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$Title{Ciguatera Fish Poisoning}
$Subject{Ciguatera Fish Poisoning Ichthyosarcotoxism Ciguatera Poisoning Fish
Poisoning Tetraodon Poisoning Scombroid Poisoning}
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Copyright (C) 1986 National Organization for Rare Disorders, Inc.

202:
Ciguatera Fish Poisoning

** IMPORTANT **
It is possible the main title of the article (Ciguatera Fish Poisoning)
is not the name you expected.  Please check the SYNONYMS listing to find the
alternate names and disorder subdivisions covered by this article.

Synonyms

     Ichthyosarcotoxism
     Ciguatera Poisoning
     Fish Poisoning including Tetraodon Poisoning and Scombroid Poisoning

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.


Ciguatera Fish Poisoning is a form of poisoning (ichthyosarcotoxism),
marked by gastrointestinal and neurological symptoms due to ingestion of fish
that store a toxin in their tissues.  This toxin occurs in more than 400
species of fish found in the tropical reefs of Florida, the West Indies, and
the Pacific.  The disorder has been occurring more frequently in the United
States during the past few years.

Symptoms

Ciguatera Fish Poisoning is characterized by itching, and tingling of the
lips, tongue, hands, and feet.  Other symptoms that may occur during the
first 6-17 hours are numbness, reversal of temperature sensations, abdominal
cramps, nausea, vomiting, and diarrhea.  Wheezing, weakness, pains in the
muscles (myalgia) and joints (arthralgia) may be present.  The patient may
also experience restlessness, apprehension, headache, dizziness, malaise, and
chills.  For months after eating the poisonous fish, unusual sensory
phenomena may keep a person from performing daily tasks.

Causes

Ciguatera Fish Poisoning is caused by eating certain tropical fish (i.e., sea
bass, grouper, barracuda and snapper) which contain the toxin molecular
phosphatidase.  Toxicity is usually greater in older, larger fish.  More than
one toxin may possibly result in the disorder.  A marine protozoan
(dinoflagellate) which is eaten by these fish may supply the toxin which
accumulates in the marine animal's flesh.  The toxin does not disappear with
cooking of the fish.

Affected Population

Anyone eating fish containing the toxin can get Ciguatera Fish Poisoning.
Cooking the fish does not eradicate the toxin.

Related Disorders

Symptoms similar to Ciguatera Fish Poisoning are found in Tetraodon
Poisoning.  This toxin is present in puffer fish and is caused by the
tetraodon toxin.  Scombroid Poisoning from mackerel, tuna, bonito, or albacore
fish is due to bacterial decomposition (breakdown by bacteria) after the fish
has been caught.  It results in facial flushing, gastrointestinal symptoms,
and a burning itch with blisters (urticaria) within a few minutes after
eating an affected fish.

Therapies:  Standard

Unless violent vomiting or diarrhea has occurred, Ciguatera Fish Poisoning is
usually treated by immediately pumping out the stomach (gastric lavage).  An
emetic or ipecac syrup to induce vomiting may be used.  Apomorphine may also
be prescribed.  A saline cathartic (e.g., sodium sulfate) may be required.
If nausea and vomiting persist, fluids containing salts and dextrose should
be prescribed for parenteral injection to fight dehydration and acid-base
imbalance.  Dextran (a polysaccharide), Normal Human Serum Albumin, or blood
transfusion may be necessary if shock threatens.  Meperidine can be given for
pain.

Therapies:  Investigational

This disease entry is based upon medical information available through
September 1989.  Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate.  Please check with the agencies listed in the Resources section for
the most current information about this disorder.

Resources

For more information on Ciguatera Fish Poisoning, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT  06812-1783
     (203) 746-6518

     Centers for Disease Control (CDC)
     1600 Clifton Road, NE
     Atlanta, GA  30333
     (404) 639-3534

For immediate help, contact the local poison control center listed in
your telephone book.

References

CECIL TEXTBOOK OF MEDICINE, 18th ed.:  James B. Wyngaarden, and Lloyd H.
Smith, Jr., Eds.:  W. B. Saunders Co., 1988.  P. 786.

THE MERCK MANUAL 15th ed:  R. Berkow, et al:  eds; Merck, Sharp & Dohme
Research Laboratories, 1987.  P. 787.