Ciguatera, a food poisoning that has been found to be increasing in Europe, is caused by the consumption of fish containing ciguatoxins (CTX). CTX are neurotoxins produced by microalgae of the genera ‘Gambierdiscus’ and ‘Fukuyoa’. These microalgae are common in the diet of tropical and subtropical fish.
The main symptoms are gastrointestinal (nausea, vomiting, abdominal pain and diarrhea), but there are also neurological and muscular signs, itching and a decrease in heart rate and hypotension.
Causes of ciguatera
Marine dinoflagellates associated with coral reefs
Ciguatoxins, the toxins responsible for ciguatera, are produced by marine dinoflagellates, invertebrates such as corals, clams, anemones and marine protozoa, associated with coral reefs. Toxins are ingested and accumulate in fish which, when consumed by humans, can cause poisoning.
Ciguatoxin has been detected in fish such as groupers, garfish, sea bream, sailfish, snappers, horse mackerel and barracuda. Ciguatoxin has no color, odor or taste and is not affected by the cooking method or freezing.
Symptoms of ciguatera
Gastrointestinal, neurological, muscular, cutaneous and cardiovascular
The first signs of ciguatera poisoning appear between 15 minutes and 24 hours after ingestion, although the average is about 12 hours. The signs of ciguatera are, in the acute phase, gastrointestinal (nausea, vomiting, abdominal pain and diarrhea).
There may also be neurological symptoms such as:
– Abnormal sensation of the tissues, cold and/or heat, tingling (paresthesia) and sensitivity disorder (dysesthesia).
– Muscle discomfort.
– Skin disorder, basically itching.
– Cardiovascular signs such as a decrease in heart rate (bradycardia), a decrease in blood pressure (hypotension) or tachycardia.
Other signs are:
– Joint discomfort.
– Vertigo.
– Headache.
– Loss of consciousness.
– Hallucinations.
– Fatigue.
– Blurred vision.
-Hiccup.
– Tialism.
– Exacerbation of acne.
– Metallic taste in the mouth.
Diagnosis of ciguatera
Description of symptoms and habits
The diagnosis is normally based on the description of symptoms and the diet followed. The doctor will ask if any type of tropical or subtropical fish has been consumed. Laboratory tests can be performed on food samples but they must be sent to reference laboratories and the results take a few days.
Ciguatera treatment and medication
Mannitol parenterally
The treatment regimen is an osmotic diuretic with parenteral mannitol to relieve symptoms. It is also important to rehydrate the patient with serum to balance the losses caused by diarrhea and vomiting.
For subsequent treatment, calcium gluconate, a mineral supplement, may be prescribed orally; and for chronic symptoms, amitriptyline, an analgesic and antidepressant.
Ciguatera prevention
Public alert
The prevention of ciguatera is a public health issue since if cases of ciguatoxin poisoning are detected, public health departments must be notified to inspect establishments that may have contaminated product and prevent further poisoning from occurring.
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