with similar symptomology include botulism, enterovirus infection [93], bacteremia [94], organophosphate pesticide poisoning, severe electrolyte disturbances from extreme vomiting and diarrhea, eosinophilic meningitis, multiple sclerosis, Guillain–Barre Syndrome, and other neurologic conditions [77].…”

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“…In these countries, consumption of rabittfish has become a public health issue because, like the indigenous herbivorous species Sarpa salpa , they can accumulate hallucinatory macroalgal toxins. This “dream” effect has been known since antiquity under the barbaric-sounding name of ichthyoallyeinotoxism [40]. Several spectacular poisoning cases attributed to Siganus luridus and Siganus rivulatus have been reported in the Middle East.…”

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“…Neomyxus leuciscus ); (h) Groupers (sp. Epinephelus corallicola , commonly called “ Coral grouper ”) ( 18 ).…”

“…The effects of eating Ichthyoallyeinotoxic raw fish may include vivid/terrifying auditory and visual hallucinations, dizziness, loss of equilibrium, lack of motor coordination and mental depression, terror and nightmares, itching, burning of the throat, muscular weakness, rarely abdominal distress ( 19 – 21 ). Symptomatology may occur within a few minutes to 2 h after consumption, and may last for up to 24 h ( 18 , 19 ). The first symptoms usually comprise imbalance, loss of coordination and a generalized malaise, followed by delirium, visual and/or auditory hallucinations (mainly zooptic), depression and nightmares ( 18 , 19 , 22 , 41 ).…”