Background: Ciguatera fish poisoning (CFP) is a disease caused by the ingestion of poisonous coral reef fish. To the best of the author’s knowledge, no attempt has so far been made to consolidate available reports of outbreaks in order to characterize the toxidrome of CFP in the Philippines. Objective: To review and consolidate data from epidemiologically-documented CFP outbreaks in order to characterize the toxidrome of CFP in the Philippines and identify the areas of high risk for outbreaks. Methods: Epidemiologic reports of CFP outbreaks in the Philippines were reviewed. A compilation of symptoms of CFP patients was done to describe the toxidrome. High risk areas in the Philippines were identified. Results: Ten reports were retrieved related to 17 CFP outbreaks from 1988 to 2010. No epidemiologic reports were found after 2010. Consolidation of reported symptoms showed a CFP toxidrome with prominent paresthesia, muscle weakness, and myalgia with some gastrointestinal symptoms. Based on the reports, the high risk islands identified were Palawan, Panay, Romblon, the islands in the Cuyo Pass, and Basilan. Cases of CFP continue to be encountered but are not reported to public health epidemiologists. Conclusion When put together, the reports describe a CFP toxidrome where the neurologic symptoms predominate over the gastrointestinal symptoms. Most of the cases occurred in the west central and southern portion of the archipelago suggesting a higher risk for CFP in that area. Cases of what appear to be CFP continue to be diagnosed although they are not reported to government epidemiology units. More systematic surveillance of CFP by government agencies is needed.
Ciguatera Poisoning ; Philippines

OBJECTIVETo find out the reason of three ciguatera fish poisoning cases in Xiamen in 2005 and identify the fish species.

METHODSThe grouper implicated in food poisoning and seven other coral reef fishes collected from market were tested by mice bioassay and ciguatoxin-test kit. The mtDNA was extracted from toxic grouper meat, and Cty b gene segment was amplified and the PCR products were sequenced. The sequences were compared with those in the GenBank.

RESULTSThe result turned out to be positive by the ciguatoxin-test kit, while the toxicity of the toxic grouper implicated in food poisoning was 0.11 mouse unit (MU)/g by mice bioassay. A 475 bp segments of Cty b gene was amplified by PCR and the sequence was 99% homologous with Epinephelus fuscoguttatus (GenBank: AY950695).No ciguatoxin in six grouper species collected from market was detected.

CONCLUSIONAll three food poisoning cases were caused by consumption of ciguatoxin-carrying groupers.

Animals ; China ; Ciguatera Poisoning ; epidemiology ; Ciguatoxins ; toxicity ; Foodborne Diseases ; epidemiology ; Humans ; Male ; Mice ; Mice, Inbred Strains ; Perciformes ; Toxicity Tests

Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed.
Animals ; Bradycardia ; complications ; diagnosis ; Ciguatera Poisoning ; complications ; diagnosis ; therapy ; Ciguatoxins ; adverse effects ; Fishes ; Humans ; Hypotension ; complications ; diagnosis ; Male ; Middle Aged

Adolescent ; Adult ; Aged ; Animals ; Catfishes ; Ciguatera Poisoning ; Eggs ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo review the clinical features and laboratory investigations of ciguatera patients in Hong Kong between 2004 and 2007 in order to show the timely sampling of implicated fish from ciguatera victims and application of validated mouse bioassay for confirming suspected clinical cases of ciguatera.

METHODSDiagnosis of the ciguatera victims was based on history of coral fish consumption and clinical presentations stated in official guidelines for clinical diagnosis of ciguatera fish poisoning in Hong Kong. Food remnants of coral fish samples were collected swiftly from ciguatera victims between 2004 and 2007 for ciguatoxins (CTXs) analysis.

RESULTSMajor clinical symptoms in ciguatera patients included gastrointestinal and neurological effects including limb numbness and diarrhoea, which developed at 0.5 to 15 hours after consumption of fish. In most cases, neurological symptoms were more common than gastrointestinal symptoms. A broad range of attack rate (10%-100%) was observed in each ciguatera outbreak. Validated mouse bioassay on ether extracts of the food remnant samples confirmed that all were CTXs-positive (<0.5 - 4.3 MU/20 mg ether extract) and directly linked to the corresponding ciguatera cases.

CONCLUSIONConsistency between clinical and laboratory analysis for ciguatera poisoning illustrates the application of laboratory mouse bioassay in a timely fashion for confirming ciguatera poisoning cases and implementing effective public health measures. With further improvement in laboratory techniques, features of ciguatera fish poisoning cases can be better defined. Further studies are needed to determine the risk of each class of CTXs (Pacific-, Indian- and Caribbean-CTXs) in Hong Kong.

Animals ; Biological Assay ; Ciguatera Poisoning ; blood ; diagnosis ; epidemiology ; Ciguatoxins ; analysis ; Disease Outbreaks ; Fishes ; Gastrointestinal Diseases ; blood ; diagnosis ; epidemiology ; Hong Kong ; epidemiology ; Humans ; Mice ; Nervous System Diseases ; blood ; diagnosis ; epidemiology ; Prevalence ; Public Health ; Risk Factors ; Time Factors