U.S. Food & Drug Administration Center for Food Safety & Applied Nutrition Foodborne Pathogenic Microorganisms and Natural Toxins Handbook

1. Name of the Organism:	Ciguatera
2. Nature of Acute Disease:	Ciguatera Fish Poisoning Ciguatera is a form of human poisoning caused by the consumption of subtropical and tropical marine finfish which have accumulated naturally occurring toxins through their diet. The toxins are known to originate from several dinoflagellate (algae) species that are common to ciguatera endemic regions in the lower latitudes.
3. Nature of Disease:	Manifestations of ciguatera in humans usually involves a combination of gastrointestinal, neurological, and cardiovascular disorders. Symptoms defined within these general categories vary with the geographic origin of toxic fish.
4. Diagnosis of Human Illness:	Clinical testing procedures are not presently available for the diagnosis of ciguatera in humans. Diagnosis is based entirely on symptomology and recent dietary history. An enzyme immunoassay (EIA) designed to detect toxic fish in field situations is under evaluation by the Association of Official Analytical Chemists (AOAC) and may provide some measure of protection to the public in the future.
5. Associated Foods:	Marine finfish most commonly implicated in ciguatera fish poisoning include the groupers, barracudas, snappers, jacks, mackerel, and triggerfish. Many other species of warm-water fishes harbor ciguatera toxins. The occurrence of toxic fish is sporadic, and not all fish of a given species or from a given locality will be toxic.
6. Relative Frequency of Disease:	The relative frequency of ciguatera fish poisoning in the United States is not known. The disease has only recently become known to the general medical community, and there is a concern that incidence is largely under-reported because of the generally non-fatal nature and short duration of the disease.
7. Course of Disease and Complications:	Initial signs of poisoning occur within six hours after consumption of toxic fish and include perioral numbness and tingling (paresthesia), which may spread to the extremities, nausea, vomiting, and diarrhea. Neurological signs include intensified paresthesia, arthralgia, myalgia, headache, temperature sensory reversal and acute sensitivity to temperature extremes, vertigo, and muscular weakness to the point of prostration. Cardiovascular signs include arrhythmia, bradycardia or tachycardia, and reduced blood pressure. Ciguatera poisoning is usually self-limiting, and signs of poisoning often subside within several days from onset. However, in severe cases the neurological symptoms are known to persist from weeks to months. In a few isolated cases neurological symptoms have persisted for several years, and in other cases recovered patients have experienced recurrence of neurological symptoms months to years after recovery. Such relapses are most often associated with changes in dietary habits or with consumption of alcohol. There is a low incidence of death resulting from respiratory and cardiovascular failure.
8. Target Populations:	All humans are believed to be susceptible to ciguatera toxins. Populations in tropical/subtropical regions are most likely to be affected because of the frequency of exposure to toxic fishes. However, the increasing per capita consumption of fishery products coupled with an increase in interregional transportation of seafood products has expanded the geographic range of human poisonings.
9. Food Analysis:	The ciguatera toxins can be recovered from toxic fish through tedious extraction and purification procedures. The mouse bioassay is a generally accepted method of establishing toxicity of suspect fish. A much simplified EIA method intended to supplant the mouse bioassay for identifying ciguatera toxins is under evaluation.
10. Selected Outbreaks:	Literature references can be found at the links below.
MMWR 47(33):1998	This report summarizes an investigation of this outbreak by the Texas Department of Health (TDH), which indicated that 17 crew members experienced ciguatera fish poisoning resulting from eating a contaminated barracuda.
MMWR 42(21):1993	Twenty cases of ciguatera fish poisoning from consumption of amberjack were reported to the Florida Department of Health and Rehabilitative Services (HRS) in August and September 1991. This report summarizes the investigation of these cases by the Florida HRS.
MMWR 35(16):1986	On October 29, 1985, the Epidemiology Division, Vermont Department of Health, learned of two persons with symptoms consistent with ciguatera fish poisoning. Both had eaten barracuda at a local restaurant on October 19.
MMWR 31(28):1982	On March 6, 1982, the U.S. Coast Guard in Miami, Florida, received a request for medical assistance from an Italian freighter located in waters off Freeport, Bahamas. Numerous crew members were ill with nausea, vomiting, and muscle weakness and required medical evacuation for hospitalization and treatment. There findings were consistent with ciguatera fish poisoning.
Morbidity and Mortality Weekly Reports	For more information on recent outbreaks see the CDC.
11. Education and Background Resources:	Literature references can be found at the links below.
Loci index for genome	Available from the GenBank Taxonomy database, which contains the names of all organisms that are represented in the genetic databases with at least one nucleotide or protein sequence.
12. Molecular Structural Data:	This structure was created by Fred Fry, Ph.D, CFSAN.
	Ciguatoxin

CDC/MMWR

The CDC/MMWR link will provide a list of Morbidity and Mortality Weekly Reports at CDC relating to this organism or toxin. The date shown is the date the item was posted on the Web, not the date of the MMWR. The summary statement shown are the initial words of the overall document. The specific article of interest may be just one article or item within the overall report.

NIH/PubMed

The NIH/PubMed button at the top of the page will provide a list of research abstracts contained in the National Library of Medicine's MEDLINE database for this organism or toxin.

AGRICOLA

The AGRICOLA button will provide a list of research abstracts contained in the National Agricultural Library database for this organism or toxin.

mow@cfsan.fda.gov
January 1992 with periodic updates