Outbreak of Ciguatera Fish Poisoning on a Cargo Ship in the Port of Hamburg

Abstract

Sailors are an occupational group at risk for ciguatera fish poisoning due to potentially unsafe food sources during international travel. Even if no fatality occurred, the disease affected marine operations due to high attack rates and chronicity of symptoms. Medical doctors must be aware that ciguatera fish poisoning is a risk for seafarers traveling in tropical and subtropical areas. Stocking of food in affected ports from safe sources, adequate training of ship cooks, and informing sailors about the risk of fishing are needed to prevent disease occurrence in seafarers in international trade and traffic.

Ciguatera fish poisoning in an international ship crew in Saint John, Canada: 2015

“…If food specimens are available they can be collected and tested for presence of ciguatera toxin. There is no antidote for ciguatera poisoning, and people who have consumed ciguatoxin receive symptomatic treatment (6). Most people suffering from ciguatera fish poisoning will recover completely within a few days or weeks, but in very rare cases, ciguatera can be fatal (4).…”

Ciguatera, an Emerging Human Poisoning in Europe

“…CTXs resist extreme temperature, weak acid treatments and alkaline conditions [2,9] and not destroyed by any preserved methods [10]. Mechanistically, the primary mode of action of the toxin is via binding to site 5 of the mammalian voltage-gated sodium channels in excitable tissues.…”

Ciguatera Poisoning and Neurological Effects

“…It has been suggested that even <0.1 ppb of CTX in fish tissue constitutes a risk of poisoning with attack rates around 80-90% [5,7]. In the course of CFP, gastrointestinal symptoms initially occur followed by neurological events.…”

“…Ideally, CFP is confirmed by laboratory testing of fish remains for the presence of CTX. Poisoning is not a result of improper handling of fish, but rather due to CTX bioaccumulation through the food chain [7].…”

“…Symptoms of CFP occur within a few minutes to 48 hours (approximate) upon ingestion of contaminated fish [6,7]. It has been suggested that even <0.1 ppb of CTX in fish tissue constitutes a risk of poisoning with attack rates around 80-90% [5,7].…”