Ciguatera: Difference between revisions
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==Background== |
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** Barracuda and moray eel are classic |
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* Causes GI symptoms (nausea, vomiting, and diarrhea), quickly followed by unusual neurological signs and symptoms (hot-cold reversal, cold allodynia, paresthesias) |
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*Barracuda and moray eel are classic, but also amberjack, grouper, snapper, and parrotfish, and, rarely, farm-raised salmon |
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* Can cause bradycardia, heart block, and hypotension |
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===Pathophysiology=== |
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*[[Gambierdiscus]] dinoflagellates that live on or around coral make ciguatera toxin, which concentrates in the fish |
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*Toxin is heat-stable, acid-stable, and lipid-soluble |
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==Clinical Manifestations== |
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*Incubation period of [[Usual incubation period::3 to 6 hours]] (range [[Incubation period range::up to 30 hours]]) |
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*Can present with a variety of symptoms, including gastrointestinal, neurologic, and cardiovascular |
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*GI symptoms develop within 3 to 6 hours, and include [[Causes::nausea]], [[Causes::vomiting]], [[Causes::diarrhea]], and [[Causes::abdominal pain]] |
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**Can take up to 4 days to resolve |
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*Cardiovascular symptoms develop within a few hours, and include [[Causes::bradycardia]], [[Causes::heart block]], and [[Causes::hypotension]] |
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**Can take up to 4 days to resolve |
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*Neurological symptoms develop within 3 to 72 hours of ingestion, and include [[Causes::hot-cold reversal]], [[Causes::cold allodynia]], and [[Causes::paresthesias]] |
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**Can last for weeks to months in a minority of cases |
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*Concomitant alcohol consumption portends a higher risk of developing [[bradycardia]], [[hypotension]], and altered sensation |
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==Investigations== |
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*Mouse bioassay is the gold standard but not often done |
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==Management== |
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*[[Mannitol]], [[gabapentin]], [[amitriptyline]], and [[pregabalin]] are sometimes used for the neurological symptoms |
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[[Category:Travel medicine]] |
[[Category:Travel medicine]] |
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Latest revision as of 16:38, 25 January 2022
Background
- Foodborne illness caused by eating reef fish that have concentrated ciguatoxin
- Barracuda and moray eel are classic, but also amberjack, grouper, snapper, and parrotfish, and, rarely, farm-raised salmon
Pathophysiology
- Gambierdiscus dinoflagellates that live on or around coral make ciguatera toxin, which concentrates in the fish
- Toxin is heat-stable, acid-stable, and lipid-soluble
Clinical Manifestations
- Incubation period of 3 to 6 hours (range up to 30 hours)
- Can present with a variety of symptoms, including gastrointestinal, neurologic, and cardiovascular
- GI symptoms develop within 3 to 6 hours, and include nausea, vomiting, diarrhea, and abdominal pain
- Can take up to 4 days to resolve
- Cardiovascular symptoms develop within a few hours, and include bradycardia, heart block, and hypotension
- Can take up to 4 days to resolve
- Neurological symptoms develop within 3 to 72 hours of ingestion, and include hot-cold reversal, cold allodynia, and paresthesias
- Can last for weeks to months in a minority of cases
- Concomitant alcohol consumption portends a higher risk of developing bradycardia, hypotension, and altered sensation
Investigations
- Mouse bioassay is the gold standard but not often done
Management
- Management is supportive
- Mannitol, gabapentin, amitriptyline, and pregabalin are sometimes used for the neurological symptoms
