Ciguatera: Difference between revisions
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==Background== |
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*Foodborne illness caused by eating reef fish that have concentrated ciguatoxin |
*Foodborne illness caused by eating reef fish that have concentrated ciguatoxin |
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*Barracuda and moray eel are classic, but also amberjack, grouper, snapper, and parrotfish, and, rarely, farm-raised salmon |
*Barracuda and moray eel are classic, but also amberjack, grouper, snapper, and parrotfish, and, rarely, farm-raised salmon |
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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]]) |
*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 |
*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]] |
*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 |
**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]] |
*Cardiovascular symptoms develop within a few hours, and include [[Causes::bradycardia]], [[Causes::heart block]], and [[Causes::hypotension]] |
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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]] |
*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 |
**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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*Management is supportive |
*Management is supportive |
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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
