Epidemiologic Notes and Reports
Ciguatera Fish Poisoning -- Bahamas, Miami
On March 6, 1982, the U.S. Coast Guard in Miami, Florida,
received
a request for medical assistance from an Italian freighter located
in
waters off Freeport, Bahamas. Numerous crew members were ill with
nausea, vomiting, and muscle weakness and required medical
evacuation
for hospitalization and treatment.
A total of 14 ill crew members were airlifted to three Florida
hospitals. Three were seen in emergency rooms and later released.
Eleven were hospitalized; seven required admission to intensive
care
units. All patients were Italian males, age 24-40 years; symptoms
included diarrhea--12 patients (86%), vomiting--11 (79%),
paresthesias--11 (79%), hypotension--10 (71%), peripheral muscular
weakness--9 (65%), nausea--8 (57%), abdominal cramping--6 (43%),
pruritis--4 (29%), and peripheral numbness--2 (14%). These
findings
were consistent with ciguatera fish poisoning, and an epidemiologic
investigation was initiated.
The ship employed 26 crew members and is permanently based near
Freeport, where it ferries petroleum products ashore from large
tankers. On March 4, a crew member caught a 25-pound barracuda
while
fishing from the ship. On March 6, 14 crew members cooked and ate
the
barracuda; all became ill within 6 hours. None of the 12 crew
members
who did not eat the barracuda became ill. Six of the ill crew
members
reported becoming sick 45 minutes to 6 hours after the implicated
meal
(median: 2.5 hours). All 14 crew members eventually recovered
without
sequelae and returned to work. Median length of hospital stay was
6
days.
Reported by SC Royal, Miami Quarantine Station, MA Poli, TJ Mende,
DG
Baden, Dept of Biochemistry, University of Miami, School of
Medicine,
RM Galbraith, TB Higerd, Dept of Clinical Immunology and
Microbiology,
Medical University of South Carolina, M Enriquez, MD, Dade County
Health Dept, HJ Janowski, MPH, Acting State Epidemiologist, Florida
Dept of Health and Rehabilitative Svcs; Field Services Div,
Epidemiology Program Office, CDC.
Editorial Note
Editorial Note: Ciguatera is a human intoxication syndrome
associated
with the consumption of marine tropical reef fishes. Although
recent
surveys indicate that poisonings are relatively uncommon in Florida
(1,2), one investigator recorded 280 intoxications from January
1978
to June 1980 (2).
The ichthyosarcotoxins are thought to be accumulated through
the
food chain, the toxins being produced by microalgae known as
dinoflagellates (3,4). The toxins are lipid-soluble and appear to
accumulate in the flesh, fatty tissue, and viscera of large
predatory
species of fish, such as barracuda, grouper, and snapper (5,6).
The
isolation, purification, and characterization of the suspected
toxins
have been hampered by limited availability of authentic ciguatoxic
fish, lack of a specific sensitive assay, and the low concentration
and heterogeneity of toxins present in specimens.
The assessment of toxicity most often used is the mouse
bio-assay. Based on signs elicited following intraperitoneal (IP)
injection, it includes, but is not limited to inactivity, diarrhea,
labored breathing, cyanosis, piloerection, tremors, paralysis, and
staggering gait. Death occurs when the injection is given in
higher
doses, with a lethal dose, 50% kill (LD((50))), of 0.45 ug/kg for
purified toxin (5). Thus, ciguatoxin is one of the most potent
marine
toxins known. The barracuda's head was toxic by mouse bio-assay
with
an LD((50)) (IP) of 2-5 gram equivalents of original fish meat.
Thin-layer chromatographic separation of extracts revealed the
presence of at least two major toxins. Further purification is
under
way to define more clearly the toxin(s) implicated in this
outbreak.
References
Lawrence DN, Enriquez MB, Lumish RM, Maceo A. Ciguatera fish
poisoning in Miami. JAMA 1980;244:254-8.
Poli MA. A review of ciguatera, with special reference to the
Caribbean, and an investigation into its significance and
incidence in Florida. Master's thesis, University of Miami,
1982.
CDC. Ciguatera fish poisoning--St. Croix, Virgin Islands of
the
United States. MMWR 1981;30:138-9.
Bagnis R, Chanteau S, Chunque E, Hurtel JM, Yasumoto T, Inoue
A.
Origins of ciguatera fish poisoning: a new dinoflagellate,
Gambierdiscus toxicus Adachi and Fukuyo, definitely involved as
a
causal agent. Toxicon 1980;18:199-208.
Withers NW. Ciguatera fish poisoning. Ann Rev Med
1982;3:97-111.
Banner AH. Ciguatera: a disease from coral reef fish. In:
Jones
OA, Endean R, eds. Biology and geology of coral reefs. New
York:
Academic Press, 1975; III:177-213.
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