Search

Background. Ciguatera is a disease caused by the ingestion of fish containing the toxins of Gambierdiscus toxicus. This dinoflagellate is frequently found in damaged coral reef systems. Previously rare in Europe, this disease entity is now seen in tourists returning from tropical countries. Case series. Eighteen patients were examined between 1997 and 2002. Nine poisonings occurred in Atlantic Ocean islands, eight in Pacific Ocean islands, and one in the Egyptian Red Sea coast. Gastrointestinal signs were always present in the Atlantic areas, but were less severe or absent in the Pacific areas. All patients had sensory disturbances, and two of them had motor disturbances affecting the respiratory muscles and leading to the death of a 73-year-old man in Cuba. The 17 surviving patients returned to France and for 2 to 18 months suffered from arthralgias, myalgias, or pruritis. Conclusion. Ciguatera is a newly imported intoxication in Europe. As the number of international tourists grows each year, this type of poisoning will be seen more frequently. Furthermore, as the condition of coral reefs declines around the world and the prevalence of G. toxicus increases, physicians in non-tropical countries should be prepared to manage such poisoned patients., INTRODUCTION Ciguatera is widespread in tropical zones of the Pacific, Indian, and Atlantic Oceans. It is a form of food poisoning caused by the consumption of normally edible fish that [...]

Introduction: Ciguatera fish poisoning arises from consumption of any of the 400 species of tropical marine reef fish containing polyether toxins. No laboratory method is available for clinical diagnosis of acute ciguatera poisoning. The objective of this pilot study was to ascertain the potential usefulness of a bioassay to detect ciguatoxins in humans suspected of acute intoxication. We analyzed plasma of healthy volunteers (asymptomatic negative controls), participants with gastrointestinal (GI) illness but without recent fish consumption (symptomatic negative controls), and participants with GI illness who had recently consumed fish. Materials and Methods: Blood samples, questionnaires, and consent forms were collected from 11 symptomatic negative controls and 86 patients that visited emergency rooms in southern Puerto Rico over a 1-year period. Patients had consumed fish within 24 hour prior to the symptoms. Plasma samples were analyzed by a neuroblastoma cell bioassay that detects seafood toxins active at the sodium voltage-gated channel in a dose-dependent fashion. Concentrations were expressed in terms of brevetoxin-1 equivalents (ng PbTx-1 equiv/mL). Results: The mean plasma concentration of 14 asymptomatic negative controls was 39.4 ng PbTx-1 equiv/mL (range 2-74). Of 86 potential ciguatoxic patients who reported fish consumption, 43 had values within the range of normal volunteers, and 9 had concentrations in the nondiagnostic range (73.9-100 ng). Thirty-four patients (40%) had concentrations 3 standard deviations above asymptomatic negative controls (>100ng PbTx-1 equiv/mL). They had a mean concentration of 1074 [+ or -] 244.5 ng PbTx-1 equiv/mL (range 101-7056 ng). Conclusion: Preliminary findings of elevated PbTx-1 equivalents in 40% of the patients with both ciguatera symptomatology and fish consumption in a geographical area where ciguatera is common suggest that the neuroblastoma bioassay may be a potential diagnostic tool for acute ciguatera intoxication., INTRODUCTION Ciguatera is a human health problem caused by intoxication resulting from ingestion of any of the 400 species of tropical marine fish. It affects over 25,000 people annually (1). [...]

The basis of the paradoxical reversal of temperature perception commonly described in ciguatera poisoning has never been defined. The sensations experienced are described as tingling, burning, 'dry ice-like', smarting, and 'electric'. Studies have demonstrated that these types of sensations are generated in C-polymodal nociceptor libers in skin and deep structures and the intensity of these sensations depends on the intensity of discharge in these fibers Ciguatoxin causes persistent sodium channel opening in nerve membrane resulting in oscillations in membrane potentials and runs of spontaneolis discharges. Studies on ciguatera victims in which their hands were immersed in water baths ranging from 0 [degrees] C to 50 [degrees] C, suggest the paradoxical sensory discomfort experienced is, most likely, a result of an exaggerated and intense nerve depolarization occurring in peripheral small A-delta myelinated and in particular, C-polymodal nociceptor fibers. Gross temperature perception was found to be intact in ciguatera poisoning and reversal of temperature does not occur. (Key Words: ciguatera,- paradoxical sensation; pruritus; temperature perception; nociceptor physiology; C-polymodal fibers; A-delta fibers; fishes, poisonous., INTRODUCTION Ciguatera poisoning is the commonest form of ichthyosarcotoxism caused by the ingestion of a wide variety of tropical and inshore fish[1,2]. Toxic fish flesh contains minute amounts of several [...]

Ciguatera is a type of marine food poisoning produced by the consumption of ciguatoxic reef fish. The disease is of significant concern in many tropical areas where it has been known for centuries. Although mortality from ciguatera is low, morbidity is high and symptoms may be debilitating and prolonged. Ciguatera produces characteristic gastrointestinal, neurological, and to a lesser extent, cardiovascular symptoms. Though the symptoms are relatively well documented, the disease often goes unreported or misdiagnosed. The toxins responsible for ciguatera are produced by marine dinoflagellates associated with coral reefs. The toxins are ingested by and accumulate in the fishes which when consumed by man ultimately cause ciguatera. Recent advances in toxin pharmacology have identified ciguatoxin as a sodium channel agonist and have begun to address other aspects of ciguatera on the molecular level. Treatment with mannitol relieves the symptoms; the precise mechanism or mechanisms of action have not been proven. Immunoassays are being developed for detecting even negligible amounts of toxins in suspect fish flesh., INTRODUCTION Ciguatera is a common form of marine food poisoning endemic in the tropics and subtropics. Due to travel and the importation of ciguatoxic food fishes, outbreaks have the potential [...]

Background: Buffalo fish toxicity is an infrequently encountered food borne disease believed to be caused by heat-stable fat-soluble toxins in blue green algae consumed by fish. Few previous cases of toxicity following consumption of Buffalo fish (Ictiobus cyprenellus) have been reported. We report two severe cases of poisoning and rhabdomyolysis following consumption of this fish. Case Report: A 50-year-old man with a previous history of coronary artery disease and hypercholesterolemia and his 48-year-old wife presented to a local emergency department with complaints of nausea, vomiting, myalgias of the lower extremities and debilitating neck pain. These symptoms began approximately 6 hours after ingestion of a meal of Buffalo fish. The fish was baked in a high temperature oven and then subsequently cooked on a stovetop. Treatment in the emergency department consisted of IV fluids, analgesics, and antiemetics. The husband's initial creatine phosphate (CK) was 244 U/L and rose to 42,260 U/L over the course of the next 11 hours. His CK peaked at 46,412 IU/L on the first hospital day. The wife's initial CK was 858 U/L and peaked at 10,643 U/L on the second hospital day. Additional symptoms noted in the husband included hypertension, bradycardia, hypothermia, myoglobinuria, and hepatic transaminase elevations with a peak AST of 1,330 U/L and ALT of 329 U/L on the first hospital day. The wife's only additional symptom was left arm pain and her AST peaked at 241 U/L on the second hospital day. Supportive treatment was provided along with urinary alkalinization of both patients. Over the course of 4 days their symptoms resolved with corresponding decreases in CK and hepatic transaminases. Conclusions: Ingestion of Buffalo fish can result in myalgia, severe rhabdomyolysis, and transient hepatic damage. Cooking does not seem to prevent toxicity. Treatment for this rare food borne toxicity is supportive., Burns D, Snyder L, Kirk M, Mowry J. Indiana Poison Center, Clarian Health Partners, Indianapolis, [...]

Background: To date no comprehensive review exists of aquatic envenomations in the US. Our objective was to characterize reported exposures including most prevalent symptoms. Methods: AAPCC TESS data (1993-1998) was examined to identify all exposures relating to aquatic animals. A subsequent search focused on symptoms associated with the most common and most serious offenders. Results: There were 15,595 aquatic animal exposures reported during this 6-year period, with 7,208 (46%) occurring during the 3 summer months. Ages ranged from 30 days to 90 years, with men accounting for 61% of cases. The ten most common exposures accounted for 13,694 (88%) of all cases: jellyfish (28%), stingray (16%), lionfish (13%), catfish (11%), gastropods (6%), other fish stings (4%), Physalia (Portuguese man-o'war) (3%), sea urchin (2%), coral (2%), and Brachirus (sole) (2%). Over 80% of each group had dermatological manifestations of toxicity, with less than 5% manifesting cardiovascular, neurological or gastrointestinal symptoms. Further analysis demonstrated 24 (0.2%) cases with major outcomes, which predominantly involved stingrays (5/24). In addition to dermatological symptoms (16/24), systemic symptoms in this group included: bradycardia (stingray and Physalia), conduction block (stingray), hypotension (stingray), peripheral neuropathy (Physalia) and ataxia (sea urchin, jellyfish, and fireworm). Conclusions: This is the first attempt to profile aquatic envenomations in the US. Although dermatological complaints are not unexpected, there was a disproportionate amount of systemic symptoms in the most severely exposed individuals. Knowledge of the most common species and symptoms can help target poison center education efforts., Hanley M, Tomaszewski C, Kerns W. Carolinas Medical Center, Charlotte, [...]

Background: Exotic fish stings or envenomation, exposure reports to poison control centers (PCC) rarely occur. 1998 TESS data report 1427 stings from the 2.24 million exposures. Unintentional injuries make up 99% of all exposures. Outcomes are: None (4%); Minor (30%); Moderate (9%); Major (0.1%). We report a case of a moderate outcome from envenomation of a Coral Catfish. Case Report: A 45-year-old male patient contacted the regional PCC ten minutes after being envenomated on his right index finger, from his pet fish, called a Coral Catfish. He immediately placed the finger in hot water, then in vinegar, and contacted the center after the pain became excruciating now radiating toward his elbow. He repeatedly 'stated how poisonous it was.' Poisindex and the American Zoo and Aquarium Association, Antivenom Index had no information about this species. He was told to continue with the hot water soak and seek medical attention immediately. He did not visualize any residual spines, but did have a puncture wound that was becoming redden. The PCC made contact with the local Aquarium, who immediately disseminated information. The protein released from this species creates a local vasoconstrictor effect and inflammation at the site of the puncture wound. Excruciating pain radiating up the arm and lasting up to 48 hours occurs. Systemic effects could include: muscle fasiculations, syncope, hypotension, and death. In the emergency department the patient received meperidine 50 mg and hydroxyzine 25 mg for the pain radiating up his arm despite continuation of hot water soak. His ECG was normal, vital signs were stable. He was admitted to a telemetry bed and remained stable throughout his hospital stay. Conclusion: We report a rare envenomation of a Coral Catfish having moderate effects, with a good outcome., Quail MT, Paul I, Stanger C, Woolf AD. MA/RI Regional Poison Control Center, Children's Hospital, Boston Medical Center, Boston, MA; South Shore Hospital, South Weymouth, [...]

Objectives: Weeverfish (genus Trachinus) and scorpionfish (genus Scorpaena) are responsible for numerous envenomations on the French Mediterranean coast. Traditional treatment by the Provence fishermen includes local temperature variation with a cigarette. This empirical therapy is described by North European physicians is a barbaric method. Furthermore, the idea of thermal destruction of the venom is not proven. This treatment is still used in emergency units encountering these poisonings in southern France. Actually, the Marseilles Poison Centre advice in such cases is the application of what we call a `thermic shock' consisting of a sudden local temperature variation (2 minutes of local heat using a cigarette or a hair dryer, then local cold with an ice cube in a tissue). In order to evaluate the efficacy of this treatment, the authors followed the clinical course of bitten patients over 48 hours. Case series: 43 envenomations were collected between 1st June and 30th September 1999. The patients were 31 men and 12 women, with an average age of 34.19 years (min 5, max 73). The fish--weeverfish 72% and scorpion-fish 28%--were responsible for bites during fishing (40% of the cases), swimming (28%), cooking (21%, recently dead fish are able to bite), diving (9%) and selling in fish shops (2%). Clinical signs were local intense pain (100% of the patients), swelling (72%), bleeding (16%), erythema (12%), numbness (12%), paresthesia (7%) and lipothymia (7%). The `thermic shock' was done for 35 patients (average delay between bite and treatment 42 minutes, (min 3 max 180 minutes). For these patients, intensive pain disappeared after an average time of 25 minutes (min 5, max 120 minutes), and for the patients who presented edema (n = 22), the swelling disappeared after 122 minutes (min 15, max 480 minutes). For 8 patients, the `thermic shock' was not applied, and they presented pain and/or swelling over an average time of 27.6 hours (min 8, max 48 hours). For 5 of them, central pain killers were administered, and for 2 of them, anesthetic blocks were used. Both treatments were described by patients as ineffective remedies. Conclusion: Even though the number of patients not treated by `thermic shock' was not significant, the values obtained with the two groups are statistically different (p [is less than] 0.02, t test for comparison of 2 average values of small samples). The Marseilles Poison Centre will continue to advise the application of a `thermic shock' for the treatment of Mediterranean fish envenomations. De Haro L, Prost N, Arditti J, Valli M, David JM. Centre Antipoison, Hopital Salvator, 13009 Marseille, France

Background: In 2000, approximately 41 tons of blowfish (puffer fish) were sold in the US with no reported cases of toxicity. We present the 1st 2 cases of blowfish-associated poisoning in the US, in which saxitoxin was detected in the non-consumed portions of the fish. Case 1: A 65 yo female ate 6 pieces of blowfish (caught by a recreational fisherman in Florida) and within minutes developed tingling of her lips and tongue. Over the next 2 hours her symptoms intensified and she had 1 episode of vomiting. Her vital signs were: BP, 160/76mmHg; pulse, 109/min; temperature 99.5F. She developed chest pain and was treated with topical nitroglycerine. Over the next 4-6 hours, she developed ascending paralysis and declining pulmonary function, and was intubated. Over the next day she regained reflexes and voluntary movement and, was extubated 72 hours later. Case 2: A 69 yo male (husband of Case 1) ate 6 pieces of blowfish and within minutes developed tingling of the lips and fingertips. On presentation his vital signs, mental status, respiratory status, and neuromuscular examination were all within normal limits. He was treated with mannitol and activated charcoal. On day #2 he was asymptomatic. Toxin analysis: Liquid chromatography-tandem mass spectrometry identified saxitoxin and 2 analogs in uneaten samples of the puffer fish, concentrations ranged from 9,000 to 20,000 mcg saxitoxin/kg of tissue. No tetrodotoxin was detected. Additional cases: Subsequent to our original case report, 10 additional suspected cases were uncovered in 2 other states. Conclusion: Blowfish caught off the Florida coast appear to be vectors for saxitoxin poisoning., Wong MY, Ruck B, Shih RD, Marcus SM. New Jersey Poison Information and Education System at the University of Medicine and Dentistry of New Jersey Newark, NJ [...]