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Ciguatera Fish Poisoning

Causative organisms: Gambierdiscus spp..  Other possible contributors include Prorocentrum spp., Ostreopsis spp., Coolia monotis, Thecadinium spp. and Amphidinium carterae

Toxins implicated: Ciguatoxins; possibly maitotoxin, okadaic acid, palytoxin analogs, and others.

Ciguatera Fish Poisoning (CFP) produces gastrointestinal, neurological, and cardiovascular symptoms. Generally, gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain occur first, followed by neurological dysfunction including muscular aches and pain, pruritis (itching),  dizziness, sweating, and numbness and tingling of the mouth and fingers, and reversal of temperature sensation. Cardiovascular symptoms are most commonly associated with regional CFP in the Pacific, and have been linked to increased potency of toxins in those areas. Paralysis and death have been documented in rare instances, however most symptoms are severely debilitating. To date there is no antidote , so supportive care and medications addressing distinct symptoms are often provided. Recovery can take between 6-12 weeks in most cases, with pain and itching being the longest lasting symptoms. Cold ice baths are recommended for relief in these cases. Treatment of acute CFP with mannitol has had some reported success, but was reported to result from a placebo effect based on scientific studies.  A chronic phase of CFP may result in approximately 20% of those acutely exposed to ciguatoxins and lasts for several years, which may be related to autoimmune dysfunction. Absolute prevention of intoxication depends upon complete abstinence from eating any tropical reef fish, as there is currently no practical way to routinely measure the toxins in any seafood product prior to consumption. Local knowledge of safe fishing areas and safe seafood species provides the best preventive guide for CFP.

U.S. Finfish, Shellfish and Wildlife Affected by CFP

Harmful Algal SpeciesGeographic AreaAffected Organisms*
Gambierdiscus spp.

Gulf of Mexico
Florida Keys
Puerto Rico
U.S. Virgin Islands
Hawaii
Guam
Grouper
Snapper
Hogfish
Triggerfish
Lionfish
Mackerel
Jacks
Barracuda
Parrot fish
Tang
Goat fish
Other finfish
Gastropods and other invertebrates
*Found to contain algal toxins, or to be adversely affected by toxic or harmful marine algae.

Medical Community

Ciguatera Fish Poisoning
Additional Information on CFP including:
Background, Clinical Presentation, Diagnosis, Management and Treatment, Chemical Structure, and Molecular Mechanism of Action.

Additional Resources

  • Friedman, M.A.; Fleming, L.E.; Fernandez, M.; Bienfang, P.; Schrank, K.; Dickey, R.; Bottein, M.-Y.; Backer, L.; Ayyar, R.; Weisman, R.; Watkins, S.; Granade, R.; Reich, A. Ciguatera Fish Poisoning: Treatment, Prevention and Management. Mar. Drugs 20086, 456-479. DOI: 10.3390/md20080022
  • Friedman, M.A.; Fernandez, M.; Backer, L.C.; Dickey, R.W.; Bernstein, J.; Schrank, K.; Kibler, S.; Stephan, W.; Gribble, M.O.; Bienfang, P.; Bowen, R.E.; Degrasse, S.; Flores Quintana, H.A.; Loeffler, C.R.; Weisman, R.; Blythe, D.; Berdalet, E.; Ayyar, R.; Clarkson-Townsend, D.; Swajian, K.; Benner, R.; Brewer, T.; Fleming, L.E. An Updated Review of Ciguatera Fish Poisoning: Clinical, Epidemiological, Environmental, and Public Health Management. Mar. Drugs 201715, 72.  https://doi.org/10.3390/md15030072