Neurological Disturbances of Ciguatera Poisoning: Clinical Features and Pathophysiological Basis

Abstract

Ciguatera fish poisoning (CFP), the most prevalent seafood poisoning worldwide, is caused by the consumption of tropical and subtropical fish contaminated with potent neurotoxins called ciguatoxins (CTXs). Ciguatera is a complex clinical syndrome in which peripheral neurological signs predominate in the acute phase of the intoxication but also persist or reoccur long afterward. Their recognition is of particular importance in establishing the diagnosis, which is clinically-based and can be a challenge for physicians unfamiliar with CFP. To date, no specific treatment exists. Physiopathologically, the primary targets of CTXs are well identified, as are the secondary events that may contribute to CFP symptomatology. This review describes the clinical features, focusing on the sensory disturbances, and then reports on the neuronal targets and effects of CTXs, as well as the neurophysiological and histological studies that have contributed to existing knowledge of CFP neuropathophysiology at the molecular, neurocellular and nerve levels.

Guidance Level for Brevetoxins in French Shellfish

“…The most common symptoms were paresthesia (81%), vertigo (60%), malaise (50%), abdominal pain (48%), nausea (44%), diarrhea (33%), weakness (31%) and ataxia (27%). Surprisingly, 17% of patients reported a reversal of temperature perception, a symptom not commonly reported in other intoxication events that happened in Florida, and which are more generally associated with ciguatera-type poisoning (reviewed in [ 50 ]). The mean time to onset of symptoms was three hours (interval between 15 min and 18 h), and the intensity of symptoms was associated with the number of shellfish ingested.…”

“…Given the similarity between BTXs and ciguatoxins, the neurotoxins responsible for ciguatera, whose effects can last several months or even years following acute exposure [ 50 ], we consider that long-term effects following acute oral exposure to BTXs cannot be ruled out.…”

Cyanobacteria, Cyanotoxins, and Neurodegenerative Diseases: Dangerous Liaisons

“…Despite the high number of cases, estimated at around 50,000-500,000 cases per year, the prognosis is usually benign. In humans, more than 170 non-specific symptoms have been reported, although the most characteristic manifestations of ciguatera fish poisoning, found in all patients, are neurological symptoms, including paraesthesia and headache [81].…”

Ciguatera Mini Review: 21st Century Environmental Challenges and the Interdisciplinary Research Efforts Rising to Meet Them

“…Historically, in-vivo-based methods, while not specific, were widely used for toxicity screening, however, due to various analytical and ethical concerns, alternative methods are preferred [ 181 , 226 ]. Most in-vitro-based methods, designed to investigate the neurocellular effects of CTXs using various cell types (mouse, guinea pig, rat, human, etc., as reviewed by L’Herondelle et al [ 227 ], and references therein), require the use of a protein-based serum and the use of essential supplements in cell culture. These supplements are mainly animal-based (e.g., fetal bovine serum), which also raises the scientific reliability/repeatability and animal-based ethical concerns of in-vivo methods.…”