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Ciguatera Poisoning

We were on a liveaboard in Fiji, and the cook served us a meal of jack from a real monster someone hauled up during our crossing. In retrospect, I probably shouldn't have eaten it, because when I asked him whether it was safe, he said: "Sure, because when the flies are attracted to the fish, it's OK." About an hour after we ate, most of us got sick, throwing up and having diarrhea. I felt like I was floating and my lips started burning. Now I feel dizzy and generally miserable. What happened?

Ciguatera fish poisoning involves a large number of tropical and semitropical bottom-feeding fish that dine on plants or smaller fish, which have accumulated toxins from microscopic dinoflagellates, such as Gambierdiscus toxicus. Therefore, the larger the fish, the greater the toxicity. The ciguatoxin-carrying fish most commonly ingested include the jack, barracuda, grouper and snapper.

Symptoms, which usually begin 15 to 30 minutes after eating the contaminated fish, include abdominal pain, nausea, vomiting, diarrhea, tongue and throat numbness, tooth pain, difficulty in walking, blurred vision, skin rash, itching, tearing of the eyes, weakness, twitching muscles, incoordination, difficulty sleeping and occasional difficulty in breathing. A classic sign of ciguatera intoxication is the reversal of hot and cold sensation (hot liquids seem cold, and vice versa), which may reflect general hypersensitivity to temperature.

Persons can become severely ill shortly after they are poisoned, with heart problems, low blood pressure, deficiencies of the central and peripheral nervous systems, and generalized collapse. Unfortunately, many of the debilitating, but not life-threatening, symptoms may persist in varying severity for weeks to months.

The Treatment

Treatment is for the most part based upon symptoms without any specific antidote, although certain drugs are beginning to prove useful for aspects of the syndrome, such as intravenous mannitol for abnormal nervous system behavior and abnormal heart rhythms. A physician must undertake these therapies.

Prochlorperazine may be useful for vomiting; hydroxyzine or cool showers may be useful for itching. There are chemical tests to determine the presence of ciguatoxins in fish and in the bloodstream of humans, but not yet a specific antidote. If a person displays symptoms of ciguatera fish poisoning, he/she should be see a physician promptly.

During recovery from ciguatera poisoning, the injured person should exclude the following from the diet: fish, fish sauces, shellfish, shellfish sauces, alcoholic beverages, nuts and nut oils.

For more information on marine life injuries, see the complete article by Paul S. Auerbach, M.D., M.S. on Marine Life Trauma from the Jan/Feb 1998 issue of Alert Diver.