CIGUATERA POISONING

[GordMay]

CIGUATERA POISONING
By
Gord May ©

Though I have often (and safely) eaten smaller Barracuda (and other predatory reef fish) over the years, I cannot recommend the practice. I am not expert on Ciguatera Poisoning, nor it’s avoidance. Perhaps I’m just lucky? I personally enjoy Barracuda (and they’re plentiful & easy to catch) - so - For what it’s worth ...

There are many excellent on-line references to Ciguatera, including:
http://www.rehablink.com/ciguatera/
http://www.rsmas.miami.edu/groups/ni.../ciguatera.htm
http://www.rsmas.miami.edu/groups/ni...ndemicarea.pdf
http://www.atsdr.cdc.gov/gis/confere...tml/stinn.html
http://www.rsmas.miami.edu/groups/ni...%20Article.pdf
http://www.rsmas.miami.edu/groups/ni...dPoisoning.pdf

Ciguatera Poisoning is caused by consuming tropical marine fish which have accumulated a toxin (icthyosarcotoxin) which originates from certain species of algae (dinoflagellate Gambierdiscus). This algae is consumed by small fish (grazers) , which in turn are eaten by larger (predatory) fish, and so on up the food chain. The toxin generally accumulates in larger predator reef fish (fish under 5 Lbs are less likely to be contaminated, or at least less so) such as:
Grouper, Amberjack, Sea Bass, Barracuda, Snappers, Eels, and Spanish Mackerel.

The toxin is odourless, tasteless, lipid soluble, and is heat stable - so cooking does not destroy it.

The occurrence of toxic fish, (usually between 35 Degrees North & 35 S.) is sporadic, and not all fish of a given species or from a given locality will be toxic. When cases are reported, or certain types of algae 'blooms' have occurred, warnings are sometimes issued to avoid eating large fish of the implicated species until testing shows the toxin no longer present. You cannot rely upon “warnings” in remote areas, but “local knowledge” may offer some insight into which reefs, at which times of year, are likely to remain uncontaminated.

Avoiding consumption of tropical reef fish is the only true method of prevention. Although the following precautions are not failsafe, they may decrease the incidence of ciguatoxin poisoning:

~ Avoid ingestion of fish larger than 4 -5 Pounds (2-3 kg) that are at the top of the food chain (Grouper, Amberjack, Sea Bass, Barracuda, Snappers, Eels, and Spanish Mackerel, etc)

~ Avoid all visceral organ and gonad meat (head, roe & guts - where ciguatoxin is concentrated)

~ Clean the fish as soon as possible after they are caught or purchased.

~ Avoid eating fish caught at sites known to have a ciguatoxic algae problem.

~ Remember that the ciguatoxin is not destroyed by cooking, drying, salting, or freezing the fish.

Symptoms
Symptoms generally appear within 6 hours of eating the toxic fish, and include numbness and tingling, nausea, vomiting and diarrhea .The GI symptoms are followed by Myalgias (tenderness or pain within a muscle) , Arthralgias (joint pain) and Paresthesias (numbness, tingling, and hyperesthesia or increased sensitivity). Any abnormality of sensation - ie: Sensory reversal - feeling hot for cold, and cold for hot may occur. (Ever been Burned by an Ice-Cube? - That’s likely Ciguatera Poisioning!).

Dr. Lora Fleming, a ciguatera expert at the University of Miami School of Medicine, says problems usually begin with symptoms of classic food poisoning: diarrhea, vomiting and nausea. However, without treatment, the symptoms progress into bizarre neurological disorders. "Generally, your nerves start acting up and sending mixed information," says Fleming. "You feel like bugs are biting your legs or your teeth hurt." In addition to confusing hot and cold, other ciguatera symptoms include pain during urination and painful sexual intercourse.

For SCUBA Divers - Ciguatera and Decompression Sickness (DCS)
But what can be most perplexing is that victims suffer some combination of vertigo, weakness, fatigue, numbness and tingling, which are similar to symptoms associated with decompression sickness. Plus, the symptoms of both illnesses can be delayed for up to a day, though decompression sickness usually appears within six hours of surfacing, and ciguatera usually begins 30 minutes to four hours after a meal.

To differentiate between ciguatera poisoning and DCS, look for ciguatera-specific symptoms, including diarrhea and no headache (decompression sickness is the other way around). According to Fleming, sensory problems like temperature reversal are highly indicative of ciguatera poisoning. Fleming says that because ciguatera's attack rate is nearly 100 percent, victims should look for afflicted dining buddies.

Treatment
There is no specific treatment, but symptoms generally subside (untreated) in a few days. There have been some severe cases where the neurological symptoms have lasted for weeks and months. There have also been some isolated cases which have persisted for years, and other cases where symptoms have recurred months or even years later. There is a low fatality rate.

The treatment is non-specific, mainly consisting of supportive care. It is also recommended that a person suffering from ciguatera fish poisoning avoid eating fish, fish sauces, shellfish, alcohol, and nuts for several months after the incident.

Certain medications (“Mannitol” - (which is given intravenously, and can resolve symptoms within minutes) have been reported to be helpful when started in the early phases of the illness. Other suggested, but unproven, treatments have included: Calcium Gluconate, Corticosteroids, Atropine, Vitamin B, Pyroxidine, Amitriptyline.
Mannitol treatment is 250 cc 20% Mannitol (1mg/kg).
For more information on Mannitol, GOTO: www.rehablink.com/ciguatera/treat.htm

With the exception of testing fresh uncooked fish, with a test kit called Cigua Check, there is no way to determine if a fish carries the toxin.
I have no information as to it’s efficacy. GOTO: http://<a href="http://www.ciguachec...acheck.com</a> - or - http://ulua-fishing.com/ciguatera.html

Happy hunting - safe eating !!!
Gord

[tauras]

Hey GordMay:
Thanks for posting the other side of the benefits of fish. I have read the sites you posted and it is good reading for everyone. Scary but good reading if you like fish.
Ray

[Joyce GVL]

Be careful with the manitol treatment. That is actually used as a stimulant laxative. I think limiting consumption to a minimum and watching the "red tide" reports is safer. Anyway, eat right, stay fit & we all die someday... Enjoy life.

[GordMay]

Thanx for the Manitol warning.
Red Tide is not associated with Cigatera.

[bcguy]

Hopefully this spreads to shark fins.

[roverhi]

Unfortunately for sharks, the fins seem to be harvested from pelagic species of shark which don't eat the toxin containing reef fish. Mahalo for the post GordMay, you are a fount of knowledge on all things nautical.

[zeehag]

mannitol is used in icu to treat edema of brain, under monitored situations, such as intensive care.. is not recommended for use at home.

[frozenhawaiian]

concerning the test kit, I thought that the cigua check had been proven to be unreliable? I know that a team at the university of hawaii has been working for years on coming up with field test kits.

[DefinitelyMe]

Originally Posted by GordMay

Red Tide is not associated with Cigatera.

Are you sure? Both are cased by Dinoflagellates.

[StuM]

Originally Posted by frozenhawaiian

concerning the test kit, I thought that the cigua check had been proven to be unreliable? I know that a team at the university of hawaii has been working for years on coming up with field test kits.

The reference above to the test kit is from 2004!

You are correct, it did prove unreliable

http://www.scirp.org/journal/PaperIn...x?PaperID=6617


and, AFAIK, there are no effective test kits currently available.

[frozenhawaiian]

Originally Posted by StuM

The reference above to the test kit is from 2004!

You are correct, it did prove unreliable

Quantitative Evaluation of Commercially Available Test Kit for Ciguatera in Fish


and, AFAIK, there are no effective test kits currently available.

thats my understanding as well, it's a real shame, I only eat small reef fish and pelagic fish because of ciguatera.

[colemj]

Originally Posted by frozenhawaiian

thats my understanding as well, it's a real shame, I only eat small reef fish and pelagic fish because of ciguatera.

I don't think you need to worry about ciguatera in Maine.

Mark

[frozenhawaiian]

Originally Posted by colemj

I don't think you need to worry about ciguatera in Maine.

Mark

haha well I was referring to when I'm in southern waters. all the fish commonl eaten up here are pretty safe, it's nice.

[Muckle Flugga]

It is definitely a serious issue. I have seen many cases among sailors who still seem to insist on eating reef fish. In the Pacfic it is RIFE. I say avoid all reef fish. Pelagics are plentiful so why bother?

There are also a lot of word of mouth methods that locals use in the islands. In French Polynesia they suggest that if the fish does not stiffen after death, it is to be discarded. Despite this having some degree of rationale, I have known several islanders who have had SEVERE intoxications with ciguatera, even after employing their various checking methods. One gentleman from a Tuamotan island, now in his early 60s, was hospitalised for TWO YEARS post ingestion of a small parrotfish. Small. He was paralysed for most of that time and it was three years before he walked correctly again. Might have been paralysed for life, and might have died. For him the local methods DID NOT WORK> I repeat I have seen many intoxications with ciguatera among cruising sailors, and the ONLY effective method of prevention is abstinence from the consupmtion of ALL reef fish, but particularly predators.

[frozenhawaiian]

Originally Posted by Muckle Flugga

It is definitely a serious issue. I have seen many cases among sailors who still seem to insist on eating reef fish. In the Pacfic it is RIFE. I say avoid all reef fish. Pelagics are plentiful so why bother?

There are also a lot of word of mouth methods that locals use in the islands. In French Polynesia they suggest that if the fish does not stiffen after death, it is to be discarded. Despite this having some degree of rationale, I have known several islanders who have had SEVERE intoxications with ciguatera, even after employing their various checking methods. One gentleman from a Tuamotan island, now in his early 60s, was hospitalised for TWO YEARS post ingestion of a small parrotfish. Small. He was paralysed for most of that time and it was three years before he walked correctly again. Might have been paralysed for life, and might have died. For him the local methods DID NOT WORK> I repeat I have seen many intoxications with ciguatera among cruising sailors, and the ONLY effective method of prevention is abstinence from the consupmtion of ALL reef fish, but particularly predators.

growing up in hawaii and spearfishing on the reefs it's a small wonder I don't have it. back home I only eat certain reef fish and in the caribbean I don't eat any reef fish.