Ciguatera Toxicity Workup

Updated: May 14, 2022
  • Author: Thomas C Arnold, MD, FAAEM, FACMT; Chief Editor: Michael A Miller, MD  more...
  • Print

Approach Considerations

All routine laboratory tests are nonspecific for ciguatera poisoning, but the results may reflect volume depletion from fluid losses. Mild creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) elevations, if present, reflect muscle tissue breakdown.

Visual contrast sensitivity testing has been reported to be useful in confirming the diagnosis. The proposed mechanism suggests that neurotoxins such as ciguatera affect the ability to accurately discern shades of white, gray, and black. [22]

An assay has been developed that can qualitatively (and potentially quantitatively) measure ciguatoxin in fish and possibly human fluids. [23] At least one group in Japan has developed a monoclonal antibody immunoassay to detect the toxin in human tissues. [2]

The laboratories of the US Food and Drug Administration (FDA) can perform ciguatera toxin analyses on remnants of consumed fish submitted from the United States, Caribbean, and South Pacific. However, because the results of such analyses are not immediately available at the time of the patient’s initial presentation, initial care of the patient must proceed based on symptom progression, recent history of reef fish consumption, and exclusion of alternative diagnoses or explanations. [24]