Ciguatera fish poisoning, with its characteristic gastrointestinal and neurological symptoms, has been clearly described in literature from the West Indies since the 18th century, with fragmentary reports dating back to the 1500s.1 It is currently a major cause of morbidity in the Caribbean,2 as well as in the South Pacific, where Bagnis and his colleagues3 have recently reported on a series of more than 3,000 cases.
In the United States 94 outbreaks (418 cases) have been reported to the Center for Disease Control (CDC) through the national foodborne disease surveillance system since 1970, making ciguatera the most frequently reported foodborne disease associated with consumption of seafood; outbreaks have occurred most frequently in southeastern Florida and Hawaii, with sporadic cases, usually associated with a history of travel to the Caribbean, reported from other parts of the country. The CDC data undoubtedly represent substantial underreporting of the disease, however.