Ciguatera fish poisoning

Ciguatera fish poisoning is a foodborne illness caused by eating tropical reef fish whose flesh has accumulated ciguatoxins. The toxins originate with Gambierdiscus toxicus, a marine dinoflagellate that grows on coral reefs in tropical and subtropical waters, and they concentrate as they move up the food chain, reaching their highest levels in larger predatory reef fish such as barracuda, grouper and moray eel. Once eaten, the toxins can produce a mix of gastrointestinal, neurological and cardiovascular symptoms, including diarrhea, vomiting, numbness, itchiness, unusual sensitivity to hot and cold temperatures, dizziness and weakness. Onset ranges from about thirty minutes to two days after the fish is eaten depending on how much toxin was consumed, and symptoms can persist for weeks or months in some cases. Because ciguatoxins are heat stable and have no detectable smell or taste, ordinary cooking does not destroy them and offers no protection. Treatment is mostly supportive, though drugs such as mannitol, gabapentin and amitriptyline are sometimes used to address particular symptoms, and death from the poisoning is extremely rare. An estimated fifty thousand cases occur worldwide each year, making it the most common seafood-related poisoning, and roughly five percent of those affected go on to develop chronic symptoms that can last for years.