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Morihara C, Yinadsawaphan T, Capirig CJ, Fujiuchi B, Hirao Y, Hu J, Malone RM, Neuendorf J, Neuendorf S, Ongsupankul S, Shiraishi K, Benavente K, Nishimura Y. Clinicoepidemiological Profile of Ciguatera Cardiotoxicity: A Systematic Review. Am J Trop Med Hyg 2024; 111:671-675. [PMID: 38981507 PMCID: PMC11376153 DOI: 10.4269/ajtmh.24-0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/29/2024] [Indexed: 07/11/2024] Open
Abstract
Patients with ciguatera poisoning commonly present with gastrointestinal and neurologic symptoms, but its cardiotoxicity has been largely unrecognized. This systematic review is the first to summarize the evidence regarding clinical characteristics of cardiotoxicity from ciguatera poisoning to provide the illness script and pertinent knowledge for clinicians. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including "ciguatera" and "cardiotoxicity" from their inception to January 2024. We included 20 articles, including 148 cases, in this systematic review. Among the included cases, the median age was 54 years with male predominance (62.2%). Based on the WHO designation, 68.5% were reported from the Western Pacific Region. Common symptoms included hypotension (75.0%) and bradycardia (67.6%), and chest pain or syncope were less commonly reported (2.7% and 1.4%, respectively). Sinus bradycardia was the most common electrocardiogram abnormality (35.9%), followed by atrioventricular blocks (15.4%). Symptomatic treatments such as atropine, dopamine, and epinephrine were commonly used, and only 4.1% required intensive care unit admission. None expired due to cardiotoxicity from ciguatera. This review summarizes the current evidence and the characteristics of cardiotoxicity from ciguatera. Although ciguatera cardiotoxicity is currently underrecognized, increased awareness of the condition in clinicians is crucial because the clinical outcomes of the patients could be benign as long as it is identified and intervened early.
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Affiliation(s)
- Clarke Morihara
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Thanaboon Yinadsawaphan
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Christian John Capirig
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Bradley Fujiuchi
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Yusuke Hirao
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Joshua Hu
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Reed McCardell Malone
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Jadon Neuendorf
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Sable Neuendorf
- Medical Education, California University of Science and Medicine, Colton, California
| | - Sorawit Ongsupankul
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Kazushige Shiraishi
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Kevin Benavente
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
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Strickler J, Kellish A. Seafood poisoning. Nursing 2024; 54:34-37. [PMID: 39051956 DOI: 10.1097/nsg.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
ABSTRACT Seafood poisoning is common worldwide but is relatively unknown by clinicians and the general public and can be confused with other causes. This article discusses two common seafood poisoning cases-ciguatera and scombroid poisoning-and offers recommended nursing considerations.
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Affiliation(s)
- Jeff Strickler
- Jeff Strickler is the chief operating officer at UNC Hospitals Hillsborough in Hillsborough, N.C., the assistant CNO for Behavioral Health at UNC Medical Center in Chapel Hill, N.C., and the president of UNC Health Chatham in Siler City, N.C. He is also a member of the Nursing2024 Editorial Board. Ashley Kellish is the director of the Center for Nursing Excellence at UNC Hospitals and an associate professor at UNC School of Nursing in Chapel Hill, N.C
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Niazi BA, Trivedi C, Perrella B. A Rare Case of Junctional Bradycardia Secondary to Oral Phenytoin. Cureus 2022; 14:e25251. [PMID: 35755519 PMCID: PMC9216670 DOI: 10.7759/cureus.25251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 12/04/2022] Open
Abstract
Phenytoin is a commonly used anti-seizure agent, which stabilizes neuronal membranes by blocking voltage-gated sodium channels to inhibit the propagation of action potentials during convulsions. However, phenytoin has also been shown to have antiarrhythmic effects as it can prolong the effective refractory period of ventricular pacemaker cells. Adverse cardiac effects such as junctional bradycardia are usually seen with intravenous use. Cardiovascular dysfunction is not well recognized in oral phenytoin toxicity. Here we present a case of junctional bradycardia due to oral phenytoin toxicity, which resolved spontaneously with the discontinuation of phenytoin. This case report will serve to increase awareness of the adverse cardiovascular effects of oral phenytoin toxicity to improve the recognition and treatment of these adverse effects.
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Epidemiology and Toxicology of Ciguatera Poisoning in the Colombian Caribbean. Mar Drugs 2020; 18:md18100504. [PMID: 33019517 PMCID: PMC7601626 DOI: 10.3390/md18100504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 01/02/2023] Open
Abstract
Ciguatera is a food intoxication caused by the consumption of primarily coral fish; these species exist in large numbers in the seas that surround the Colombian territory. The underreported diagnosis of this clinical entity has been widely highlighted due to multiple factors, such as, among others, ignorance by the primary care practitioner consulted for this condition as well as clinical similarity to secondary gastroenteric symptoms and common food poisonings of bacterial, parasitic or viral etiology. Eventually, it was found that people affected by ciguatoxins had trips to coastal areas hours before the onset of symptoms. Thanks to multiple studies over the years, it has been possible to identify the relation between toxigenic dinoflagellates and seagrasses, as well as its incorporation into the food chain, starting by fish primarily inhabiting reef ecosystems and culminating in the intake of these by humans. Identifying the epidemiological link, its cardinal symptoms and affected systems, such as gastrointestinal, the peripheral nervous system and, fortunately with a low frequency, the cardiovascular system, leads to a purely clinical diagnostic impression without necessitating further complementary studies; in addition, what would also help fight ciguatera poisoning is performing an adequate treatment of the symptoms right from the start, without underestimating or overlooking any associated complications.
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