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Ciguatera: The Common Fish-Borne Disease You Never Heard Of

by — Last updated: 2015-08-21 in Nutrition & Dieting

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.

Trey and Sally had left their wedding reception directly for the airport for a dream vacation in the Bahamas. Their sey had snorkeled and sunbathed all morning, and for lunch they had a delicious meal of exotic barracuda. A few hours later they became violently ill. They experienced vomiting and diarrhea, and they had to make a trip to the emergency room that night to get treatment for dehydration. It was certainly a memorable day on their honeymoon.

What had gone wrong? It turned out that Trey and Sally had been poisoned by a tiny microorganism known as Gambierdiscus toxicus. This one-celled organism is a member of a group of marine microbes that sometimes make their own food with photosynthesis and sometimes hunt down other microbes hiding on seaweed or bleached coral. To another microbe, an encounter with Gambiercus is deadly. It is paralyzed and quickly gobbled down by the predator.

However, for many tiny fish that live in seaweeds or hide in bleached (dead) coral, Ganbiercus is lunch. They are predators of the predator microbe, at least until they are themselves eaten by larger fish, which are in turn eaten by larger fish. The toxin the microbe uses to kills its own prey is concentrated at each step of the food chain, so that it builds up to levels that can affect humans in barracuda, amberjack, snapper, parrotfish, triggerfish, moray eels, and grouper. All of these fish can accumulate toxic levels of the toxin ciguatera.

What Is Ciguatera?

Ciguatera is a poison in a class of poisons known as sodium channel agonists. It opens microscopically small channels in the surface of cells so that sodium pours in. Sodium has a positive charge. Many of the nutrients and regulator hormones that cells need are also positively charged. The poison shuts down the cell so that it effectively starves.
 
Because muscle cells are more active than other kinds of cells, and the heart is the most active of all the muscles in the body, the heart is the organ most vulnerable to the toxin. However, the effects of ciguatera are first noticed in the digestive tract. Its later effects are noticed in the nervous system, increasing the activity of the parasympathetic nervous system, which controls the activities we don't think about, and decreasing activity of the sympathetic nervous system, which controls the activities we do think about.
 
Ciguatera is a very stable chemical. Heat does not destroy it. Stomach acid does not break it down. There is no cooking method that makes affected fish safe to eat. 
 
It is tasteless, odorless, and has no affect on the flavor of the fish. Caribbean cooks sometimes put a piece of fish on the ground to see whether ants eat it, or place a silver coin on the skin to see whether it turns black, but neither of these methods actually works.

Who Gets Ciguatera Poisoning?

Ciguatera is especially common in the West Indies, where up to three percent of tourists come down with some degree of the disease. The condition is also relatively common in Australia and in the South Pacific. St. Thomas in the Virgin Islands has an anuual rate of 4.4 percent of households, and seven percent of Puerto Ricans are poisoned with ciguatera at some time in their lifetimes.

What Are The Symptoms Of Ciguatera Poisoning, And What Can You Do If You Experience Them?

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.
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