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Publisher: Peytchinski, Gospodin Iliev ET
ISSN: 1312-773X (Online)
Issue: 2017, vol. 23, issue 1
Subject Area: Medicine
Pages: 1474-1479
DOI: 10.5272/jimab.2017231.1474
Published online: 21 February 2017
J of IMAB 2017 Jan-Mar;23(1):1474-1479
CIGUATERA POISONING: PACIFIC DISEASE, FOODBORNE POISONING FROM FISH IN WARM SEAS AND OCEANS. Review
Snezha Zlateva1, Petko Marinov1, Marieta Yovcheva1, Georgi Bonchev1
,
, Dobri Ivanov2, Kaloyan Georgiev3,
1) Clinic for Intensive Treatment of Acute Intoxications and Toxicoallergies, Naval Hospital – Varna, Military Medical Academy, Bulgaria
2) Department of Biology, Faculty of Pharmacy, Medical University – Varna, Bulgaria
3) Department of Pharmaceutical Technologies, Faculty of Pharmacy, Medical University – Varna, Bulgaria.
ABSTRACT:
Purpose: The review is provoked because of lack of awareness of the medical practitioners in Bulgaria concerning of the ethnology, pathogenesis, clinical symptoms and treatment of the ciguatera fish poisoning (CFP). This can be a source of prolonged diagnostic delays, as some cases reporting in another country in Europe, for example Germany, Spain and UK. Varna is the sea town with many sailor crews returning from tropical and subtropical regions, or CFP can affect people who travel to the Pacific and Caribbean or ate exotic fish from supermarket. The information of this fish food-borne poisoning is part of student’s education in discipline “Marine medicine” in Medical University, Varna.
Materials and methods: To present better information from different authors and last scientific data, we made review of published materials of 58 issues to construct definition, history, etiology, pathogenesis (toxins and mechanisms of action), clinical symptoms, treatment and prevention of the Ciguatera or ichtyosarcotoxicosis, a wide spread food-born poisoning.
Results: Ciguatera poisoning is ichtyosarcotoxicosis, a wide-spread foodborne poisoning in people after consumption of flesh of different kinds of fishes in which toxins produced by poisonous microorganisms (Dinoflagellates) have accumulated. The poisoning develops by accumulating toxins higher up the food chain starting with toxin producing dinoflagellates (species: Gambierdiscus toxicus, Prorocentrum concavum, Pr. lima, Ostreoposis lenticularis, Ostr. Siamensis and others), continuing with the poisoned algae (species: Portieria, Halymenia, Turbinaria, Sargassum), and after that involving small crustacea and small fishes to greater fishes (vector fishes, genus Herbivores and Carnivores), in which the toxins have been stored in amount, great enough to cause foodborne poisoning in humans. This poisoning is widespread in tropical and subtropical regions, but because of its delayed toxic effects, lasting for months and years, there is a possibility that every medic can encounter its unusual symptoms, requiring specific treatment. The following toxins cause the poisoning: ciguatoxin, meitotoxin, ostreotoxin, domoic acid and some other unspecified toxins. They are lipid soluble, thermo stable and cannot be decomposed by culinary processing. These toxins have neurotoxic, cardiotoxic, hemolytic properties and cause diarrheic syndrome. Clinical presentation is characterized by average latent period of 12 hours after the consummation, vomiting and diarrhea next 24 hours and neurological symptoms that appear at the beginning of the poisoning with paresthesias along the body, changing feeling of hot and cold, strong myalgia. Disturbances in cardiac rhythm and conduction, strong dehydration or shock are possible in severe cases. Light cases pass over in several days, but, more often the poisoning has a chronic course – from 3-4 months to 1 year, with prevalence of neurologic symptoms: myalgia, paresthesias, skin itching with scratches, depression. The management is not specific and includes stomach lavage with activated charcoal, fluids replacement during the first 24 hours, corticosteroids, antiallergics, high doses of vitamins from group B (Vit. B1, Vit. B6, Vit. B12), mannitol IV, nootropic medicaments, antidepressants and other symptomatic medicaments. The prophylaxis is done by examining every fish with specific test for detecting ciguateratoxin.
Key words: ichtyosarcotoxicosis, dinoflagellates, ciguatoxin, meitotoxin, domoic acid, ciguatera poisoning,
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Please cite this article in PubMed Style or AMA (American Medical Association) Style:
Zlateva S, Marinov P, Yovcheva M, Bonchev G, Ivanov D, Georgiev K. CIGUATERA POISONING: Pacific disease, foodborne poisoning from fish in warm seas and oceans. Review. J of IMAB. 2017 Jan-Mar;23(1):1474-1479. DOI: 10.5272/jimab.2017231.1474.
Correspondence to: Georgi Bonchev, PhD; Head, Laboratory of Analytical Toxicology, Military Medical Academy, Naval Hospital – Varna; 3, Hristo Smirnenski Blvd., 9010 Varna, Bulgaria; E-mail: toxilab.varna@abv.bg
REFERENCES:
1. Bagnis R. [Ciguatera fish poisoning: Known biological processes and perspectives on the edge of 80]. [in French] Ann Inst Océanogr. 1981;57:5-24.
2. Salvat B, editor. Human impacts on coral reefs: facts and recommendations. Moorea, Polynesie Francaise: Museum national d'histoire naturelle et Ecole pratique des hautes etudes, Antenne de Tahiti, Centre de l'environment; 1987. 241-53 p.
3. Dickey RW, Plakas SM. Ciguatera: a public health perspective. Toxicon. 2010 Aug 15;56(2):123-36. [PubMed]
4. Skinner MP, Brewer TD, Johnstone R, Fleming LE, Lewis RJ. Ciguatera fish poisoning in the Pacific Islands (1998 to 2008). PLoS Negl Trop Dis. 2011 Dec;5(12):e1416. [PubMed] [CrossRef]
5. Chan TY. Ciguatera fish poisoning in East Asia and Southeast Asia. Mar Drugs. 2015 Jun 2;13(6):3466-78. [PubMed]
6. Arnold TC. Ciguatera Toxicity. Medscape. 2015 Dec 29. [Internet].
7. Cunha JP. Ciguatera Poisoning. Editor: Stoppler MC. MedicineNet. 2016 Mar 11. [Internet]
8. Lewis RJ. Ciguatera: Australian perspectives on a global problem. Toxicon. 2006 Dec;48(7):799–809. [PubMed]
9. Farrell H, Zammit A, Manning J, Shadbolt C, Szabo L, Harwood DT, et al. Clinical diagnosis and chemical confirmation of ciguatera fish poisoning in New South Wales, Australia. Commun Dis Intell Q Rep. 2016 Mar 31;40(1):E1-6. [PubMed]
10. Llewellyn LE. Revisiting the association between sea surface temperature and the epidemiology of fish poisoning in the South Pacific: reassessing the link between ciguatera and climate change. Toxicon. 2010 Oct 56(5):691-7. [PubMed]
11. Rongo T, van Woesik R. The effects of natural disturbances, reef state and herbivorous fish densities on ciguatera poisoning in Rarotonga, Southern Cook Islands. Toxicon. 2013 Mar 15;64:87-95. [PubMed]
12. Tester PA, Feldman RL, Nau AW, Kibler SR, Wayne Litaker R. Ciguatera fish poisoning and sea surface temperatures in the Caribbean Sea and the West Indies. Toxicon. 2010 Oct 56(5):698-710. [PubMed]
13. Barrett JR. Under the weather with ciguatera fish poisoning: Climate variables associated with increases in suspected cases. Environ Health Perspect. 2014 Jun;122(6):A167. [PubMed]
14. Glaziou P, Legrand AM. The epidemiology of ciguatera fish poisoning. Toxicon. 1994 Aug;32(8):863-73. [PubMed]
15. Kohler ST, Kohler CC. Dead bleached coral provides new surfaces for dinoflagellates implicated in ciguatera fish poisoning. Env Biol Fish. 1992;34(4):413-6.
16. Gramade HR, Dickey R. Recent advances in ciguatera fish poisoning research. 15th Annual Conference: Tropical and Subtropical Fisheries Technological Conf. of the Americas; 1990 Dec 2-5; Orlando, Florida, USA. Gainesville, Florida: University of Florida; 1991 Aug. 527 p.
17. Centers for Disease Control and Prevention (CDC). Ciguatera fish poisoning - New York City, 2010-2011. MMWR Morb Mortal Wkly Rep. 2013 Feb 1;62(4):61-5. [PubMed]
18. Mattei C, Vetter I, Eisenblatter A, Krock B, Ebbecke M, Desel H, et al. Ciguatera fish poisoning: a first epidemic in Germany highlights an increasing risk for European countries. Toxicon. 2014 Dec;91:76-83. [PubMed]
19. Zimmermann K, Eisenblдtter A, Vetter I, Ebbecke M, Friedemann M, Desel H. [Imported tropical fish causes ciguatera fish poisoning in Germany]. [in German] Dtsch Med Wochenschr. 2015 Jan;140(2):125-30. [PubMed]
20. Lawley R. Ciguatoxins. Food safety watch. 2013 January 30. [Internet]
21. Kipping R, Eastcott H, Sarangi J. Tropical fish poisoning in temperate climates: food poisoning from ciguatera toxin presenting in Avonmouth. J Public Health (Oxf). 2006 Dec;28(4):343-6. [PubMed]
22. Schlaich C, Hagelstein JG, Burchard GD, Schmiedel S. Outbreak of ciguatera fish poisoning on a cargo ship in the port of Hamburg. J Travel Med. 2012 Jul;19(4):238-42. [PubMed]
23. Boada LD, Zumbado M, Luzardo OP, Almeida-González M, Plakas SM, Granade HR, Abraham A, Jester EL, Dickey RW. Ciguatera fish poisoning on the West Africa Coast: An emerging risk in the Canary Islands (Spain). Toxicon. 2010 Dec;56(8):1516-9. [PubMed]
24. Fukuyo Y, Ishimaru T. Toxic dinoflagellates in Japan. In: Maclean JL, Dizon LB. Hosillos LV. (Eds.), Proceedings of the 1st Asian Fisheries Forum, Manila, Philippines; 1986 May 26-31. p.307-10.
25. Bagnis R. Natural versus anthropogenic disturbances to coral reef. Comparison in epidemiological patterns of ciguatera. Mem Queensl Mus. 1994;34:455-60.
26. Bagnis R., Chanteau S, Yasumoto T. [A probable causative agent of ciguatera.]. [in French] CR Acad Sci. 1977; 285:105-8.
27. Bomber JW, Morton SL, Babinchak JA, Norris DR, Morton JG. Epiphtic dinoflagellates of drift algae-another toxigenic community in the ciguatera food chain. Bull Mar Sci. 1988;43:204-14.
28. Adachi R, Fukuyo Y. The thecal structure of a marine toxic dinoflagellate Gambierdiscis toxicus gen. and sp. nov. collected in a ciguatera endemic area. Bull Jap Soc Sci Fish. 1979;45(1):67-71.
29. Bomber JW, Rubio MG, Norris DR. Epiphytism of dinoflagellates associated with the disease ciguatera: substrate specifity and nutrition. Phycologia. 1989;28:360-8.
30. Millar DM. Ciguatera Seafood toxins. CRC Press; 1990. p,135-70
31. Radke EG, Reich A, Morris JG Jr. Epidemiology of Ciguatera in Florida. Am J Trop Med Hyg. 2015 Aug;93(2):425-32. [PubMed]
32. Grzebyk D. Dinoflagellés marins toxiques: biologie, écophysiologie [dissertation]. [Marceille]: Univerisite D'Aix-Marseille II; 1993. 202 p. [in French]
33. Grzebyk D, Berland B, Thomassin BA, Bosi C, Arnoux A. The ecology of ciguateic dinoflagellates in the coral reef complex of Mayotte Island (S.W. Indian ocean). J Exp Mar Biol Ecol. 1994;178(1):51-66.
34. Friedman MA, Arena P, Levin B, Fleming L, Fernandez M, Weisman R, et al. Neuropsychological study of ciguatera fish poisoning: a longitudinal case-control study. Arch Clin Neuropsychol. 2007 May;22(4):545-53. [PubMed]
35. Arena P, Levin B, Fleming LE, Friedman MA, Blythe DG. A pilot study of the cognitive and psychological correlates of chronic ciguatera poisoning. Harmful Algae. 2004; 3:51-60.
36. Quod JP, Turquet J. Ciguatera in Reunion Island (SW Indian Ocean): epidemiology and clinical patterns. Toxicon. 1996 Jul;34(7):779-85. [PubMed]
37. Bagnis R, Legrand AM. Clinical features on 12,890 cases of ciguatera (fish poisoning) in French Polynesia. Progress in venom and toxin research. National University of Singapore, Singapore. 1987. p.372-84.
38. [Poisoning with a fish Ciguatera]. [in Bulgarian] Framar.bg. 2013 Jul 26. [Internet]
39. Davis CP. Ciguatera Fish Poisoning (Ciguatera Toxin). New York: WebMD, LLC; 2016 Sep 30. [Internet]
40. Radke EG, Grattan LM, Morris JG. Association of cardiac disease and alcohol use with the development of severe ciguatera. South Med J. 2013 Dec;106(12):655-7. [PubMed]
41. Friedman MA, Fleming LE, Fernandez M, Bienfang P, Schrank K, Dickey R, et al. Ciguatera Fish Poisoning: Treatment, Prevention and Management. Marine Drugs. 2008; 6(3):456-479. [PubMed]
42. Gillespie N, Lewis R, Burke J, Holmes M. The significance of the absence of ciguatoxin in a wild population of G. toxicus. In: Gabrie C and Salvat B (Assoc. Eds.), Proceedings of the 5th international coral reef congress; 1985 May 27–June 1; Tahiti, French Polynesia. p.437-42.
43. Withers NW. Ciguatera fish poisoning. Ann Rev Med. 1982; 33:97-111. [PubMed]
44. Chateau-Degat ML, Huin-Blondey MO, Chinain M, Darius T, Legrand AM, Nguyen NL, et al. Prevalence of chronic symptoms of ciguatera disease in French Polynesian adults. Am J Trop Med Hyg. 2007 Nov;77(5):842-6. [PubMed]
45. Pearn J. Neurology of ciguatera. J Neurol Neurosurg Psych. 2001 Jan;70(1):4-8. [PubMed]
46. Schnorf H, Taurarii M, Cundy T. Ciguatera fish poisoning: a double-blind randomized trial of mannitol therapy. Neurology. 2002 Mar;58(6):873-80. [PubMed]
47. Bagnis R, Spiegel A, Boutin JP, Burucoa C, Nguyen L, Cartel JL, et al. Evaluation of the efficacy of mannitol in the treatment of ciguatera in French Polynesia. Med Tropicale. 1992; 52:67-73.
48. Blythe DG, Hack E, Washington G, Fleming LE. Foodborne disease handbook. Hui YH, Kitts D, Stanfield PS, editors. New York: Marcel Dekker; 2001. 311-20 p.
49. Palafox NA, Jain LG, Pinano AZ, Gulick TM, Williams RK, Schatz IJ. Successful treatment of ciguatera fish poisoning with intravenous mannitol. J Am Med Assoc. 1988; 259:2740-2. [CrossRef]
50. Blythe DG, de Sylva DP, Fleming LE, Ayyar RA, Baden DG, Shrank K. Clinical experience with i.v. mannitol in the treatment of ciguatera. Bull Soc Pathol Exotique. 1992; 85(5 Pt 2):425-6. [PubMed]
51. Blythe DG, Fleming LE, Ayyar RA, de Sylva DP, Baden DG, Shrank K. Mannitol therapy for acute and chronic ciguatera fish poisoning. Memoirs of the Queensland Museum. Brisbane: Queensland Museum; 1994;34(2):465-70.
52. Eastaugh JA. Delayed use of intravenous mannitol in ciguatera (fish poisoning). Ann Emerg Med. 1996;28(1):105-6. [PubMed]
53. Birinyi-Strachan LC, Davies MJ, Lewis RJ, Nicholson GM. Neuroprotectant effects of iso-osmolar D-mannitol to prevent Pacific ciguatoxin-1 induced alterations in neuronal excitability: a comparison with other osmotic agents and free radical scavengers. Neuropharmacology. 2005 Oct;49(5):669-86. [PubMed]
54. Schnorf H, Taurarii M, Cundy T. Ciguatera fish poisoning: a double-blind randomized trial of mannitol therapy. Neurology. 2002 Mar;58(6):873-80. [PubMed]
55. Inoue M, Lee N, Tsumuraya T, Fujii I, Hirama M. Use of monoclonal antibodies as an effective strategy for treatment of ciguatera poisoning. Toxicon. 2009 Jun;53(7-8):802-5. [PubMed]
56. Tsumuraya T, Fujii I, Hirama M. Production of monoclonal antibodies for sandwich immunoassay detection of Pacific ciguatoxins. Toxicon. 2010 Oct;56(5):797-803. [PubMed]
57. Lawley R, Curtis L, David J. The food safety hazard guidebook. 2nd ed. London: RSC Publishing; 2012. 205 p.
58. Regulation (EC) №853/2004 of the European Parliament and of the Council. Official Journal of the European Union. 2004 April 30;L139(55). 116 p. [Internet]
Received: 01 September 2016
Published online: 21 February 2017