1
|
Cardoso CW, Oliveira e Silva MM, Bandeira AC, Silva RB, Prates APPB, Soares ÊS, Silva JJM, de Souza LJR, Souza MMDS, Muhana MA, Pires RSS, Araujo Neto JF, Santos MSS, Mafra Junior LL, Alves TP, Schramm MA, Ribeiro GS. Haff Disease in Salvador, Brazil, 2016-2021: Attack rate and detection of toxin in fish samples collected during outbreaks and disease surveillance. LANCET REGIONAL HEALTH. AMERICAS 2021; 5:100092. [PMID: 36776458 PMCID: PMC9904022 DOI: 10.1016/j.lana.2021.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Background From late 2016 to early 2021, cases of Haff disease, a rare cause of rhabdomyolysis, possibly due to poisoning by palytoxin-like compounds in seafood, were detected in Salvador, Brazil. Surveillance was established to detect additional cases aiming at describing the clinical characteristics of the cases, identifying associated factors, estimating disease attack rate, and investigating the presence of biotoxins and trace metals in selected fish specimens obtained from cases. Method Between December/2016-January/2021, surveillance investigated Haff disease suspected cases, and obtained clinical and fish samples to test. Findings Of 65 cases investigated during the 2016-2017 outbreak, 43 (66%) had high creatine phosphokinase (CPK) levels. Among those with laboratory-confirmed rhabdomyolysis, 38 (88%) were hospitalized, 11 (26%) required intensive care, and three (7%) dialysis. Ingestion of marine fish 24h before disease onset was reported by 74% of the cases with elevated CPK and by 41% of those without CPK measurement (P=0·02). Attack rate for individuals who ate fish related to the outbreak was 55%. Following this outbreak, surveillance identified 12 suspected cases between 2017-2019, and a second outbreak in 2020-2021, with 16 laboratory-confirmed rhabdomyolysis patients (five required intensive care; one died). No traces of ciguatoxins and metals were detected in fish specimens obtained in 2016, found to be Seriola rivoliana. Some fish samples from 2020 were screened for palytoxin (PlTX)-like compounds and contained detectable levels of molecule fragments characteristics of isobaric PlTX, ovatoxin-a (OVTX-a), OVTX-b and OVTX-d. Interpretation These findings support the hypothesis that compounds related to PlTX accumulated in marine fish may be the toxic agent causing the disease. Haff disease is a life-threatening condition, requiring clinical suspicion for patients with sudden-onset myalgia following fish ingestion. Suspected cases should be reported to health authorities for investigation.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guilherme Sousa Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil,Corresponding author:
| |
Collapse
|
2
|
Xu Y, He X, Lee WH, Chan LL, Lu D, Wang P, Tao X, Li H, Yu K. Ciguatoxin-Producing Dinoflagellate Gambierdiscus in the Beibu Gulf: First Report of Toxic Gambierdiscus in Chinese Waters. Toxins (Basel) 2021; 13:toxins13090643. [PMID: 34564646 PMCID: PMC8473099 DOI: 10.3390/toxins13090643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
Ciguatera poisoning is mainly caused by the consumption of reef fish that have accumulated ciguatoxins (CTXs) produced by the benthic dinoflagellates Gambierdiscus and Fukuyoa. China has a long history of problems with ciguatera, but research on ciguatera causative organisms is very limited, especially in the Beibu Gulf, where coral reefs have been degraded significantly and CTXs in reef fish have exceeded food safety guidelines. Here, five strains of Gambierdiscus spp. were collected from Weizhou Island, a ciguatera hotspot in the Beibu Gulf, and identified by light and scanning electron microscopy and phylogenetic analyses based on large and small subunit rDNA sequences. Strains showed typical morphological characteristics of Gambierdiscus caribaeus, exhibiting a smooth thecal surface, rectangular-shaped 2′, almost symmetric 4″, and a large and broad posterior intercalary plate. They clustered in the phylogenetic tree with G. caribaeus from other locations. Therefore, these five strains belonged to G. caribaeus, a globally distributed Gambierdiscus species. Toxicity was determined through the mouse neuroblastoma assay and ranged from 0 to 5.40 fg CTX3C eq cell−1. The low level of toxicity of G. caribaeus in Weizhou Island, with CTX-contaminated fish above the regulatory level in the previous study, suggests that the long-term presence of low toxicity G. caribaeus might lead to the bioaccumulation of CTXs in fish, which can reach dangerous CTX levels. Alternatively, other highly-toxic, non-sampled strains could be present in these waters. This is the first report on toxic Gambierdiscus from the Beibu Gulf and Chinese waters and will provide a basis for further research determining effective strategies for ciguatera management in the area.
Collapse
Affiliation(s)
- Yixiao Xu
- Key Laboratory of Environment Change and Resources Use in Beibu Gulf, Ministry of Education, Nanning Normal University, Nanning 530001, China; (Y.X.); (X.H.); (X.T.); (H.L.)
- Guangxi Key Laboratory of Earth Surface Processes and Intelligent Simulation, Nanning Normal University, Nanning 530001, China
- Guangxi Laboratory on the Study of Coral Reefs in the South China Sea, Guangxi University, Nanning 530004, China
| | - Xilin He
- Key Laboratory of Environment Change and Resources Use in Beibu Gulf, Ministry of Education, Nanning Normal University, Nanning 530001, China; (Y.X.); (X.H.); (X.T.); (H.L.)
- Guangxi Key Laboratory of Earth Surface Processes and Intelligent Simulation, Nanning Normal University, Nanning 530001, China
| | - Wai Hin Lee
- The State Key Laboratory of Marine Pollution, Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, China; (W.H.L.); (L.L.C.)
- Shenzhen Key Laboratory for the Sustainable Use of Marine Biodiversity, Research Centre for the Oceans and Human Health, City University of Hong Kong Shenzhen Research Institute, Shenzhen 518057, China
| | - Leo Lai Chan
- The State Key Laboratory of Marine Pollution, Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, China; (W.H.L.); (L.L.C.)
- Shenzhen Key Laboratory for the Sustainable Use of Marine Biodiversity, Research Centre for the Oceans and Human Health, City University of Hong Kong Shenzhen Research Institute, Shenzhen 518057, China
| | - Douding Lu
- Key Laboratory of Marine Ecosystem Dynamics, Second Institute of Oceanography, Ministry of Natural Resources, Hangzhou 310012, China; (D.L.); (P.W.)
- The Fourth Institute of Oceanography, Ministry of Natural Resources, Beihai 536000, China
| | - Pengbin Wang
- Key Laboratory of Marine Ecosystem Dynamics, Second Institute of Oceanography, Ministry of Natural Resources, Hangzhou 310012, China; (D.L.); (P.W.)
- The Fourth Institute of Oceanography, Ministry of Natural Resources, Beihai 536000, China
| | - Xiaoping Tao
- Key Laboratory of Environment Change and Resources Use in Beibu Gulf, Ministry of Education, Nanning Normal University, Nanning 530001, China; (Y.X.); (X.H.); (X.T.); (H.L.)
- Guangxi Key Laboratory of Earth Surface Processes and Intelligent Simulation, Nanning Normal University, Nanning 530001, China
| | - Huiling Li
- Key Laboratory of Environment Change and Resources Use in Beibu Gulf, Ministry of Education, Nanning Normal University, Nanning 530001, China; (Y.X.); (X.H.); (X.T.); (H.L.)
- Guangxi Key Laboratory of Earth Surface Processes and Intelligent Simulation, Nanning Normal University, Nanning 530001, China
| | - Kefu Yu
- Guangxi Laboratory on the Study of Coral Reefs in the South China Sea, Guangxi University, Nanning 530004, China
- Correspondence:
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Chinain M, Gatti CMI, Ung A, Cruchet P, Revel T, Viallon J, Sibat M, Varney P, Laurent V, Hess P, Darius HT. Evidence for the Range Expansion of Ciguatera in French Polynesia: A Revisit of the 2009 Mass-Poisoning Outbreak in Rapa Island (Australes Archipelago). Toxins (Basel) 2020; 12:E759. [PMID: 33271904 PMCID: PMC7759781 DOI: 10.3390/toxins12120759] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 01/14/2023] Open
Abstract
Ciguatera poisoning (CP) results from the consumption of seafood contaminated with ciguatoxins (CTXs). This disease is highly prevalent in French Polynesia with several well-identified hotspots. Rapa Island, the southernmost inhabited island in the country, was reportedly free of CP until 2007. This study describes the integrated approach used to investigate the etiology of a fatal mass-poisoning outbreak that occurred in Rapa in 2009. Symptoms reported in patients were evocative of ciguatera. Several Gambierdiscus field samples collected from benthic assemblages tested positive by the receptor binding assay (RBA). Additionally, the toxicity screening of ≈250 fish by RBA indicated ≈78% of fish could contain CTXs. The presence of CTXs in fish was confirmed by liquid chromatography tandem mass spectrometry (LC-MS/MS). The potential link between climate change and this range expansion of ciguatera to a subtropical locale of French Polynesia was also examined based on the analysis of temperature time-series data. Results are indicative of a global warming trend in Rapa area. A five-fold reduction in incidence rates was observed between 2009 and 2012, which was due in part to self-regulating behavior among individuals (avoidance of particular fish species and areas). Such observations underscore the prominent role played by community outreach in ciguatera risk management.
Collapse
Affiliation(s)
- Mireille Chinain
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| | - Clémence Mahana iti Gatti
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| | - André Ung
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| | - Philippe Cruchet
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| | - Taina Revel
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| | - Jérôme Viallon
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| | - Manoëlla Sibat
- Institut Français de Recherche Pour l’Exploitation de la Mer, Phycotoxins Laboratory, 44311 Nantes, France; (M.S.); (P.H.)
| | - Patrick Varney
- Météo France, Direction Inter-Régionale en Polynésie Française, P.O. Box 6005, 98702 Faa’a, Tahiti, French Polynesia; (P.V.); (V.L.)
| | - Victoire Laurent
- Météo France, Direction Inter-Régionale en Polynésie Française, P.O. Box 6005, 98702 Faa’a, Tahiti, French Polynesia; (P.V.); (V.L.)
| | - Philipp Hess
- Institut Français de Recherche Pour l’Exploitation de la Mer, Phycotoxins Laboratory, 44311 Nantes, France; (M.S.); (P.H.)
| | - Hélène Taiana Darius
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| |
Collapse
|
5
|
Soliño L, Costa PR. Global impact of ciguatoxins and ciguatera fish poisoning on fish, fisheries and consumers. ENVIRONMENTAL RESEARCH 2020; 182:109111. [PMID: 31927300 DOI: 10.1016/j.envres.2020.109111] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/31/2019] [Accepted: 01/01/2020] [Indexed: 06/10/2023]
Abstract
Ciguatera fish poisoning (CFP) is one of the most devastating food-borne illnesses caused by fish consumption. Ciguatoxins (CTXs) are potent neurotoxins synthesized by the benthic microalgae Gambierdiscus spp. and Fukuyoa spp. that are transmitted to fish by grazing and predation. Despite the high incidence of CFP, affecting an estimated number of 50,000 persons per year in tropical and subtropical latitudes, the factors underlying CTXs occurrence are still not well understood. Toxin transfer and dynamics in fish and food-webs are complex. Feeding habits and metabolic pathways determine the toxin profile and toxicity of fish, and migratory species may transport and spread the hazard. Furthermore, CTX effect on fish may be a limiting factor for fish recruitment and toxin prevalence. Recently, new occurrences of Gambierdiscus spp. in temperate areas have been concomitant with the detection of toxic fish and CFP incidents in non-endemic areas. CFP cases in Europe have led to implementation of monitoring programs and fisheries restrictions with considerable impact on local economies. More than 400 species of fish can be vectors of CTXs, and most of them are high-valued commercial species. Thus, the risk uncertainty and the spread of Gambierdiscus have serious consequences for fisheries and food safety. Here, we present a critical review of CTXs impacts on fish, fisheries, and humans, based on the current knowledge on CFP incidence and CTXs prevalence in microalgae and fish.
Collapse
Affiliation(s)
- Lucía Soliño
- IPMA - Instituto Português do Mar da Atmosfera, Rua Alfredo Magalhães Ramalho, 6, 1495-006, Lisbon, Portugal; CCMAR - Centre of Marine Sciences, University of Algarve, Campus of Gambelas, 8005-139, Faro, Portugal.
| | - Pedro Reis Costa
- IPMA - Instituto Português do Mar da Atmosfera, Rua Alfredo Magalhães Ramalho, 6, 1495-006, Lisbon, Portugal; CCMAR - Centre of Marine Sciences, University of Algarve, Campus of Gambelas, 8005-139, Faro, Portugal
| |
Collapse
|
6
|
Friedemann M. [First ciguatera outbreak in Germany in 2012]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:1556-1565. [PMID: 27778083 DOI: 10.1007/s00103-016-2456-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In November 2012, 23 cases of ciguatera with typical combinations of gastrointestinal and neurological symptoms occurred in Germany after consumption of imported tropical fish (Lutjanus spp.). A questionnaire was used to gather information on the disease course and fish consumption. All patients suffered from pathognomonic cold allodynia. Aside from two severe courses of illness, all other cases showed symptoms of moderate intensity. During a three-year follow-up, seven patients reported prolonged paresthesia for more than one year. Two of them reported further neuropathies over almost three years. This is the first time that long-term persistence of symptoms has been documented in detail. Outbreak cases were allocated to eight clusters in seven German cities. A further cluster was prevented by the successful recall of ciguatoxic fish. Three clusters were confirmed by the detection of ciguatoxin in samples of suspicious and recalled fish. An extrapolation on the basis of ciguatoxic samples revealed twenty prevented cases of ciguatera. Further officially unknown cases should be assumed. During the outbreak investigations, inadvertently falsely labelled fish species and fishing capture areas on import and retail level documents were observed. The ascertainment of cases and the outbreak investigations proved to be difficult due to inconsistent case reports to poisons centers, local health and veterinary authorities. In Germany, many physicians are unaware of the disease pattern of ciguatera and the risks caused by tropical fish. The occurrence of further outbreaks during the following years emphasizes the increasing significance of ciguatera in Germany.
Collapse
Affiliation(s)
- Miriam Friedemann
- Dokumentation und Bewertung von Vergiftungen, Bundesinstitut für Risikobewertung (BfR), Diedersdorfer Weg 1, 12277, Berlin, Deutschland.
| |
Collapse
|
7
|
An Updated Review of Ciguatera Fish Poisoning: Clinical, Epidemiological, Environmental, and Public Health Management. Mar Drugs 2017; 15:md15030072. [PMID: 28335428 PMCID: PMC5367029 DOI: 10.3390/md15030072] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 01/07/2023] Open
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.
Collapse
|
8
|
Inserra MC, Israel MR, Caldwell A, Castro J, Deuis JR, Harrington AM, Keramidas A, Garcia-Caraballo S, Maddern J, Erickson A, Grundy L, Rychkov GY, Zimmermann K, Lewis RJ, Brierley SM, Vetter I. Multiple sodium channel isoforms mediate the pathological effects of Pacific ciguatoxin-1. Sci Rep 2017; 7:42810. [PMID: 28225079 PMCID: PMC5320492 DOI: 10.1038/srep42810] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/13/2017] [Indexed: 01/04/2023] Open
Abstract
Human intoxication with the seafood poison ciguatoxin, a dinoflagellate polyether that activates voltage-gated sodium channels (NaV), causes ciguatera, a disease characterised by gastrointestinal and neurological disturbances. We assessed the activity of the most potent congener, Pacific ciguatoxin-1 (P-CTX-1), on NaV1.1–1.9 using imaging and electrophysiological approaches. Although P-CTX-1 is essentially a non-selective NaV toxin and shifted the voltage-dependence of activation to more hyperpolarising potentials at all NaV subtypes, an increase in the inactivation time constant was observed only at NaV1.8, while the slope factor of the conductance-voltage curves was significantly increased for NaV1.7 and peak current was significantly increased for NaV1.6. Accordingly, P-CTX-1-induced visceral and cutaneous pain behaviours were significantly decreased after pharmacological inhibition of NaV1.8 and the tetrodotoxin-sensitive isoforms NaV1.7 and NaV1.6, respectively. The contribution of these isoforms to excitability of peripheral C- and A-fibre sensory neurons, confirmed using murine skin and visceral single-fibre recordings, reflects the expression pattern of NaV isoforms in peripheral sensory neurons and their contribution to membrane depolarisation, action potential initiation and propagation.
Collapse
Affiliation(s)
- Marco C Inserra
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Rd, St Lucia, Queensland 4072, Australia
| | - Mathilde R Israel
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Rd, St Lucia, Queensland 4072, Australia
| | - Ashlee Caldwell
- Visceral Pain Group, South Australian Health and Medical Research Institute (SAHMRI), School of Medicine, Flinders University, Adelaide, South Australia 5000, Australia.,Centre for Nutrition and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia 5000, Australia
| | - Joel Castro
- Visceral Pain Group, South Australian Health and Medical Research Institute (SAHMRI), School of Medicine, Flinders University, Adelaide, South Australia 5000, Australia.,Centre for Nutrition and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia 5000, Australia
| | - Jennifer R Deuis
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Rd, St Lucia, Queensland 4072, Australia
| | - Andrea M Harrington
- Visceral Pain Group, South Australian Health and Medical Research Institute (SAHMRI), School of Medicine, Flinders University, Adelaide, South Australia 5000, Australia.,Centre for Nutrition and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia 5000, Australia
| | - Angelo Keramidas
- Queensland Brain Institute, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Sonia Garcia-Caraballo
- Visceral Pain Group, South Australian Health and Medical Research Institute (SAHMRI), School of Medicine, Flinders University, Adelaide, South Australia 5000, Australia.,Centre for Nutrition and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia 5000, Australia
| | - Jessica Maddern
- Visceral Pain Group, South Australian Health and Medical Research Institute (SAHMRI), School of Medicine, Flinders University, Adelaide, South Australia 5000, Australia.,Centre for Nutrition and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia 5000, Australia
| | - Andelain Erickson
- Visceral Pain Group, South Australian Health and Medical Research Institute (SAHMRI), School of Medicine, Flinders University, Adelaide, South Australia 5000, Australia.,Centre for Nutrition and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia 5000, Australia
| | - Luke Grundy
- Visceral Pain Group, South Australian Health and Medical Research Institute (SAHMRI), School of Medicine, Flinders University, Adelaide, South Australia 5000, Australia.,Centre for Nutrition and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia 5000, Australia
| | - Grigori Y Rychkov
- Centre for Nutrition and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia 5000, Australia
| | - Katharina Zimmermann
- Klinik für Anästhesiologie am Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Richard J Lewis
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Rd, St Lucia, Queensland 4072, Australia
| | - Stuart M Brierley
- Visceral Pain Group, South Australian Health and Medical Research Institute (SAHMRI), School of Medicine, Flinders University, Adelaide, South Australia 5000, Australia.,Centre for Nutrition and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia 5000, Australia
| | - Irina Vetter
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Rd, St Lucia, Queensland 4072, Australia.,School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Queensland 4102, Australia
| |
Collapse
|
9
|
The Emergence and Epidemiology of Haff Disease in China. Toxins (Basel) 2016; 8:toxins8120359. [PMID: 27916937 PMCID: PMC5198553 DOI: 10.3390/toxins8120359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/23/2016] [Accepted: 11/28/2016] [Indexed: 11/17/2022] Open
Abstract
Haff disease is a rare syndrome of unexplained myalgia and rhabdomyolysis occurring within 24 h of consumption of certain types of cooked freshwater fish or crustacean. It is caused by a yet unidentified heat-stable toxin. In the present review of published case studies and official press releases, the main objective is to report the emergence and epidemiology of Haff disease in China. Haff disease first occurred in Beijing in 2000 and in Lianzhou and Liannan, Guangdong Province in 2009. Subsequent outbreaks mostly occurred in the Jiangsu Province—Nanjing, Yangzhou, Huai’an, and Yancheng. Isolated outbreaks occurred in other cities since 2010—Shijiazhuang, Yueyang, Shanghai, Wuhu, Baoding, Shenzhen, and Hong Kong (imported cases from Shenzhen). Outbreaks occurred predominately in the summer. Crayfish accounted for almost all the outbreaks. Two large outbreaks occurred in Lianzhou and Liannan in 2009 (n = 54) after eating pomfrets and in Nanjing in 2010 (n = 42) after eating crayfish. Other reports or outbreaks involved only 1–9 subjects (median 2 subjects). Variability in individual susceptibility and attack rates were noted, with many subjects remaining asymptomatic despite sharing the same seafood meal as the index cases. Adults were predominately involved. Symptoms occurred within 3–20 h of seafood ingestion, including myalgia, weakness, and, less frequently, nausea, vomiting, abdominal pain, and diarrhea. Myalgia and muscle weakness should normally subside within 2–3 days. Serum creatine phosphokinase became normal within 5–6 days. Abnormal renal function was uncommon. Serious complications (renal failure, multi-organ failure, and prolonged myopathy) and death were rare. In any subjects with unexplained myalgia and rhabdomyolysis, seafood consumption should be included in the history. All suspected cases of Haff disease, including milder presentations, should be reported to public health authorities.
Collapse
|
10
|
Chan TYK. Characteristic Features and Contributory Factors in Fatal Ciguatera Fish Poisoning--Implications for Prevention and Public Education. Am J Trop Med Hyg 2016; 94:704-9. [PMID: 26787145 DOI: 10.4269/ajtmh.15-0686] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/08/2015] [Indexed: 11/07/2022] Open
Abstract
In this review, the main objective was to describe the characteristic features of fatal ciguatera fish poisoning and identify contributory factors, with a view to promote prevention and public education. Ciguatera-related deaths, although rare, have been reported from the Pacific, Caribbean, and Indian Ocean regions. The clinical features were generally dominated by convulsions and coma, with various focal neurological signs. Several contributory factors could be identified, including consumption of ciguatoxin (CTX)-rich fish parts (viscera and head) in larger amounts, the most ciguatoxic fish species (e.g.,Gymnothorax flavimarginatus) and reef fish collected after storms and individuals' susceptibility. Mass ciguatera fish poisoning with mortalities also occurred when G. flavimarginatus and other ciguatoxic fish species were shared in gatherings and parties. The characteristic features of fatal ciguatera fish poisoning must be recognized early. The public should be repeatedly reminded to avoid eating the most ciguatoxic fish species and the CTX-rich parts of reef fish. To prevent mass poisoning in gatherings and parties, the most ciguatoxic fish species and potentially toxic fish species must be avoided. Particularly after hits by disastrous storms, it is important to monitor the toxicity of reef fish and the incidence rates of ciguatera.
Collapse
Affiliation(s)
- Thomas Y K Chan
- Division of Clinical Pharmacology and Drug and Poisons Information Bureau, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; Centre for Food and Drug Safety, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
11
|
Chan TYK. Ciguatoxic Potential of Brown-Marbled Grouper in Relation to Fish Size and Geographical Origin. Am J Trop Med Hyg 2015; 93:1117-21. [PMID: 26324735 DOI: 10.4269/ajtmh.15-0434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/18/2015] [Indexed: 11/07/2022] Open
Abstract
To determine the ciguatoxic potential of brown-marbled grouper (Epinephelus fuscoguttatus) in relation to fish size and geographical origin, this review systematically analyzed: 1) reports of large ciguatera outbreaks and outbreaks with description of the fish size; 2) Pacific ciguatoxin (P-CTX) profiles and levels and mouse bioassay results in fish samples from ciguatera incidents; 3) P-CTX profiles and levels and risk of toxicity in relation to fish size and origin; 4) regulatory measures restricting fish trade and fish size preference of the consumers. P-CTX levels in flesh and size dependency of toxicity indicate that the risk of ciguatera after eating E. fuscoguttatus varies with its geographical origin. For a large-sized grouper, it is necessary to establish legal size limits and control measures to protect public health and prevent overfishing. More risk assessment studies are required for E. fuscoguttatus to determine the size threshold above which the risk of ciguatera significantly increases.
Collapse
Affiliation(s)
- Thomas Y K Chan
- Division of Clinical Pharmacology and Drug and Poisons Information Bureau, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China; Centre for Food and Drug Safety, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
12
|
Ciguatera fish poisoning in East Asia and southeast Asia. Mar Drugs 2015; 13:3466-78. [PMID: 26042615 PMCID: PMC4483640 DOI: 10.3390/md13063466] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022] Open
Abstract
In the coastal countries of East Asia and Southeast Asia, ciguatera should be common because of the extensive tropical and subtropical coral reefs along the coasts and in the neighboring seas with ciguatoxic fishes. An extensive search of journal databases, the Internet and the government websites was performed to identify all reports of ciguatera from the regions. Based on the official data and large published case series, the incidence of ciguatera was higher in the coastal cities (Hong Kong, Foshan, Zhongshan) of southern China than in Japan (Okinawa Prefecture). In Singapore, ciguatera appeared to be almost unknown. In other countries, only isolated cases or small case series were reported, but under-reporting was assumed to be common. Ciguatera may cause severe acute illness and prolonged neurological symptoms. Ciguatera represents an important public health issue for endemic regions, with significant socio-economic impact. Coordinated strategies to improve risk assessment, risk management and risk communication are required. The systematic collection of accurate data on the incidence and epidemiology of ciguatera should enable better assessment and management of its risk. Much more work needs to be done to define the size threshold for important coral reef fish species from different regions, above which the risk of ciguatera significantly increases.
Collapse
|