Date: Wed 16 Jul 2014
Source: Bay News 9 [summ., edited]
Two Manatee County teens contracted a potentially deadly illness while on a fishing trip in the Bahamas. One of the teens is home now and the other is still in a Miami hospital. Their symptoms included hallucinations, seizures, vomiting, and shaking, all from eating some bad fish.
A 14-year-old and a 15-year-old, the older boy's mother along with her boyfriend were supposed to be on a fun trip to the Bahamas last week [week of 7 Jul 2014]. It was until they decided to go on a fishing trip. "We were just going to go down there and do some spear fishing and diving." The 2 boys dove along a coral reef and harpooned 2 large fish, which they ate the next day. "We fried it and just ate it with some tartar sauce," he said.
Unfortunately, it was a meal the boys will never forget. The next day the younger boy started feeling sick and started vomiting. Then everyone got sick. The whole group ended up at the hospital. One of the boys was even having hallucinations. "I remember being really scared," he said. His parents say doctors didn't know what was wrong. "They didn't have a treatment or a game plan so we felt kind of helpless," said [his father]. That's when it was decided to bring his son back to Florida. It was a doctor in Miami who diagnosed the symptoms as ciguatera poisoning, a deadly disease that you can get from eating fish that have ingested toxins from algae.
The boy is doing better now however, his doctor told the father that he could have health problems in the future because of the poisoning. The other boy had a more severe case and is still in the Miami hospital. His sister said it was scary to see him so ill. "He wasn't able to eat for about 6 days and he was already pretty skinny as it was and he is still a little shaky," said the sister.
A marine biologist from the Florida Aquarium says that there is about a 1 in 50 chance of contracting ciguatera poisoning around the Gulf but it is best to avoid eating large fish. [Byline: Randi Nissenbaum]
[The following is taken from CDC: Cluster of ciguatera fish poisoning -- North Carolina, 2007. MMWR 2009; 58(11): 283-5 (<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5811a3.htm
>; edited; original citation numbering retained):
"Ciguatoxins are lipid-soluble cyclic polyether compounds and are the most potent sodium channel toxins known (3). Carnivorous tropical and semitropical fish, such as barracuda, amberjack, red snapper, and grouper, become contaminated with ciguatoxins by feeding on plant-eating fish that have ingested _Gambierdiscus toxicus_ or another member of the _Gambierdiscus_ genus, a group of large dinoflagellates commonly found in coral reef waters (4). Gambiertoxins from _Gambierdiscus_ spp. are converted into more potent lipid-soluble ciguatoxins. Spoilage of fish that have been caught is not a factor in toxin development, and cooking does not deactivate the toxin. Humans who eat contaminated predatory fish are exposed to variable concentrations of ciguatoxin, depending on the fish size, age, and part consumed (toxins concentrate more in the viscera, especially liver, spleen, gonads, and roe). The attack rate can be as high as 80 to 90 per cent in persons who eat affected fish, depending on the amount of toxin in the fish.
"Persistence or recurrence of neurologic symptoms are hallmarks of CFP [ciguatera fish poisoning]. 3 of the 9 patients in this cluster had recurrences of one or more symptoms for more than 6 months after their initial illness. If these patients are again exposed to fish (either ciguatoxin-contaminated or even non-contaminated fish), their symptoms likely will be more severe than those experienced with their initial episodes of CFP (3).
"Variations in the geographic distribution of the various ciguatoxins might explain regional differences in symptom patterns. CFP symptoms associated with eating fish from the Pacific Ocean are primarily neurologic, and symptoms associated with eating fish from the Caribbean Sea are more commonly gastrointestinal (4). Amberjack of en
is linked to CFP cases in the Caribbean. Although the amberjack fish responsible for this cluster of CFP cases tested positive for C-CTX-1, it was not tested for the presence of other ciguatoxins, which also might have been present and could have altered disease presentation (7).
"CFP has been associated almost exclusively with eating fish caught in tropical or semitropical waters, but increased global marketing of these species has increased the possibility that persons in temperate zones might become ill with CFP (4). Moreover, warming seawaters might expand the ranges of ciguatoxin-contaminated fish (8). In the USA, such fish have been found as far north as the coastal waters of North Carolina. Despite underreporting, CFP now is considered one of the most common illnesses related to fish consumption in the USA (9).
"Any level of Caribbean ciguatoxin 0.1 ppb [parts per billion] or more of fish tissue is thought to pose a health risk (3). As this illness becomes more common in nontropical areas of the world, clinicians need to be aware of its manifestations and how to manage it. Although opinions vary on the most effective course of treatment, intravenous mannitol has been a mainstay of management of neurologic symptoms for more than 20 years. Early mannitol treatment is considered more effective, but anecdotal evidence suggests that even delayed therapy benefits some patients. Amitriptyline also has been useful in relieving some of the neurologic symptoms of CFP (10). If evaluating a possible case, clinicians should consult their local poison control center for the latest treatment guidelines.
7. Lewis RJ, Jones A: Characterization of ciguatoxins and ciguatoxin congeners present in ciguateric fish by gradient reverse-phase high-performance liquid chromatography/mass spectrometry. Toxicon 1997; 35(2): 159-68 [abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/9080572
8. Chateau-Defat ML, Chinain M, Cerf N, et al: Seawater temperature, _Gambierdiscus_ spp. Variability and incidence of ciguatera poisoning in French Polynesia. Harmful Algae 2005; 4: 1053-62 [abstract available at <http://www.ilm.pf/node/1356
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