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ABSTRACT Ciguatera poisoning is the most common form of non-bacterial food-poisoning from fish worldwide. The incidence among Brazilians returning from high-risk regions is unclear because it is not a mandatory reportable disease. We describe a previously healthy 53-year-old Brazilian woman developed Ciguatera fish poisoning while traveling to Havana, Cuba. Physicians and health care professionals should advise travelers to avoid eating ciguatoxic fish species and potentially toxic fish species in the Caribbean islands. Despite the prognosis for most cases is good with a short duration of self-limited symptoms, early recognition of the identifying clinical features of ciguatera can result in improved patient care.
Subject(s)
Humans , Animals , Female , Middle Aged , Travel , Ciguatera Poisoning/diagnosis , West Indies , BrazilABSTRACT
Introduction@#Ciguatera fish poisoning (CFP) is common in tropical and subtropical waters. On 13 November 2015, eight Filipino seafarers from a cargo ship sailing in the Caribbean Sea experienced a range of symptoms after consuming a barracuda. Upon their return to the Philippines, an investigation was conducted to describe the cases.@*Methods@#A case-series was conducted. A CFP case was defined as a previously well individual on the ship who developed at least one gastrointestinal symptom and at least one neurologic manifestation after eating barracuda on 13 November 2015. All cases were admitted to hospital in Manila, Philippines and were interviewed using a standard questionnaire. Urine and serum samples of cases were collected for ciguatoxin (CTX) testing by radiological and receptor-binding assay.@*Results@#Eight of the 25 seafarers on the ship ate the barracuda; all eight met the CFP case definition. The age of cases ranged from 37 to 58 years (median: 47 years) and all were males. Onset of symptoms ranged from 1 to 3 hours (median: 2 hours) from the time of ingestion of the barracuda. All cases experienced gastrointestinal (nausea, vomiting, diarrhoea) and neurologic (temperature allodynia, itchiness) symptoms but no cardiovascular manifestations. Urine and serum specimens of all eight cases showed CTX below the detection limit.@*Discussion@#The Philippines Epidemiology Bureau recommended that the Philippine Maritime Authority include CTX poisoning and its health risks in seafarers’ training to prevent future cases of CFP. The Event-based Surveillance and Response system will continue to provide a mechanism for the reporting and appropriate management of CFP cases.
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<p><b>Objective:</b> To report the first case of ciguatera-associated rheumatoid arthritis in Japan.</p><p><b>Patient:</b> A 53-year-old man presented to our clinic with morning stiffness and pain in the fingers and wrists.</p><p><b>Results:</b> For six months, he had suffered from chronic pain in both hands and shoulders caused by ciguatera poisoning. He was referred to a local general hospital and diagnosed with RA.</p><p><b>Conclusion:</b> When synovitis becomes evident in chronic ciguatera poisoning, reevaluation is necessary, including investigation of chronic arthritis, which might be associated with the onset of RA.</p>
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Introducción: frecuentemente en las regiones insulares de países tropicales se reportan casos de intoxicación por ciguatera, los cuales se asocian al consumo de ciertos tipos de peces que se alimentan de algas tóxicas. Debido a que la aparición de la intoxicación es impredecible, y que los peces portadores de la ciguatoxinas presentan sabor y olor como los peces no contaminados, existen grandes dificultades en la prevención de esta enfermedad, ocacionando serios problemas socio-económicos en las comunidades que habitan estas regiones. Objetivo: con el propósito de entender la bio-acumulación de las ciguatoxinas en la cadena alimentaria marina, se propone un sistema no lineal de ecuaciones diferenciales que puede ser utilizado como herramienta en la determinación de tiempos de veda en el consumo de peces y mitigar los riesgos de intoxicación. Métodos: se analiza la estabilidad de la solución de equilibrio del sistema que tienen sentido ecológico y se presentan y discuten simulaciones numéricas para diferentes escenarios de brotes de las ciguatoxinas. Resultados: los resultados indican que la evolución del sistema de transporte y bio-acumulación de toxina depende de la dinámica del sistema poblacional. Conclusiones: El modelo puede convertirse en una orientación para los ecólogos que investigan en actividades de campo relacionadas con la enfermedad, ya que sugiere algunas medidas importantes que son necesarias para calibrar el modelo y hacer de él una herramienta valiosa en la toma de decisiones por las autoridades encargadas del tema de salud pública en zonas costeras caribeñas donde la enfermedad sea endémica.
Introduction: Island regions in tropical countries often report cases of ciguatera fish poisoning associated with consumption of certain types of fish feeding on toxic algae. The emergence of intoxication is unpredictable, and fish carrying ciguatoxins taste and smell just like uncontaminated fish. Therefore, it is very difficult to prevent this disease, which causes serious socio-economic problems in the communities inhabiting these regions. Objective: with the purpose of understanding the bioaccumulation of ciguatoxins in the marine food chain, a proposal is made of a non-linear system of differential equations which may be used as a tool to lay down closed seasons in fish consumption and thus mitigate poisoning risks. Methods: an analysis is conducted of the stability of the equilibrium solution of the system which makes ecological sense, and a presentation and discussion are provided of numerical simulations for various scenarios of ciguatoxin outbreaks. Results: results show that evolution of the toxin transport and bioaccumulation system depends on the dynamics of the population system. Conclusions: the model may be used as a guideline for ecologists carrying out field research into the disease, since important measures are suggested which are required to calibrate the model and turn it into a valuable tool for the taking of decisions by public health authorities in Caribbean coastal areas where the disease is endemic.
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The Eastern Tropical Pacific is a region reported as free of ciguatera poisoning that causes serious gastrointestinal, neural and cardiovascular problems, even death. But with this study we found a high incidence of benthic microalgae involved in ciguatera poisoning in Isla del Coco National Park (PNIC, from its name in Spanish), Costa Rica. Between 2006 and 2011, during expeditions to PNIC, 420 phytoplankton samples with the interest of finding benthic dinoflagellates involved in the ciguatera poisoning were collected and analyzed. Samples were taken with phytoplankton nets, towed vertically and horizontally or carried by diving, between 5 to 30 m depth, over reef areas, and by direct extraction from benthic macroalgae. We found the dinoflagellates Gambierdiscus spp., Coolia tropicalis, Coolia cf. areolota, Prorocentrum concavum, Prorocentrum compressum, Amphidinium carterae and Ostreopsis siamensis. The quantity of dinoflagellates by macroalgae weight was high, mainly for Gambierdiscus. Ostreopsis and Prorocentrum, the most widely distributed genera throughout the collection sites. Gambierdiscus is a ciguatera producing genus. Two different sizes of Gambierdiscus were found, and comparing our samples with other studies, we conclude that they are different to any previously reported. They possibly represent two new species. Coco Island is an oceanic island and because of its protection status, it is an ideal site for studying the evolution of marine phytoplankton. Also, long-term monitoring is important due to the variety of potentially toxic dinoflagellates living in this marine ecosystem. This is the first study to report benthic dinoflagellates implicated in ciguatera poisoning in other areas of the Eastern Tropical Pacific.
El Pacífico Tropical Oriental se ha indicado como una región de los océanos libre de ciguatera, una intoxicación que causa serios trastornos gastrointestinales, neurológicos y cardiovasculares, en casos extremos, la muerte. Pero con el presente estudio hemos encontrado una incidencia alta de microalgas bénticas involucradas en la producción de ciguatera en el Parque Nacional Isla del Coco (PNIC), Costa Rica. En campañas oceanográficas realizadas entre el 2006 y el 2011 al PNIC se recolectaron 420 muestras de fitoplancton con el interés de encontrar especies de dinoflagelados bentónicos implicados en la producción de ciguatera. Las muestras se tomaron con red de fitoplancton o mediante buceos, entre los 5 y 30 m de profundidad en zonas de arrecife y por extracción directa de macroalgas. Se encontró a los dinoflagelados Gambierdiscus spp., Coolia tropicales, Coolia cf. areolota, Prorocentrum concavum, Prorocentrum compressum, Amphidinium carterae y Ostreopsis siamensis. Se determinó que la cantidad de dinoflagelados por peso de macroalga era elevada, principalmente para el género Gambierdiscus. Los géneros Ostreopsis y Prorocentrum mostraron tener la mayor distribución en los sitios de colecta. Gambierdiscus es un género productor de ciguatera. Se encontraron dos tamaños diferentes de individuos de Gambierdiscus, Comparando los especímenes de Gambierdiscus encontradas con otros estudios, se concluye que son diferentes a las descritas anteriormente, por lo que podría tratarse de especies nuevas, lo que se confirmará con cultivos y análisis moleculares. Al ser la Isla del Coco un sitio oceánico aislado y en estado de conservación, es un sitio ideal para el estudio de la evolución de especies de fitoplancton marino. Además, el monitoreo a largo plazo es muy importante debido a la variedad de dinoflagelados bentónicos potencialmente tóxicos que habitan en este ecosistema marino. Este es el primer estudio donde se da a conocer la incidencia de dinoflagelados bentónicos implicados en ciguatera para el Pacífico Tropical Oriental.
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Dinoflagellida/classification , Benthic Fauna/analysis , Phytoplankton/classification , Costa RicaABSTRACT
In this paper we report two incidents of ciguatera fish poisoning (CFP) that occurred in 2008 on Kakeroma Island in Kagoshima Prefecture, Japan. A family consisting of father (42 y.o.), mother (39 y.o.), daughter (11 y.o.) and son (6 y.o.), as well as a friend of the family (male, 78 y.o.) consumed sliced flesh (sashimi) and developed typical symptoms of CPF 4-5 h later: diarrhea, vomiting, and paresthesia of the extremities. Additionally, the two male adults (42 and 78 y.o.) developed mild hypotention (84/48 and 94/40 mmHg, respectively) and bradycardia (36 and 50 bpm, respectively) and were rushed to the ER of the nearest hospital, located on an adjacent island. The implicated fish were caught together off the west coast of the island and were identified as <i>Variola louti</i> and <i>Lutjanus monostigma</i> based on analysis of 16S rRNA gene coded on mtDNA. Remnants of the implicated fish and other fish caught on the same occasion were examined by the official mouse bioassay method (MBA), which defines the minimum amount of CFP toxin needed to kill a male mouse of ddY strain of 20 g body weight within 24 h as one mouse unit (MU). A significantly high toxicity was detected in the <i>V. louti</i> (0.2 MU/g) eaten by the family and the <i>L. monostigma</i> (0.8 MU/g) eaten by the elderly man. Other specimens of <i>Lethrinus nebulosus</i>, <i>Variola albimarginata</i>, <i>Lutjanus gibbus</i> (2 specimens), <i>Aphareus rutilans</i>, and <i>Sphyraena forsteri</i> (2 specimens) were found to be nontoxic (< 0.025 MU/g).<br> The medical records regarding island inhabitants (ca. 1,500) kept at Kakeroma Tokushukai Clinic, the only medical facility on the Island, and also at Setouchi Tokushukai Hospital, a nearest hospital on an adjacent island (Amami) revealed 6 CFP outbreaks involving 13 cases between 2005 and 2008. The estimated frequency of CFP was 10.0 incidents/10,000 persons/year and the morbidity rate was 21.7 cases/10,000 persons/year. The symptoms and signs observed in the patients and the implicated fish species, <i>L. monostigma</i> and<i> V. louti</i>, were typical of CFP in this region.
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Se reportó un caso de un paciente masculino de 34 años de edad con antecedentes personales de buena salud, que acudió al Cuerpo de Guardia del Hospital de Gibara, Provincia de Holguín, intoxicado por el consumo de pescado fresco, específicamente el conocido como Sierra (Perticnis Pertinata). Durante la Colonia, un hacendado inglés se intoxicó tras la ingestión de algún pescado que no recoge la Historia, así como varios de sus familiares y colonos; uno de los colonos, criollo, lo oyó llamar este cuadro como sea water fish poisoning, lo que devino después en "Ciguatera", nunca antes reconocida ni diagnosticada en Cuba. Se describieron las características clínicas de la enfermedad, su etiología, y evolución, así como la conducta asumida. Su proceso correspondió al diagnóstico de Ciguatera. Para la confección del trabajo se revisaron fuentes bibliográficas disponibles, además de las búsquedas en bases de datos de Infomed; como resultados más relevantes, obtuvimos la presentación de manifestaciones clínicas atípicas, así como elementos coincidentes con la bibliografía revisada. Se describieron las características clínicas de la enfermedad, su etiología y evolución, así como la conducta asumida.
A case of 34 years old male patient is presented that went to the department of the Gibara Hospital, Holguin County intoxicated specifically by the consumption of fresh fish known as Sierra (perticnis Pertinata), the process corresponded with the diagnosis of Ciguatera. During colonization a farmowner described his disease after eating a coast fish as "Sea Water poisoning", and one of his apprentice man(also sick) named the disease ( Ciguatera)" as a Creole name for it, never known or recognized in Cuba For the creation of this article, available bibliography sources were revised in our libraries, as well as the databases in infomed, as a results: Outstanding atypical clinical manifestations of the illness and other are described with the revised bibliography, as well as its genesis and evolution.
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The spatial and temporal abundance of epiphytic dinoflagellates associated with ciguatera was studied over two annual cycles (March 1999 to March 2000 and March 2001 to March 2002) in the northwestern coast of Cuba. From 14 species of macroalgae (Phaeophyta, Chlorophyta, and Rhodophyta), 1340 samples were obtained identifying seven species as potentially noxious; five of them are new reports for Cuba's phytobenthos: Prorocentrum belizeanum Faust, P. concavum Fukuyo, P. mexicanum Tafall, Coolia monotis Meunier, and Ostreopsis lenticularis Fukuyo. ANOVA/MANOVA analysis showed significant spatial differences: lower cell abundance near the shoreline adjacent to a river inlet and higher cell abundance in the deepest area. Prorocentrum lima (Ehrenberg) Dodge 1975 was found mainly on Phaeophyta followed by Chlorophyta and Rhodophyta. Gambierdiscus toxicus was found mainly on Phaeophyta followed by Rhodophyta and Chlorophyta. All the species reported in the study area were mainly on Padina spp. (Phaeophyta). Acanthophora spicifera (Rhodophyta) did not host dinoflagellate species. Environmental conditions in summer (higher temperature, more nutrients, greater water transparency, and low wind intensity) are suitable for macroalgae development, which serves as a substrate for potentially harmful dinoflagellates, and possibly the main vector for spreading ciguatera along the coast of Cuba.
Se estudió la abundancia espacial y temporal de dinoflagelados epífitos asociados a la ciguatera durante dos ciclos anuales (marzo 1999 a marzo 2000, y marzo 2001 a marzo 2002) en la costa del noroeste de Cuba. Recolectamos 14 especies de macroalgas (Phaeophyta, Chlorophyta y Rhodophyta) y obtuvimos 1340 muestras. Identificamos siete especies de dinoflagelados potencialmente nocivas, cinco de ellas nuevos registros para el fitobentos cubano: Prorocentrum belizeanum Faust, P. concavum Fukuyo, P. mexicanum Tafall, Coolia monotis Meunier, y Ostreopsis lenticulares Fukuyo. El análisis de ANOVA/MANOVA mostró diferencias espaciales significativas: la abundancia celular más baja se encontró cerca de la desembocadura del río y la más alta en el área más profunda. Prorocentrum lima (Ehrenberg) Dodge, se encontró principalmente sobre las Phaeophyta seguido de las Chlorophyta y Rhodophyta. Gambierdiscus toxicus se encontró principalmente sobre las Phaeophyta seguido de las Rhodophyta y Chlorophyta. Todas las especies halladas en el área del estudio estaban sobre Padina spp. (Phaeophyta). No se encontró ninguna especie de dinoflagelado sobre Acanthophora spicifera (Rhodophyta). Las condiciones ambientales en verano (temperatura, nutrientes, transparencia de agua y la baja velocidad del viento) favorecen el desarrollo de las macroalgas, siendo un substrato adecuado para el desarrollo de dinoflagelados potencialmente nocivos, y posiblemente el vector principal para la extensión de la ciguatera en la costa noroeste cubana.