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

doi:10.3390/md15030072

Review

. 2017 Mar 14;15(3):72.

doi: 10.3390/md15030072.

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

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.

PMID: 28335428
PMCID: PMC5367029
DOI: 10.3390/md15030072

Review

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

Melissa A Friedman et al. Mar Drugs. 2017.

. 2017 Mar 14;15(3):72.

doi: 10.3390/md15030072.

Authors

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.

PMID: 28335428
PMCID: PMC5367029
DOI: 10.3390/md15030072

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.

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Conflict of interest statement

The authors declare no conflict of interest.

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References

1. Friedman M.A., Fleming L.E., Fernandez M., Bienfang P., Schrank K., Dickey R., Bottein M.Y., Backer L., Ayyar R., Weisman R., et al. Ciguatera fish poisoning: Treatment, prevention and management. Mar. Drugs. 2008;6:456–479. doi: 10.3390/md6030456. - DOI - PMC - PubMed
1. Lewis R.J., Vernoux J.P., Brereton I.M. Structure of Caribbean ciguatoxin isolated from Caranx latus. J. Am. Chem. Soc. 1998;120:5914–5920. doi: 10.1021/ja980389e. - DOI
1. Abraham A., Jester E.L.E., Granade H.R., Plakas S.M., Dickey R.W. Caribbean ciguatoxin profile in raw and cooked fish implicated in ciguatera. Food Chem. 2012;131:192–198. doi: 10.1016/j.foodchem.2011.08.059. - DOI
1. Parsons M.L., Settlemier C.J., Ballauer J.M. An examination of the epiphytic nature of Gambierdiscus toxicus, a dinoflagellate involved in ciguatera fish poisoning. Harmful Algae. 2011;10:598–605. doi: 10.1016/j.hal.2011.04.011. - DOI - PMC - PubMed
1. U.S. Food and Drug Administration [(accessed on 10 March 2017)];Fish and Fishery Products Hazards and Controls Guidance. (4th ed.). 2011 Available online: www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformati....

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[1] Friedman M.A., Fleming L.E., Fernandez M., Bienfang P., Schrank K., Dickey R., Bottein M.Y., Backer L., Ayyar R., Weisman R., et al. Ciguatera fish poisoning: Treatment, prevention and management. Mar. Drugs. 2008;6:456–479. doi: 10.3390/md6030456. - DOI - PMC - PubMed

[2] Friedman M.A., Fleming L.E., Fernandez M., Bienfang P., Schrank K., Dickey R., Bottein M.Y., Backer L., Ayyar R., Weisman R., et al. Ciguatera fish poisoning: Treatment, prevention and management. Mar. Drugs. 2008;6:456–479. doi: 10.3390/md6030456. - DOI - PMC - PubMed

[3] Lewis R.J., Vernoux J.P., Brereton I.M. Structure of Caribbean ciguatoxin isolated from Caranx latus. J. Am. Chem. Soc. 1998;120:5914–5920. doi: 10.1021/ja980389e. - DOI

[4] Lewis R.J., Vernoux J.P., Brereton I.M. Structure of Caribbean ciguatoxin isolated from Caranx latus. J. Am. Chem. Soc. 1998;120:5914–5920. doi: 10.1021/ja980389e. - DOI

[5] Abraham A., Jester E.L.E., Granade H.R., Plakas S.M., Dickey R.W. Caribbean ciguatoxin profile in raw and cooked fish implicated in ciguatera. Food Chem. 2012;131:192–198. doi: 10.1016/j.foodchem.2011.08.059. - DOI

[6] Abraham A., Jester E.L.E., Granade H.R., Plakas S.M., Dickey R.W. Caribbean ciguatoxin profile in raw and cooked fish implicated in ciguatera. Food Chem. 2012;131:192–198. doi: 10.1016/j.foodchem.2011.08.059. - DOI

[7] Parsons M.L., Settlemier C.J., Ballauer J.M. An examination of the epiphytic nature of Gambierdiscus toxicus, a dinoflagellate involved in ciguatera fish poisoning. Harmful Algae. 2011;10:598–605. doi: 10.1016/j.hal.2011.04.011. - DOI - PMC - PubMed

[8] Parsons M.L., Settlemier C.J., Ballauer J.M. An examination of the epiphytic nature of Gambierdiscus toxicus, a dinoflagellate involved in ciguatera fish poisoning. Harmful Algae. 2011;10:598–605. doi: 10.1016/j.hal.2011.04.011. - DOI - PMC - PubMed

[9] U.S. Food and Drug Administration [(accessed on 10 March 2017)];Fish and Fishery Products Hazards and Controls Guidance. (4th ed.). 2011 Available online: www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformati....

[10] U.S. Food and Drug Administration [(accessed on 10 March 2017)];Fish and Fishery Products Hazards and Controls Guidance. (4th ed.). 2011 Available online: www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformati....

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

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

Authors

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Abstract

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