Ciguatera toxicity

Ciguatera poisoning is the most common foodborne illness caused by a chemical toxin in the United States and is endemic in the Caribbean and Indo-Pacific. Ciguatoxin, produced by a marine dinoflagellate that attaches to algae, is passed up the food chain to large fish and, finally, to humans. The toxin has anticholinesterase activity. The clinical picture is characterized by a variety of gastrointestinal, neurologic and cardiovascular symptoms, usually self-limited. Amitriptyline is reported to be beneficial.

Treatment of ciguatera fish poisoning with amitriptyline and nifedipine

Ciguatera fish poisoning is the most common fish poisoning in the United States. Symptoms involve the gastrointestinal, cardiovascular and neurological systems. No known treatment exists. We explore the therapeutic effect of amitriptyline in two patients and nifedipine in one patient. Amitriptyline demonstrated resolution of most symptoms except for heat/cold reversal in one patient and heat/cold reversal, pruritus and headache in the second patient. We then used nifedipine in the second patient and noted only the resolution of his headaches. We recommend further study of these agents for the treatment of ciguatera fish poisoning.

Ciguatera in Australia. Occurrence, clinical features, pathophysiology and management

Ciguatera is a type of food poisoning that results from eating certain tropical fish which have become toxic. It is common in Australia: 175 outbreaks, which involved 527 people, were reported in Queensland between 1965 and 1984. It seems restricted to certain areas around the Australian coastline. Most reports have involved the narrow-barred Spanish mackerel, Scomberomorus commersoni, most of which were caught in southern Queensland waters. Up to 2100 cases may have occurred in north Queensland between 1965 and 1984, which were not recorded by the writers. The symptoms of ciguatera in Australia are similar to those reported elsewhere in the South Pacific. Ciguatoxin acts by increasing the permeability of excitable membranes to sodium ions. This type of membrane is found throughout the body in nerve tissue as well as in heart and skeletal muscle. The treatment of ciguatera remains symptomatic and supportive only. Major advances in treatment for ciguatera and detection of ciguatoxin await the means of producing additional ciguatoxin.

The neuro-ophthalmologic signs of ciguatera poisoning: a case report

Twenty-four hours after the ingestion of black grouper, lower-extremity paresthesias, left retrobulbar pain, pruritus, diarrhea, and urinary frequency developed in a 57-year-old woman. Over a three-month period, her symptoms gradually resolved completely. A review of the systemic and neuro-ophthalmologic manifestations of ciguatera poisoning is presented.

Ciguatera poisoning: a report of three cases

Confirmed ciguatera poisoning is reported in three Canadian adults who ingested grouper imported from Florida. Two required hospitalization for management of marked gastrointestinal, neurological, and cardiovascular disturbances. Outside of endemic areas, the recognition of this type of fish poisoning may be inadequate. The pathogenesis, diagnosis, and therapy of the disease are outlined.

Disease and development: ciguatera fish poisoning

Ciguatera, a form of fish poisoning with a pantropical distribution, has been a recognized health problem in the Caribbean and the Pacific for centuries (in the decade from 1973 to 1983 for the island Pacific region as a whole, reported incidence, conservatively 20% of actual incidence, was 97/100,000). Island peoples in subsistence communities have developed strategies to minimize its impact. These strategies are less effective when people move to towns, cities and wage labor. The existence of ciguatoxic fish, which are indistinguishable from those that are not, has serious implications for development in island states. Furthermore, development activities which result in disruption of the marine environment increase the potential for ciguatoxic biotopes. The distribution of this health risk in the Pacific region is presented, adaptive strategies discussed, and implications for health, nutrition, resource development and tourism explored.

Scombroid poisoning: mini-review with case histories

Scombroid poisoning has become an almost world-wide medical problem. It is probably the most common cause of fish poisoning, although frequently misdiagnosed as "Salmonella infection'. While there remains some question as to the definitive etiology, there is little doubt that the poisoning is caused by the ingestion of certain mackerel-like fishes whose tissues have undergone a number of changes provoked by bacteria, and involving the conversion of histidine to histamine, potentiated by diamines. Improper storage of the fishes, usually at temperatures above 20 degrees C, appears to be the most important predisposing factor. The organisms most commonly involved are Proteus sp., Clostridium sp., Escherichia sp., Salmonella sp. and Shigella sp. Twenty-five cases of scombroid poisoning are presented. The clinical manifestations were very similar in most cases, consisting of: alterations in taste; anxiety; hyperemia, particularly of the face and neck; nausea; pruritus; headache; certain other symptoms and signs. Most patients responded to antihistamitics, and all cases were self-limiting.

Ichthyotoxism by a paralytic toxin produced by marine dinoflagellates of the genus Ceratium: relationship to fraction beta isolated from the sponge Tedania ignis

Two hundred tons of the plankton feeding sardine Cetengraulis edentulus died in March 1982, in Carenero (10 degrees 10' N, 66 degrees 05' W), Venezuela. A fraction was extracted from this fish that was toxic to mice by i.p. injection. The animals died in less than 4 min and showed generalized flaccid paralysis. Gel filtration on Sephadex G15 and Bio Gel P2 showed that the toxicity is related to a fraction that blocks the release of acetylcholine in frog (Rana pipiens) neuromuscular junctions. This toxin is similar in chemical properties and presynaptic effect to fraction beta isolated from the sponge T. ignis by Sevcik and Barboza. Fractions of the same biological action and chemical properties were isolated from plankton samples collected in the area of the ichthyotoxism. The correlation analysis between the presence of toxin and a plankton species in a sample, was carried out with a feasibility index (as %) defined by Sevcik and Mijares. Random samples of plankton (29) were collected in 3 locations (11 degrees 50' N, 68 degrees 15' W; 10 degrees 36' 24'' N, 67 degrees 14'7'' W and 10 degrees 21' N, 64 degrees 21' W). The correlation carried out over 167 species of phytoplankton present in the samples indicates that the species most likely to be responsible for the production of the fraction beta, in order of feasibility index (in parentheses) are: Ceratium furca (54%), Protoperidinium sp. (1.7%) and Protoperidinium pallidum (1.6%). In some samples a fraction similar to fraction alpha from T. ignis was also found. The identification of the phytoplankton responsible for this fraction is, however, less conclusive. The feasibility indexes are: Protoperidinium sp. (58%), Ceratium inflatum (30%), Podolampas sp. (23%), Ornithocercus steini (21%). The genus Ceratium was the second most abundant in Carenero at the time of the fish death. These results suggest that the toxins isolated from C. edentulus and T. ignis have a planktonic origin.

Blue-green algae poisoning

Poisoning by blue-green algae occurs after an algal "bloom" caused by warm weather and algal concentration. On death or disintegration, the algae release liver toxins and neurotoxins (fast death factor). Although deaths are common in animal exposures, human exposures have been limited to various allergic reactions, mild liver enzyme elevation, and gastroenteritis. A case of animal deaths and its relationship to human exposures is discussed.

Hazardous marine animals

Both traumatic injury and the damage inflicted by envenomating marine animals are considered in this article. Among the creatures causing traumatic injury are sharks, barracudas, moray eels, and needlefish. Envenomating animals include sponges, coelenterates, coral, various mollusks, sea urchins, sea cucumbers, stingrays, sea snakes, and others.

An analysis of poison control center reports of ciguatera toxicity in Puerto Rico for one year

Forty-five cases of ciguatera poisoning in Puerto Rico (P.R.) are described. These cases represent all those reported to the P.R. Poison Control Center in 1982. Most of the cases were reported in the spring and summer months. The most common fish ingested was the grouper. The clinical presentation of acute and long term symptoms was similar to that reported in other geographical areas, except the incidence of paresthesias. Paresthesias were reported in 11% of the patients reported to the poison center. A companion telephone survey indicated that persons in P.R. that do not eat fish do so because of fear of ingesting the toxin. Our findings indicate an overall familial contact with the ciguatera toxin in Puerto Rico at 7%. This study is the first to document that ciguatera is a common poisoning reported to the Poison Control Center in Puerto Rico. Our findings also support other authors contentions of geographical variations in clinical symptomatology.

Survival after severe envenomation by the blue-ringed octopus (Hapalochlaena maculosa)

I report two cases of life-endangering respiratory failure after envenomation by a blue-ringed octopus (Hapalochlaena maculosa). Early and efficient support of respiratory function is vital in such cases. Cardiac asystole occurred in one patient. Both patients recovered completely after the vigorous application of routine resuscitation techniques.

Preliminary immunologic studies of ciguatera poisoning

Preliminary immunologic studies of ciguatera poisoning were performed with serum samples from patients and extracts from both toxic and nontoxic fish. Counterimmunoelectrophoresis disclosed precipitin lines with toxic fish extracts and effectively discriminated between samples established as toxic or nontoxic on the basis of human toxic reactions and by an in vivo mouse bioassay. However, it is not currently possible to conclude that affected individuals had specific antibody to ciguatoxin, since putative immune and nonimmune serum samples gave equally clear precipitin reactions with toxic extracts.

Marine envenomations

As man takes increasing advantage of the waters of the world for recreational, commercial and scientific purposes, the hazards of human contact with inhabitants must be appreciated. Many invertebrate and vertebrate animal species have developed natural defense mechanisms, some of which involve envenomation, with a few species posing the threat of serious injury or death. This paper discusses the more common and more serious marine envenomations encountered worldwide, including toxicology of the associated venoms and a discussion of current treatment recommendations.

Foods, and food and drug combinations, responsible for head and neck pain

The literature has been reviewed to uncover the existence of head and neck pain syndromes caused by foods and food and drug combinations. Knowledge of the etiology of such syndromes may help in their treatment. At least twenty-five syndromes have been described. These include those induced by coloring and flavoring agents, alcoholic products, chocolate, coffee and tea, foods containing tyramine, vitamins, minerals, pesticides, and several others. Where possible, the active ingredients and the minimal amounts responsible for the induction of pain have been identified.

Scombrotoxin and scombrotoxin-like poisoning from canned fish

A number of scombrotoxin poisoning incidents which have recently occurred in the UK following the consumption of canned fish have been investigated. Symptoms are described and the relationship between the histamine content of incriminated samples and toxicity is discussed.

[Stings by venomous cones observed in New Caledonia and dependencies (author's transl)]

Authors review height cases of stings by venomous cones observed in New Caledonia. They describe the morphology of the venom apparatus of these attracting molluscs and emphasize the severity of the injuries. Prognosis is the worst in children, and Conus geographus is the most dangerous species of the genus Conus. There is no valuable treatment and prevention is the sole protection.

[Injuries by marine animals in New Caledonia and dependencies (author's transl)]

Injuries by marine animals present diverse types and forms. The responsible sea-animals resort to many zoological species, vertebrates and invertebrates, ranging from fishes to sponges. The vulnerant processes are also various: the wound being or not associated with envenomation. Venoms are different, according to the species: some ones are only histotoxic and have a local effect around the wound, others are viscerotoxic, giving a generalized and sometimes fatal intoxication. New Caledonia is an archipelago situated in particularly warm waters, and therefore is a privileged area to observe marine animals injuries. These accidents are more frequent in number in Noumea area, but mainly concern newcomers. In other areas, the insular population much in contact with sea because the food it harvests from it, provides many victims. From personal cases and from those recorded in dispensaries and in G. Bourret Hospital of Noumea, the authors describe the main syndromes: --traumas by non venomous marine animals, --traumas by venomous marine animals: --bites --pricks: single or few - multiple and urticant. For each of these syndromes, the responsible animals, their vulnerant apparatus and their modes of action, their symptomatologies and their treatment are given with a practical view.

Dogger bank itch. 4. An eczema-causing sulfoxonium ion from the marine animal, Alcyonidium gelatinosum [Bryozoa]

Repeated exposure to the marine bryozoan, Alcyonidium gelatinosum, frequently provokes an eczematous allergic contact dermatitis known as the "Dogger Bank Itch". The dermatitis, representing a severe occupational disease, is especially widely distributed among trawlermen working in the Dogger Bank area in the North Sea. The allergy is shown to belong to the type of cell-mediated hypersensitivity. The hapten has been identified as the (2-hydroxyethyl)dimethylsulfoxonium ion. The isolation, structure determination and synthesis are discussed.