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Toxicity, Ciguatera: Differential Diagnoses & Workup

Author: Thomas Arnold, MD, Medical Director, Louisiana Poison Control Center, Associate Professor and Chairman, Department of Emergency Medicine, Section of Clinical Toxicology, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: Aug 19, 2009

Differential Diagnoses

Aeromedical Transport
Toxicity, Disulfiram
Shock, Septic
Toxicity, Isoniazid
Sinus Bradycardia
Toxicity, Lithium
Snake Envenomations, Cobra
Toxicity, Mercury
Snake Envenomations, Coral
Toxicity, Mushroom - Amatoxin
Snake Envenomations, Sea
Toxicity, Mushroom - Disulfiramlike Toxins
Stroke, Ischemic
Toxicity, Mushroom - Gyromitra Toxin
Toxicity, Antidysrhythmic
Toxicity, Organophosphate and Carbamate
Toxicity, Arsenic
Toxicity, Phenytoin
Toxicity, Beta-blocker
Toxicity, Scombroid
Toxicity, Calcium Channel Blocker
Toxicity, Shellfish
Toxicity, Carbamazepine
Toxicity, Tetrodotoxin

Other Problems to Be Considered

Botulism toxicity

Workup

Laboratory Studies

  • All routine laboratory tests are nonspecific for ciguatera poisoning but may reflect volume depletion from fluid losses. Mild creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) elevations, if present, reflect muscle tissue breakdown.
  • Currently, home products are available to detect ciguatoxin in fish at the time of preparation. Reliability of these products in the hands of the consumer has not been validated.
  • Other companies are developing similar products for detection of ciguatoxin in human blood.

More on Toxicity, Ciguatera

Overview: Toxicity, Ciguatera
Differential Diagnoses & Workup: Toxicity, Ciguatera
Treatment & Medication: Toxicity, Ciguatera
Follow-up: Toxicity, Ciguatera
References
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References

  1. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline].

  2. Centers for Disease Control and Prevention. Cluster of ciguatera fish poisoning--North Carolina, 2007. MMWR Morb Mortal Wkly Rep. Mar 27 2009;58(11):283-5. [Medline]. [Full Text].

  3. Ting JY, Brown AF. Ciguatera poisoning: a global issue with common management problems. Eur J Emerg Med. Dec 2001;8(4):295-300. [Medline].

  4. Friedman MA, Fleming LE, Fernandez M, Bienfang P, Schrank K, Dickey R, et al. Ciguatera fish poisoning: treatment, prevention and management. Mar Drugs. 2008;6(3):456-79. [Medline]. [Full Text].

  5. Schnorf H, Taurarii M, Cundy T. Ciguatera fish poisoning: a double-blind randomized trial of mannitol therapy. Neurology. Mar 2002;58(6):873-80. [Medline].

  6. Friedman MA, Arena P, Levin B, Fleming L, Fernandez M, Weisman R, et al. Neuropsychological study of ciguatera fish poisoning: A longitudinal case-control study. Arch Clin Neuropsychol. May 3 2007;22(4):545-553. [Medline].

  7. Bagnis R, Kuberski T, Laugier S. Clinical observations on 3,009 cases of ciguatera (fish poisoning) in the South Pacific. Am J Trop Med Hyg. Nov 1979;28(6):1067-73. [Medline].

  8. Blume C, Rapp M, Rath J, Köller H, Arendt G, Bach D. [Ciguatera poisoning. Growing differential diagnostic significance in the age of foreign tourism]. Med Klin (Munich). Jan 15 1999;94(1):45-9. [Medline].

  9. Blythe DG, De Sylva DP, Fleming LE, Ayyar RA, Baden DG, Shrank K. Clinical experience with i.v. Mannitol in the treatment of ciguatera. Bull Soc Pathol Exot. 1992;85(5 Pt 2):425-6. [Medline].

  10. Butera R, Prockop LD, Buonocore M, Locatelli C, Gandini C, Manzo L. Mild ciguatera poisoning: Case reports with neurophysiological evaluations. Muscle Nerve. Oct 2000;23(10):1598-603. [Medline].

  11. Cameron J, Capra MF. The basis of the paradoxical disturbance of temperature perception in ciguatera poisoning. J Toxicol Clin Toxicol. 1993;31(4):571-9. [Medline].

  12. Fleming LE, Baden DG, Ayyar RA, Bean JA, Blythe DG, Shrank K, et al. A pilot study of a new ELISA test for ciguatoxin in humans. Bull Soc Pathol Exot. 1992;85(5 Pt 2):508-9. [Medline].

  13. Frenette C, MacLean JD, Gyorkos TW. A large common-source outbreak of ciguatera fish poisoning. J Infect Dis. Nov 1988;158(5):1128-31. [Medline].

  14. Gopalakrishnakone P, Tan CK. Clinical features on 12,890 cases of ciguatera (fish poisoning) French Polynesia. Proceedings: First Asia-Pacific Congress on Animal, Plant and Microbial Toxins. 1987;June 24-27:372-385.

  15. Habermehl GG, Krebs HC, Rasoanaivo P, Ramialiharisoa A. Severe ciguatera poisoning in Madagascar: a case report. Toxicon. Dec 1994;32(12):1539-42. [Medline].

  16. Inoue M, Miyazaki K, Uehara H, Maruyama M, Hirama M. First- and second-generation total synthesis of ciguatoxin CTX3C. Proc Natl Acad Sci U S A. Aug 17 2004;101(33):12013-8. [Medline].

  17. Lewis RJ. The changing face of ciguatera. Toxicon. Jan 2001;39(1):97-106. [Medline].

  18. Mines D, Stahmer S, Shepherd SM. Poisonings: food, fish, shellfish. Emerg Med Clin North Am. Feb 1997;15(1):157-77. [Medline].

  19. Morris PD, Campbell DS, Freeman JI. Ciguatera fish poisoning: an outbreak associated with fish caught from North Carolina coastal waters. South Med J. Apr 1990;83(4):379-82. [Medline].

  20. Park DL, Gamboa PM, Goldsmith CH. Rapid facile solid-phase immunobead assay for screening ciguatoxic fish in the market place. Bull Soc Pathol Exot. 1992;85(5 Pt 2):504-7. [Medline].

  21. Pearn J. Neurology of ciguatera. J Neurol Neurosurg Psychiatry. Jan 2001;70(1):4-8. [Medline].

  22. Pottier I, Vernoux JP, Lewis RJ. Ciguatera fish poisoning in the Caribbean islands and Western Atlantic. Rev Environ Contam Toxicol. 2001;168:99-141. [Medline].

  23. Swift AE, Swift TR. Ciguatera. J Toxicol Clin Toxicol. 1993;31(1):1-29. [Medline].

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Further Reading

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Keywords

ciguatera poisoning, ciguatoxin, Gambierdiscus toxicus, grouper, amberjack, red snapper, eel, sea bass, barracuda, Spanish mackerel, ciguatera toxicity, fish-borne poisoning, reef fish poisoning

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Contributor Information and Disclosures

Author

Thomas Arnold, MD, Medical Director, Louisiana Poison Control Center, Associate Professor and Chairman, Department of Emergency Medicine, Section of Clinical Toxicology, Louisiana State University Health Sciences Center
Thomas Arnold, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Louisiana State Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Dana A Stearns, MD, Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital
Dana A Stearns, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Michael J Burns, MD, Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center
Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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