0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
JAMA Patient Page |

Ciguatera Fish Poisoning FREE

Denise M. Goodman, MD, MS; Jennifer Rogers, MS; Edward H. Livingston, MD
JAMA. 2013;309(24):2608. doi:10.1001/jama.2013.3826.
Text Size: A A A
Published online

People may become ill with ciguatera fish poisoning after eating certain contaminated fish. The ciguatera toxin is created by microalgae that naturally live in warm-water oceans, and this disease has been known for centuries. Fish eat the toxin-containing algae, and as larger fish eat smaller fish, the toxin becomes concentrated in the larger fish. Tropical and subtropical fish that may contain the toxin include amberjack, grouper, snapper, and barracuda. The presence of toxin in fish is unpredictable, and the frequency of ciguatera toxin illness in the United States is unknown. Ciguatera fish poisoning is probably underreported in the continental United States, since most cases are of short duration and it is not well known outside areas where it is common, such as the Caribbean and Hawaii. A cluster of cases in New York City from August 2010 to July 2011 affected 28 people. Ciguatera toxin–producing algae may be increasing because of warmer sea temperatures.

SIGNS AND SYMPTOMS

Symptoms begin within 6 to 24 hours of eating affected fish and may include gastrointestinal, neurologic, and cardiovascular problems.

  • Gastrointestinal problems include nausea, vomiting, and diarrhea.

  • Neurologic symptoms may include numbness or tingling, pain in the joints or muscles, headaches, dizziness, and weakness. Some people report that hot things feel cold or cold things feel hot.

  • Cardiovascular problems may include irregular heart rhythm, slow (most common) or fast heart rate, and low blood pressure.

DIAGNOSIS

There is no readily available test for diagnosing ciguatera fish poisoning in sick patients. The diagnosis is based on symptoms and dietary history. Public health officials may be able to test the fish if an outbreak is suspected and remains from the fish are available. This helps public health officials decide if ciguatera fish poisoning is a possible cause of symptoms.

TREATMENT

There is no specific cure for ciguatera fish poisoning, but symptoms can be treated until the illness resolves on its own. Most poisoning resolves in a few days or weeks, but in severe cases the neurologic symptoms may last for weeks or months. Sometimes, neurologic symptoms may return after being absent for months to years.

PREVENTION

Ciguatera toxin is not destroyed by cooking or freezing and is odorless, so the only prevention is to avoid eating fish from warm-water areas where ciguatera is known to occur. Greater public awareness can help public health officials identify outbreaks and minimize their impact.

Sources: US Food and Drug Administration, Centers for Disease Control and Prevention, California Department of Public Health
Dickey RW, Plakas SM. Ciguatera: a public health perspective.Toxicon.2010;56(2):123-136
Ciguatera fish poisoning—New York City, 2010- 2011.MMWR Morb Mortal Wkly Rep.2013;62 (4):61-65

FOR MORE INFORMATION

INFORM YOURSELF

To find this and previous JAMA Patient Pages, go to the Patient Page index on JAMA 's website at www.jama.com. Many are available in English and Spanish.

ARTICLE INFORMATION

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Topic: FOOD-BORNE ILLNESS

Tables

References

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Spanish Patient Page: Ciguatera: envenenamiento por ingesta de peces

Supplemental Content

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles