An outbreak of ciguatoxin poisoning following barracuda fish ingestion in southern Taiwan

Background: Barracuda fish ingestion is not common in southern Taiwan. Therefore, outbreak of ciguatoxin poisoning following barracuda fish ingestion had rarely been described before. We report an outbreak of ciguatoxin poisoning following barracuda fish ingestion in southern Taiwan. Case series: Three patients of a family developed nausea, vomiting, watery diarrhea and myalgias about one hour after taking three to ten pieces of eggs of barracuda fish. Numbness and tingling of the lip and four limbs followed the GI symptoms about 2 hours after ingestion. Severe headache and dizziness were noted. The more severe two patients were sent to our hospital right away. Physical examination revealed hyperthermia, hypotension, bradycardia and hyperre-flexia. Initial laboratory studies included normal renal and liver function. ECG showed sinus bradycardia. After receiving volume resuscitation with normal saline, and dopamine infusion at 10 [micro]g/kg/min, her blood pressure raised to 110/70 mmHg. Subsequent treatment included repeated doses of intravenous atropine 1 miligram each. Vomiting and diarrhea got recovered one day later; however, bradycardia persisted for several days, and one patient required intravenous atropine continuous infusion 40 mg totally within 2 days. EMG and nerve conduction study revealed negative finding. Further follow up of the patients disclosed improvement of neurological sequelae and bradycardia, but still with sensory impairment. Conclusion: This is an outbreak of ciguatoxin poisoning following barracuda fish ingestion in Taiwan. Ciguatoxin poisoning can cause severe bradycardia requiring careful ECG monitoring. Adequate hydration and atropine use is mandatory in the management of ciguatoxin poisoning.
Hung YM, Chung HM, Hung SY, Lee PT, Hung GC, Tung CN, * LIN TJ. Kaohsiung Veterans General Hospital, and * Kaohsiung Medical University, Kaohsiung, [...]