Ciguatera
From IDWiki
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
