Fish is a favorite food of all of us, especially the delicious fish caught in the sea of Sri Lanka. But sometimes, unexpectedly, after eating it, you may suddenly experience stomach aches, dizziness, and even fainting. Even if you don't know the cause, it could be a dangerous fish poisoning. Today, we are going to talk about a fish poisoning that is a little serious, but very important to know about. This is called Ciguatera.
What is Ciguatera? Simply put...
Simply put, Ciguatera is a type of food poisoning that occurs when we eat fish that contains a toxin called Ciguatoxin . This Ciguatoxin is a type of neurotoxin . This means that it directly affects the functioning of our nervous system .
Imagine, a type of seaweed (algae) called dinoflagellates (especially the species `Gambierdiscus toxicus`) that grows near coral reefs in the sea, which are too small to be seen with the naked eye, produces this toxin called ciguatoxin. Then, the small fish that eat these plants accumulate this toxin in their bodies. Then, the larger fish that eat those small fish – like the grouper and snapper that we eat – accumulate this toxin in their bodies as well.
The strange thing is, these toxins don't do much harm to the fish. However, the problem is if we eat a fish that has this kind of poison. Then it can affect not only our digestive system , our nervous system , but in some severe cases, our cardiovascular system , that is, our heart.
Ciguatera is not usually a life-threatening illness. However, if you experience these symptoms, it is very important to go to a hospital emergency room (ER) immediately . This is the only way to stabilize your condition and prevent serious complications.
Where is this poisoning most commonly reported?
Anyone in the world can get this poisoning. This mainly happens when you eat fish in areas with coral reefs that contain the toxic algae (Dinoflagellates) that I mentioned earlier. This includes areas like the Caribbean Sea and the South Pacific Ocean. In the United States, this risk exists among fish in the seas of South Florida, the Bahamas, the Virgin Islands, Puerto Rico, and Hawaii.
But then, fish caught in places like these are distributed all over the world. So, no matter where you eat fish from, the most important thing is to know what kind of sea area the fish you eat was caught in. Since we also have coral reefs in Sri Lanka, it is very important to be aware of this.
What types of fish can contain Ciguatoxin?
More than 400 species of large fish that eat small fish can contain this ciguatoxin. This means that if you eat any of these fish, you can get this poisoning. Most of the time, these are large fish that live near coral reefs and prey on other fish. For example, fish like moray eels, barracudas, and amberjacks.
Here are some of the types of fish that most commonly cause Ciguatera poisoning:
- Amberjack
- Barracuda
- Grouper
- Moray eel
- Parrot fish
- Red snapper
- Sea bass
- Spanish mackerel
- Sturgeon
- Surgeonfish
How do you know if a fish has ciguatoxin?
That's the problem. There's no way to know for sure unless you test it in a lab. In the United States, the Food and Drug Administration (FDA) has labs that test for these toxins in fish. But that's not practical when you're cooking fish at home or eating fish with a friend for dinner.
A fish that contains Ciguatoxin does not change its smell, taste, or appearance in any way. It is just like any other normal fish. Also, this toxin does not disappear even after being put in ice or cooked thoroughly. That is one of the biggest challenges in preventing Ciguatera fish poisoning. The problem is that it is impossible to detect the presence of this toxin without looking in a lab, and the toxin cannot be removed during cooking.
How common is Ciguatera?
This is the most commonly reported food poisoning related to fish. About half a hundred thousand (50,000) cases are reported worldwide each year. However, it is likely that many more people are treated for this and go unreported.
Scientists say that the number of Ciguatera patients may increase with climate change . This is because climate change is increasing the destruction of coral reefs. The algae called `Gambierdiscus toxicus` that produces the ciguatoxin grows well in the vicinity of dead or dying coral reefs. However, the growth of this algae is affected by many other factors, such as water temperature, salinity, and light. Scientists are still researching this.
What are the symptoms of Ciguatera fish poisoning?
Symptoms usually begin within six hours of eating poisonous fish. Sometimes symptoms can appear as early as 30 minutes after eating the fish, or they can be delayed by up to a day.
The main symptoms are these:
- Nausea and vomiting
- Diarrhea (stomach ache)
- Feeling lethargic and tired
- Headache
- Blurred vision
- Hallucinations (seeing things that are not there)
- Dizziness and vertigo
- Heavy sweating
- Severe itching
- Feeling like a toothache or a tooth moving
- A burning, metallic taste in the mouth
- Muscle, joint, or stomach pain
- Numbness or tingling in the mouth, fingertips, and toes
- Feeling hot things as cold and cold things as hot (this is called `Allodynia`)
In addition to these, there are other severe, but slightly less common symptoms:
- Feeling cold, shivering
- Skin damage
- Paralysis (loss of limbs)
- Watering from the mouth and eyes
- Difficulty breathing (Dyspnea)
- Slow heart rate (Bradycardia)
- Low blood pressure (Hypotension)
If you experience one or more of these symptoms after eating such fish, you should see a doctor immediately.
Why does Ciguatera occur?
Ciguatera is caused by the way our bodies react to the toxin I mentioned , Ciguatoxin. This toxin is produced by a type of seaweed. As this toxin moves up the food chain – from small fish to large fish and then to humans – it becomes more potent and more harmful. For example, large tropical fish that eat small fish have very high concentrations of Ciguatoxin in their digestive systems. This toxin can be particularly high in the fish’s head, intestines, liver and eggs .
When you eat a poisonous fish, your nervous system is exposed to the poison. It changes the way your nerves work. As a result, you experience these symptoms:
- Digestive system related (such as nausea, vomiting)
- Nervous system-related (such as numbness, tingling, pain)
- Cardiovascular system (such as a slow heart rate)
How does this spread?
You only get Ciguatera if you eat poisonous fish.
But, there is one thing. Several breastfeeding mothers who have contracted Ciguatera have reported that their babies also developed symptoms like diarrhea and skin rashes . This means that the toxin can be passed on to the baby through breastfeeding. Therefore, it is best to stop breastfeeding until you have recovered from this condition.
What are the possible complications of Ciguatera?
If you vomit a lot, you may become dehydrated . This means that your body doesn't have enough water. You may need to be given saline (IV fluids) in the emergency room (ETU) to replenish your body's fluids. Life-threatening complications include respiratory failure and heart failure . Although ciguatera is not usually fatal, it is important to get to the emergency room as soon as possible to prevent these serious complications.
How to recognize Ciguatera?
The only way to know for sure if you have Ciguatera is to have the fish you ate tested in a lab to see if it contains the toxin. But then, there's no time for that when you go to the emergency room.
Therefore, the doctor or nurse will examine you based on your symptoms and whether you have recently eaten a type of high-risk fish .
What are the treatments for Ciguatera?
There is no specific antidote for this venom, so treatment is primarily aimed at controlling symptoms and preventing life-threatening complications.
What are these treatments?
The following can be done as treatment:
- Activated charcoal: If you ate the fish within four hours, and you are not at risk of dehydration, your doctor may give you activated charcoal to induce vomiting. This may also reduce the absorption of some of the toxins.
- Osmotic diuretics: These medications help reduce the amount of water in your body and help reduce symptoms related to the nervous system. If your condition is stable and you are not at risk of dehydration, you may be given a medicine called Mannitol (Osmitrol®) through a saline (IV) line to reduce symptoms.
- Pain medications: You may be given Gabapentin or Amitriptyline to reduce nerve pain. These can also reduce side effects such as severe itching. For general pain, you may be given a nonsteroidal anti-inflammatory drug (NSAID) or acetaminophen (Tylenol®) .
What foods and drinks should I avoid after treatment?
There are certain foods that can cause symptoms to return in people who have recovered from Ciguatera. Therefore, your doctor may advise you to avoid these foods.
It's best to avoid these things for at least six months :
- Alcohol (this increases the risk of heart-related symptoms).
- Fish (even non-poisonous fish).
- Nuts.
- Types of seeds.
How quickly will I recover after treatment?
For most people, symptoms subside within a few days or weeks . However, in some cases, symptoms can last for months, and rarely even years. Often, symptoms related to the nervous system last longer.
What happens if you get Ciguatera?
Most people get better within a few weeks. However, it can take months, even years, for all symptoms of the nervous system to completely disappear. If you avoid foods and drinks (such as alcohol) that can trigger those symptoms, you will eventually recover completely.
The death rate from Ciguatera poisoning is very low – about one in 1,000. Most deaths are due to complications affecting the heart and lungs. Such complications can be prevented if you go to an emergency room quickly.
Can Ciguatera fish poisoning be prevented?
The only way to prevent Ciguatera is to avoid eating fish that contain the toxin. The problem is, there's no way to know if a particular fish contains this toxin without testing it in a lab.
You can reduce your risk by avoiding fish that are found near coral reefs, which are more likely to contain Ciguatera. If you do eat such fish, be sure to avoid the parts that are most likely to contain the toxin – the head, intestines, liver, and eggs.
When should I go to a hospital (ETU) immediately?
If you have recently eaten fish from tropical and subtropical waters and you are experiencing any of the symptoms of Ciguatera, go to an emergency room (ETU) immediately. Acting quickly can prevent life-threatening complications.
What questions should I ask the doctor?
When you see a doctor, it's a good idea to ask these questions:
- What kind of treatment do I need to control my symptoms?
- When I am recovering, how often will I be checked?
- What foods and drinks should I avoid in the coming days/weeks/months?
- How can I stay healthy and active while recovering from this food poisoning?
- Should I completely avoid eating coral reef fish in the future?
Take-Home Message
Ciguatera is a disease that can send you to the hospital in an instant after eating a delicious fish. The only way to prevent it – which is to stop eating tropical fish altogether – can be a bit difficult because it means giving up your favorite food. Not every red snapper or rockfish you eat contains this toxin. However, it is important to know what symptoms you should see a doctor about immediately.
If you eat one of those dangerous fish and experience stomach upset, weakness, numbness, tingling, or other neurological symptoms, go to an emergency room (ETU) immediately. That's the best thing you can do.
` Ciguatera, fish poisoning, ciguatoxin, food poisoning, neurotoxin, coral reef fish, symptoms
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