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Ciguatera is a form of human poisoning caused by the consumption of subtropical and tropical marine finfish which have accumulated naturally occurring toxins through their diet. The toxins are known to originate from several dinoflagellate (algae) species that are common to ciguatera endemic regions in the lower latitudes.
Manifestations of ciguatera in humans usually involves a combination of gastrointestinal, neurological, and cardiovascular disorders. Symptoms defined within these general categories vary with the geographic origin of toxic fish.
Initial signs of poisoning occur within six hours after consumption of toxic fish and include perioral numbness and tingling (paresthesia), which may spread to the extremities, nausea, vomiting, and diarrhea. Neurological signs include intensified paresthesia, arthralgia, myalgia, headache, temperature sensory reversal and acute sensitivity to temperature extremes, vertigo, and muscular weakness to the point of prostration. Cardiovascular signs include arrhythmia, bradycardia or tachycardia, and reduced blood pressure.
Ciguatera poisoning is usually self-limiting, and signs of poisoning often subside within several days from onset. However, in severe cases the neurological symptoms are known to persist from weeks to months. In a few isolated cases neurological symptoms have persisted for several years, and in other cases recovered patients have experienced recurrence of neurological symptoms months to years after recovery. Such relapses are most often associated with changes in dietary habits or with consumption of alcohol.
There is a low incidence of death resulting from respiratory and cardiovascular failure.
Clinical testing procedures are not presently available for the diagnosis of ciguatera in humans. Diagnosis is based entirely on symptomology and recent dietary history.
The disease has only recently become known to the general medical community, and there is a concern that incidence is largely under-reported because of the generally non-fatal nature and short duration of the disease.
Marine finfish most commonly implicated in ciguatera fish poisoning include the groupers, barracudas snappers, jacks, mackerel, and triggerfish. Many other species of warm-water fishes harbour ciguatera toxins. The occurrence of toxic fish is sporadic, and not all fish of a given species or from a given locality will be toxic.
This only way this toxicosis may be avoided is by not consuming tropical marine fish species.
All humans are believed to be susceptible to ciguatera toxins. Populations in tropical/subtropical regions are most likely to be affected because of the frequency of exposure to toxic fishes. However, the increasing per capita consumption of fishery products coupled with an increase in interregional transportation of seafood products has expanded the geographic range of human poisonings.
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