Epidemiologic Notes and Reports Ciguatera Fish Poisoning --
Vermont
On October 29, 1985, the Epidemiology Division, Vermont
Department
of Health, learned of two persons with symptoms consistent with
ciguatera fish poisoning. Both had eaten barracuda at a local
restaurant on October 19. One ill person, a 48-year-old woman, had
vomiting, diarrhea, myalgia, and chills 4 hours after the meal,
followed the next morning by pruritus, flushing, burning of the
tongue, and reversal of hot and cold temperature sensation of
objects
held in her hands. The second ill person, a 30-year-old male
bartender at the restaurant, sought medical attention for severe
myalgia and gingival and dental dysesthesia several hours after
eating
barracuda. In both patients, most symptoms subsided; however, some
pruritus and temperature reversal persisted 6 weeks later. A third
patron reported pruritus to the restaurant after the meal but was
lost
to follow-up. No additional cases were identified by contacting
the
two local emergency rooms and requesting case reports in the
Vermont
Disease Control Bulletin.
The restaurant had served 24 portions of barracuda received
fresh
by air from a fish distributor in Florida. Two other restaurants
in
Burlington had received barracuda from the same shipment. One
served
44 portions, and the second froze all portions received. The fish
distributor reported that the fish was purchased from boats fishing
in
Florida's coastal waters but could not identify the exact location.
The distributor ships to locations throughout the contiguous United
States. No information was available about the distribution of
other
fish from the same catch.
All portions of a single barracuda frozen by one restaurant and
tested for ciguatoxin by enzyme immunoassay at the Department of
Pathology, University of Hawaii, were positive for ciguatoxin.
Reported by RL Vogt, MD, State Epidemiologist, Vermont Dept of
Health;
AP Liang, MD, State Epidemiologist, Hawaii Dept of Health; Div of
Field Svcs, Epidemiology Program Office, Enteric Diseases Br, Div
of
Bacterial Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note:Human ciguatera poisoning can occur after
consumption
of a wide variety of coral reef fish, such as barracuda, grouper,
red
snapper, amberjack, surgeonfish, and sea bass (1,2). Ciguatoxin
and
related toxins are derived from dinoflagellates, which herbivorous
fish consume while foraging through the macro-algae (3). Humans
ingest the toxin by consuming either herbivorous fish or
carnivorous
fish that have eaten the contaminated herbivores. Larger, more
predacious reef fish are generally more likely to be toxic (4,5).
Since the toxin is heat-stable, cooking does not make the fish safe
to
eat.
As the domestic and imported fish industry expands its market,
the
diagnosis of this "tropical" disease must be considered even in
areas
to which coral-reef fish are not native. Ciguatera fish poisoning
can
be diagnosed by the characteristic combination of gastrointestinal
and
neurologic symptoms in a person who ate a suspect fish (6). The
diagnosis can be supported by detection of ciguatoxin in the
implicated fish.
Hawaii now uses a "stick test" immunoassay to detect ciguatoxin
in
fish (7). The test is sensitive, specific, inexpensive, and easy
to
use in the field. In Hawaii, if an outbreak-related fish tests
positive for ciguatoxin, the reef area of catch is posted to
discourage further fishing in that area. In Miami, Florida,
because
barracuda have been frequently associated with ciguatera poisoning,
a
city ordinance bans the sale of barracuda (8).
References
Morris JG Jr, Lewin P, Smith CW, Blake PA, Schneider R.
Ciguatera
fish poisoning: epidemiology of the disease on St. Thomas, U.S.
Virgin Islands. Am J Trop Med Hyg 1982;31:574-8.
Halstead BW. Class osteichthyes: poisonous ciguatoxic fishes.
In: Halstead BW. Poisonous and venomous marine animals of the
world. Princeton: Darwin Press, Inc., 1978:325-402.
Bagnis R, Chanteau S, Chungue E, Hurtel JM, Yasumoto T, Inoue
A.
Origins of ciguatera fish poisoning: a new dinoflagellate,
Gambierdiscus toxicus Adachi and Fukuyo, definitively involved
as
a causal agent. Toxicon 1980;18:199-208.
CDC. Ciguatera fish poisoning--Bahamas, Miami. MMWR
1982;31:391-2.
Craig CP. It's always the big ones that should get away .
JAMA
1980;244:272-3.
Hughes JM, Merson MH. Fish and shellfish poisoning. N Engl J
Med
1976;295:1117-20.
Hokama Y. A rapid, simplified enzyme immunoassay stick test
for
the detection of ciguatoxin and related polyethers from fish
tissues. Toxicon 1985;23:939-46.
Lawrence DN, Enriquez MB, Lumish RM, Maceo A. Ciguatera fish
poisoning in Miami. JAMA 1980;244:254-8.
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