An Updated Review of Ciguatera Fish Poisoning: Clinical, Epidemiological, Environmental, and Public Health Management

Melissa A Friedman; Mercedes Fernandez; Lorraine C Backer; Robert W Dickey; Jeffrey Bernstein; Kathleen Schrank; Steven Kibler; Wendy Stephan; Matthew O Gribble; Paul Bienfang; Robert E Bowen; Stacey Degrasse; Harold A Flores Quintana; Christopher R Loeffler; Richard Weisman; Donna Blythe; Elisa Berdalet; Ram Ayyar; Danielle Clarkson-Townsend; Karen Swajian; Ronald Benner; Tom Brewer; Lora E Fleming

doi:10.3390/md15030072

An Updated Review of Ciguatera Fish Poisoning: Clinical, Epidemiological, Environmental, and Public Health Management

Mar Drugs. 2017 Mar 14;15(3):72. doi: 10.3390/md15030072.

Authors

Melissa A Friedman¹, Mercedes Fernandez², Lorraine C Backer³, Robert W Dickey⁴, Jeffrey Bernstein^{5

6}, Kathleen Schrank⁷, Steven Kibler⁸, Wendy Stephan⁹, Matthew O Gribble¹⁰, Paul Bienfang¹¹, Robert E Bowen¹², Stacey Degrasse¹³, Harold A Flores Quintana¹⁴, Christopher R Loeffler¹⁵, Richard Weisman¹⁶, Donna Blythe¹⁷, Elisa Berdalet¹⁸, Ram Ayyar¹⁹, Danielle Clarkson-Townsend²⁰, Karen Swajian²¹, Ronald Benner²², Tom Brewer²³, Lora E Fleming²⁴

Affiliations

¹ Mount Sinai Medical Center, Miami Beach, FL 33140, USA. melissafried@yahoo.com.
² Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL 33314, USA. mf934@nova.edu.
³ National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. lfb9@cdc.gov.
⁴ Marine Science Institute, University of Texas at Austin, Port Aransas, TX 78373, USA. robt.dickey@austin.utexas.edu.
⁵ Jackson Memorial Medical Center, Department of Medicine, University of Miami, Miami, FL 33136, USA. jbernstein@med.miami.edu.
⁶ Florida Poison Information Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA. jbernstein@med.miami.edu.
⁷ Jackson Memorial Medical Center, Department of Medicine, University of Miami, Miami, FL 33136, USA. kschrank@med.miami.edu.
⁸ NOAA-National Ocean Service, Center for Coastal Fisheries and Habitat Research, Beaufort, NC 28516, USA. steve.kibler@noaa.gov.
⁹ Florida Poison Information Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA. wstephan@med.miami.edu.
¹⁰ Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA. matt.gribble@emory.edu.
¹¹ Oceanography Department, University of Hawaii, Honolulu, HI 96822, USA. bienfang@soest.Hawaii.edu.
¹² School for the Environment, University of Massachusetts Boston, Boston, MA 02125, USA. bob.bowen@umb.edu.
¹³ Food and Drug Administration, College Park, MD 20740, USA. stacey.degrasse@fda.hhs.gov.
¹⁴ Food and Drug Administration, Dauphin Island, AL 36528, USA. harold.floresquintana@fda.hhs.gov.
¹⁵ Food and Drug Administration, Dauphin Island, AL 36528, USA. christopher.loeffler@fda.hhs.gov.
¹⁶ Florida Poison Information Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA. rweisman@med.miami.edu.
¹⁷ Private Practice, Miami, FL 33133, USA. blythedrdiva@aol.com.
¹⁸ Institut de Ciències del Mar (CSIC), 08003 Barcelona, Spain. berdalet@icm.csic.es.
¹⁹ Department of Neurology, University of Miami, Miami, FL 33136, USA. dayyar@med.miami.edu.
²⁰ Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA. danielle.clarkson-townsend@emory.edu.
²¹ Food and Drug Administration, College Park, MD 20740, USA. karen.swajian@fda.hhs.gov.
²² Food and Drug Administration, Dauphin Island, AL 36528, USA. ronald.benner@fda.hhs.gov.
²³ Northern Institute, Charles Darwin University, Darwin 0909, Australia and Australian Institute of Marine Science, Darwin 0811, Australia. tom.brewer@cdu.edu.au.
²⁴ European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall Tr1 3HD, UK. l.e.fleming@exeter.ac.uk.

Abstract

Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs), diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future directions, and recommendations for clinicians and patients. It updates and expands upon the previous review of CFP published by Friedman et al. (2008) and addresses new insights and relevant emerging global themes such as climate and environmental change, international market issues, and socioeconomic impacts of CFP. It also provides a proposed universal case definition for CFP designed to account for the variability in symptom presentation across different geographic regions. Information that is important but unchanged since the previous review has been reiterated. This article is intended for a broad audience, including resource and fishery managers, commercial and recreational fishers, public health officials, medical professionals, and other interested parties.

Keywords: Gambierdiscus; algae; ciguatera fish poisoning; ciguatoxin; climate change; diagnosis; environmental change; food poisoning; harmful algal bloom; human health; natural toxins; neurology; neuropsychology; neurotoxin; seafood poisoning; treatment.

Publication types

Review

MeSH terms

Animals
Ciguatera Poisoning / epidemiology*
Ciguatoxins / toxicity*
Disease Outbreaks
Fishes / metabolism*
Humans
Public Health
Seafood / poisoning*

Substances

Ciguatoxins

Abstract

Publication types

MeSH terms

Substances

Grants and funding