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Ciguatera is a fish-borne illness for which there is no treatment. It's the sort of thing that can ruin a tropical vacation, unless you know which fish to avoid at sea-side restaurants. Recognizing symptoms is the only way you can get timely treatment.
Vomiting and diarrhea are only the first symptoms of ciguatera poisoning. They can occur as soon as 15 minutes after eating the fish, or up to 24 hours later. Even though the toxin triggers diarrhea, defecation is usually painful. Men who are able to achieve sexual activities experience painful ejaculation. Both males and females may have problems passing urine, that is, they feel the need to "go" but can't, and have multiple muscle pains that seem to move around.
Ciguatera poisoning can produce a number of bizarre neurological symptoms. Hot objects may feel cold, and vice versa. The lips or the tongue may be paralyzed. The teeth may feel loose, even though they are not, and there can be muscle pain (myalgia) and nerve pain (neuralgia). There can be joint pain, itching without obvious skin changes, and an odd combination of numbness and pain in the fingers and toes. In the most severe cases, there can be respiratory failure or coma.
In the later stages of the most severe cases, there can be bradycardia (extremely slow heart rate), pulmonary edema (swelling and fluid on the lungs), and heart failure.
In the United States, about one percent of people who get ciguatera poisoning die. In some outbreaks, up to 20 percent of victims die from the toxin.
What Can You Do To Avoid Or Treat Ciguatera Poisoning?
- It's still OK to eat predator fish harvested in clean waters, where coral are healthy. However, if you don't know where your fish were caught, order something else. Avoid eating large reef fish, especially any snapper or moray eel weighing more than 3 kilos (about 6 pounds). The poison is concentrated in the head, roe, and "guts." Avoid them.
- Seek treatment as soon as you have symptoms. Sometimes taking activated charcoal in the first three to four hours after eating the fish absorbs the toxin. Don't do anything to encourage vomiting. If your reflexes are compromised, vomiting can lead to aspiration of vomit, making the condition work.
- Cool showers and antihistamines relieve itching. Your doctor may give you an old-style antidepressant known as amitriptylline (Elavil) for both itching and nerve pain.
- Losing too much fluid can cause heart failture. If you are unable to keep liquids down, you must get medical treatment. Waiting overnight to see the doctor is too long. Get IV fluid replacement as soon as possible if you are vomiting or you have severe diarrhea.
- Once you get over the most severe symptoms of ciguatera poisoning, you need to avoid fish, shellfish, dairy products, nuts, and nut oils for several weeks to avoid a relapse of your symptoms.
- Breastfeeding mothers can transmit the toxin to their infants through breast milk.
- Home test kits for ciguatera toxin are available, but they are not reliable.
- Friedman MA et al. Ciguatera Fish Poisoning: Treatment, Prevention, and Management. Mar Drugs. 2008 September. 63:456-479.
- Photo courtesy of Marco Zanferrari via Flickr: www.flickr.com/photos/tuttotutto/3497623155
- Photo courtesy of zenilorac via Flickr: www.flickr.com/photos/zenilorac/2114822861
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