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

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.

Neuropsychological study of ciguatera fish poisoning: a longitudinal case-control study.

PURPOSE: The purpose of the study was to evaluate the neuropsychological effects of ciguatera fish poisoning (CFP). METHOD: In a longitudinal matched cohort study, 12 CFP cases and 12 matched friend-controls received baseline neuropsychological evaluations within one month after intoxication and follow-up evaluations approximately six months after baseline. RESULTS: Only one case received intravenous mannitol treatment, which occurred 10 or more days after intoxication. At baseline and follow-up evaluations, there were no statistically significant differences between CFP cases and controls on cognitive measures. At baseline, however, CFP cases endorsed significantly greater subjective toxicity symptoms (e.g. fatigue, tingling sensations) and greater anxiety symptoms than controls. Follow-up evaluations suggested resolution of all symptoms after six months. Subsequent analyses, in which data from this study were pooled with data from an earlier pilot study, supported these results. CONCLUSION: Untreated ciguatera was associated acutely with significant subjective neurotoxicity symptoms and anxiety which were transient, but not with objectively measured cognitive changes. Future investigation with a larger sample size is warranted.

Outbreak bias in illness reporting and case confirmation in ciguatera fish poisoning surveillance in south Florida.

OBJECTIVE: Ciguatera fish poisoning is a potentially life-threatening disease caused by eating coral reef fish contaminated with ciguatoxins and is the most common marine poisoning. However, existing surveillance systems capture few cases. To improve regional ciguatera surveillance in South Florida, this study compared ciguatera illnesses in the Florida Poison Information Center-Miami (FPICM) call database to ciguatera cases in the Florida Department of Health (FDOH) disease surveillance systems. METHODS: Univariate and multivariate logistic regression were used to identify predictors of when FPICM reported ciguatera illnesses to FDOH and whether FDOH confirmed reported ciguatera cases. RESULTS: FPICM staff preferentially reported ciguatera illnesses that were of shorter duration (adjusted odds ratio [AOR] = 0.84 per additional illness day; 95% confidence interval [CI] 0.74, 0.97); outbreak-associated (AOR = 7.0; 95% CI 2.5, 19.5); and clinically more severe (AOR = 21.6; 95% CI 2.3, 198.5). Among ciguatera illnesses reported to FDOH, outbreak-associated illnesses were more likely than single, sporadic illnesses to become confirmed surveillance cases (crude OR = 11.1; 95% CI 2.0, 62.5). CONCLUSIONS: The over-representation of outbreak-associated ciguatera cases underestimates the true contribution of sporadic illnesses to ciguatera disease burden. This bias should be considered when evaluating surveillance systems that include both outbreak-associated and sporadic illness reports.