Ciguatera is endemic to regions in the Indo-Pacific as well as the Caribbean. However, the transport of fish by air has meant that ciguatera can occur almost anywhere. The ciguatera toxins are accumulated in tropical reef fish and then cause poisoning when ingested. Numerous fish have been implicated, including Spanish mackerel, bass, moray eels and some cod species (see table 1).
Table 1: A list of fish species that have been implicated in ciguatera from the Pacific and the Caribbean.[1,2] * Specific problems in the Caribbean.
|Fish Family||of fish and their common names|
|Scombrids||Mackerel, including tunas, Spanish mackerel|
|Lutjanids||Red bass, snappers|
|Lethrinids||Emperors and scavengers|
|Epinephelids||Cod, including flowery cod and spotted cod|
|Serranids||Sea bass and groupers, includes coral trout from the Great Barrier Reef|
|Carangids*||Jacks and scads,|
There are two forms of ciguatera, a combination of gastrointestinal and neurotoxicity in the Indo-Pacific region and mainly gastrointestinal effects in the Caribbean. The range of clinical effects are listed in the table. Gastrointestinal effects occur early within hours of ingestion and resolve within 24 hours. The neurological effects develop later within 24 hours and may persist for days. The most characteristic finding is cold allodynia which is the uncomfortable sensation when touching cold objects, sometimes referred to as heat reversal.
Table 2: Frequency of clinical effects in ciguatera cases from Pacific Regions and the Atlantic [3-12]
|Clinical Features||Frequency Range (percent)|
|Gastrointestinal Features |
|26 – 55
30 – 38
50 – 78
47 – 70
|Neurological Effects |
Paresthesiae (mouth, hands and/or feet)
Cold allodynia (burning on contact with cold)
Dizziness or vertigo
|56 – 83
52 – 91
62 – 86
55 – 94
50 – 74
38 – 54
38 – 62
|Other Effects: |
Loss of energy/asthenia/weakness
|60 – 90
42 – 78
34 – 43
23 – 50
9 – 16
22 – 41
25 – 43
10 – 26
0 – 26
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