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Chinain M, Gatti CMI, Darius HT, Quod JP, Tester PA. Ciguatera poisonings: A global review of occurrences and trends. HARMFUL ALGAE 2021; 102:101873. [PMID: 33875186 DOI: 10.1016/j.hal.2020.101873] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 06/12/2023]
Abstract
Ciguatera Poisoning (CP) is the most prevalent, phycotoxin related seafood poisoning across the globe, affecting between 10,000 and 50,000 people annually. This illness results from the consumption of seafood contaminated with lipid soluble toxins known as ciguatoxins (CTXs) that are produced by benthic dinoflagellates in the genera Gambierdiscus and Fukuyoa. The present work reviews the global occurrence of CP events and outbreaks, based on both scientific and gray literature. Ciguatera prevalence is significantly underestimated due to a lack of recognition of ciguatera symptoms, limited collection of epidemiological data on a global level, and reticence to report ciguatera in CP-endemic regions. Analysis of the time-series data available for a limited number of countries indicates the highest incidence rates are consistently reported from two historical CP-endemic areas i.e., the Pacific and Caribbean regions, a situation due in part to the strong reliance of local communities on marine resources. Ciguatera-related fatalities are rare (<0.1% of reported cases). The vast majority of outbreaks involve carnivorous fish including snappers, groupers, wrasses, and barracudas. Since 2000, an expansion of the geographical range of CP has been observed in several areas like Macaronesia and east and southeast Asia. In some of these locales, random surveys confirmed the presence of CTXs in locally sourced fish, consistent with the concurrent report of novel CP incidents (e.g., Canary Islands, Madeira, Selvagens Islands, New South Wales). One characteristic of outbreaks occurring in Asia is that they often present as large disease clusters due to group consumption of a single contaminated fish. Similar observations are reported from the Indian Ocean in the form of shark poisoning outbreaks which often lead to singular types of CP characterized by a high fatality rate. Other atypical forms of CP linked to the consumption of marine invertebrates also have been documented recently. Owing to the significant health, socioeconomic and socio-cultural impacts of ciguatera, there is an urgent need for increased, standardized, coordinated efforts in ciguatera education, monitoring and research programs. Several regional and international initiatives have emerged recently, that may help improve patients' care, data collection at a global scale, and risk monitoring and management capabilities in countries most vulnerable to CP's toxic threat.
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Affiliation(s)
- M Chinain
- Laboratory of Marine Biotoxins, Institut Louis Malardé - UMR 241 EIO, BP 30, 98713 Papeete, Tahiti, French Polynesia.
| | - C M I Gatti
- Laboratory of Marine Biotoxins, Institut Louis Malardé - UMR 241 EIO, BP 30, 98713 Papeete, Tahiti, French Polynesia
| | - H T Darius
- Laboratory of Marine Biotoxins, Institut Louis Malardé - UMR 241 EIO, BP 30, 98713 Papeete, Tahiti, French Polynesia
| | - J-P Quod
- ARVAM-Pareto, Technopole de la Réunion, 14 rue Henri Cornu, 97490 Sainte-Clotilde, La Réunion, France
| | - P A Tester
- Ocean Tester, LLC, 295 Dills Point Road, Beaufort, NC 28516, USA
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Haouzi A, Khraishah H, Diamond J, Pinto DS. A case report of cardiac toxicity from barracuda ingestion in Mexico. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33442632 PMCID: PMC7793170 DOI: 10.1093/ehjcr/ytaa433] [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] [Received: 03/04/2020] [Revised: 04/07/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022]
Abstract
Background Ciguatera toxicity is a fish-borne illness that initially manifests with gastrointestinal symptoms, followed by bizarre neurological symptoms including heat-cold sensation alteration, peculiar feeling of loose teeth, and peripheral neuropathy. However, cardiac manifestations are rare and underreported in the literature. Case summary A 73-year-old man presented with symptomatic bradycardia and hypotension after ingestion of barracuda fish in Mexico. He received atropine and dopamine with subsequent improvement in his symptoms, but continued to experience peripheral neuropathic and other odd sensations. Four of his family members ingested the same fish and had similar symptoms. He was managed conservatively and did not require temporary or permanent pacing. Within 1 week from toxin exposure, bradycardia had improved. Heart rate was 40–50 b.p.m. at rest, and he was discharged with an ambulatory monitor. Heart rate had increased to 77 b.p.m. at 1-month follow-up on repeat electrocardiogram (ECG). Discussion Although the predominant manifestations of ciguatera toxicity are neurological, cardiac complications tend to be more acute and require attention. Unlike neurological symptoms, bradycardia and hypotension are short-lived, often resolving within a week. Treatment continues to be largely supportive, and patients may require temporary treatment with positive chronotropic agents such as atropine or dopamine.
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Affiliation(s)
- Alice Haouzi
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA 02215, USA
| | - Haitham Khraishah
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA 02215, USA
| | - Jamie Diamond
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA 02215, USA
| | - Duane S Pinto
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Boston, MA 02215, USA
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Adt C, D’Araujo L. Gastroentérite atypique révélant une intoxication métropolitaine à la ciguatoxine. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ciguatera in Mexico (1984⁻2013). Mar Drugs 2018; 17:md17010013. [PMID: 30597874 PMCID: PMC6356608 DOI: 10.3390/md17010013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/04/2018] [Accepted: 12/12/2018] [Indexed: 11/17/2022] Open
Abstract
Historical records of ciguatera in Mexico date back to 1862. This review, including references and epidemiological reports, documents 464 cases during 25 events from 1984 to 2013: 240 (51.72%) in Baja California Sur, 163 (35.12%) in Quintana Roo, 45 (9.69%) in Yucatan, and 16 (3.44%) cases of Mexican tourists intoxicated in Cuba. Carnivorous fish, such as snapper (Lutjanus) and grouper (Epinephelus and Mycteroperca) in the Pacific Ocean, and great barracuda (Sphyraena barracuda) and snapper (Lutjanus) in the Atlantic (Gulf of Mexico and Caribbean Sea), were involved in all cases. In the Mexican Caribbean, a sub-record of ciguatera cases that occurred before 1984 exists. However, the number of intoxications has increased in recent years, and this food poisoning is poorly studied in the region. Current records suggest that ciguatera fish poisoning in humans is the second most prevalent form of seafood poisoning in Mexico, only exceeded by paralytic shellfish poisoning (505 cases, 21 fatalities in the same 34-year period). In this study, the status of ciguatera in Mexico (epidemiological and treatment), and the fish vectors are reviewed. Dinoflagellate species Gambierdiscus, Ostreopsis, and Prorocentrum are related with the reported outbreaks, marine toxins, ecological risk, and the potential toxicological impact.
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Sintunawa C, Wacharapluesadee S, Saraya A, Hemachudha T. Surveillance of marine fish for ciguatera toxin at fish markets in Bangkok, Thailand. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0802.288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Ciguatera intoxication is a form of food poisoning. It is caused by the consumption of certain warm-water fish that have accumulated ciguatera toxin (CTX) through the marine food chain. Ciguatera fish poisoning (CFP) is a global disease, which although common, has been largely ignored in Thailand. This may be attributed to lack of confirmatory tests and seemingly nonspecific clinical presentations.
Objective: We studied CTX contamination in marine fish sold at Bangkok markets.
Methods: A surveillance of CTX in fish using the Cigua-Check assay has been conducted in Bangkok, the center of seafood marketing in Thailand. Here, there are several types of fish. Some come from domestic fishing and others are imported from Indonesia, Myanmar, or India.
Results: A random survey at three fish markets in Bangkok revealed two samples possibly contaminated with ciguatera toxin from a total 227 fish samples (of 21 fish species). This is the first report of finding CTX contamination in fish meat sold in Bangkok.
Conclusion: It is possible that these CTX-positive fish were caught from other countries. Even though the positivity (0.88%) is lower when compared with studies of other endemic areas (5.0% in Hawaii and Pacific Islands), this finding should raise awareness of the possibility of facing rare CFP intoxication from fish obtained at local Thai markets.
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Affiliation(s)
- Chirapol Sintunawa
- Faculty of Environment and Resource Studies, Mahidol University, Nakorn Pathom 73170, Thailand
| | - Supaporn Wacharapluesadee
- Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, and WHO Collaborating Centre for Research and Training on Viral Zoonoses, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Abhinbhen Saraya
- Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, and WHO Collaborating Centre for Research and Training on Viral Zoonoses, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Thiravat Hemachudha
- Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, and WHO Collaborating Centre for Research and Training on Viral Zoonoses, Thai Red Cross Society, Bangkok 10330, Thailand
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Meyer L, Capper A, Carter S, Simpfendorfer C. An investigation into ciguatoxin bioaccumulation in sharks. Toxicon 2016; 119:234-43. [DOI: 10.1016/j.toxicon.2016.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 05/26/2016] [Accepted: 06/07/2016] [Indexed: 12/01/2022]
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Abstract
This case report presents two British medical students who contracted ciguatera poisoning while on elective in the Cook Islands. Thirty-six hours after consuming two reef fish they developed paraesthesia of the mouth, hands and feet, myalgia, pruritis and cold allodynia. Neurological examination was normal. Diagnosis of ciguatera poisoning was made on history of reef fish consumption and classical clinical presentation. Management was symptomatic (antihistamines) and both students made a full recovery within 10 weeks.
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Stewart I, Lewis RJ, Eaglesham GK, Graham GC, Poole S, Craig SB. Emerging tropical diseases in Australia. Part 2. Ciguatera fish poisoning. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 104:557-71. [DOI: 10.1179/136485910x12851868779902] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Kumar-Roiné S, Taiana Darius H, Matsui M, Fabre N, Haddad M, Chinain M, Pauillac S, Laurent D. A review of traditional remedies of ciguatera fish poisoning in the Pacific. Phytother Res 2012; 25:947-58. [PMID: 21287650 DOI: 10.1002/ptr.3396] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Ciguatera fish poisoning (CFP) is an illness caused by eating tropical coral fish contaminated with ciguatoxins (CTXs). The clinical management of patients with CFP is generally supportive and symptomatic in nature as no antidote exists. Of the many drugs prescribed, several have been claimed to be efficient in small, uncontrolled studies, but the outcomes of treatments with these medicines are often contradictory. In New Caledonia, traditional remedies are commonly employed in the treatment of CFP and of the 90 plant species catalogued as useful in CFP, the most popular herbal remedy by far is a decoction prepared from the leaves of Heliotropium foertherianum Diane & Hilger (Boraginaceae). Other important plants used in the treatment of CFP include Euphorbia hirta L. (Euphorbiaceae) and Vitex L. sp. (Lamiaceae). This review focuses on the evidence for efficacy of these species and pharmacological studies which support their use. Other plants used in CFP and the conventional treatment of CFP are also discussed briefly.
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Affiliation(s)
- Shilpa Kumar-Roiné
- UMR 152-Laboratoire de Pharmacochimie des Substances Naturelles et Pharmacophores Redox, Université de Toulouse, UPS, 118 Rte de Narbonne, F-31062 Toulouse Cedex 9, France
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Boada LD, Zumbado M, Luzardo OP, Almeida-González M, Plakas SM, Granade HR, Abraham A, Jester EL, Dickey RW. Ciguatera fish poisoning on the West Africa Coast: An emerging risk in the Canary Islands (Spain). Toxicon 2010; 56:1516-9. [DOI: 10.1016/j.toxicon.2010.07.021] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 06/22/2010] [Accepted: 07/29/2010] [Indexed: 11/29/2022]
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Kumar-Roiné S, Matsui M, Reybier K, Darius HT, Chinain M, Pauillac S, Laurent D. Ability of certain plant extracts traditionally used to treat ciguatera fish poisoning to inhibit nitric oxide production in RAW 264.7 macrophages. JOURNAL OF ETHNOPHARMACOLOGY 2009; 123:369-377. [PMID: 19501268 DOI: 10.1016/j.jep.2009.03.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 03/24/2009] [Accepted: 03/25/2009] [Indexed: 05/27/2023]
Abstract
AIM OF THE STUDY Ciguatera fish poisoning (CFP) is an intertropical ichthyosarcotoxism that manifests in complex assortment of symptoms in humans. Ciguatoxins (CTXs), issued from Gambierdicus spp., are causative agents of this intoxication. We have recently demonstrated that a Pacific CTX (P-CTX-1B) strongly modulated iNOS expression, leading to overproduction of nitric oxide (NO) in RAW 264.7 murine macrophage cells. NO produced in large amounts is involved in a wide range of pathophysiological processes. Many traditional remedies are commonly used in the Pacific against CFP. In this context, bioassay-guided screening was carried out to study NO inhibiting capacity of 28 selected plant extracts. MATERIALS AND METHODS We prepared aqueous extracts of plants used in New Caledonia in the treatment of CFP and screened their NO inhibitory activity in lipopolysaccharide (LPS)-activated RAW 264.7 macrophages. RESULTS Among 28 plants tested, Euphorbia hirta (Euphorbiaceae), Syzygium malaccense (Myrtaceae), Schinus terebenthifolius (Anacardiaceae), Punica granatum (Punicaceae), Cerbera manghas (Apocynaceae), Vitex trifolia (Labiateae) and Ximenia americana (Olacaceae) showed inhibitory activity, validating their use as traditional remedies in CFP, and the potential for use in the treatment of conditions accompanied by NO overproduction. CONCLUSION These plants are promising candidates for further screening of their active compounds through activity-guided fractionation.
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Affiliation(s)
- Shilpa Kumar-Roiné
- Université de Toulouse, UPS, UMR 152 (Laboratoire de Pharmacochimie des Substances Naturelles et Pharmacophores Redox), 118 Rte de Narbonne, F-31062 Toulouse Cedex 9, France
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Specific and dynamic detection of palytoxins by in vitro microplate assay with human neuroblastoma cells. Biosci Rep 2008; 29:13-23. [DOI: 10.1042/bsr20080080] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Palytoxin is one of the most complex and biggest molecules known to show extreme acute toxicity. The dinoflagellate Ostreopsis spp., the producer organism of palytoxin, has been shown to be distributed worldwide, thus making palytoxin an emerging toxin. Rat-derived hepatocytes (Clone 9) and BE (2)-M17 human neuroblastoma cells were used to test palytoxin or palytoxin-like compounds by measuring the cell metabolic rate with Alamar Blue. The dose-dependent decrease in viability was specifically inhibited by ouabain in the case of BE (2)-M17 neuroblastoma cells. This is a functional, dynamic and simple test for palytoxins with high sensitivity (as low as 0.2 ng/ml). This method was useful for toxin detection in Ostreopsis extracts and naturally contaminated mussel samples. A comparative study testing toxic mussel extracts by LC (liquid chromatography)-MS/MS (tandem MS), MBA (mouse bioassay), haemolysis neutralization assay and a cytotoxicity test indicated that our method is suitable for the routine determination and monitoring of palytoxins and palytoxin-like compounds.
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