Ciguatera: Difference between revisions
No edit summary |
No edit summary |
||
| Line 3: | Line 3: | ||
*Most common fish are barracuda, moray eel, amberjack, and certain types of grouper, mackerel, parrotfish, and red snapper | *Most common fish are barracuda, moray eel, amberjack, and certain types of grouper, mackerel, parrotfish, and red snapper | ||
*Caused by fish eating dinoflagellates that grow on and around coral reefs and contain a heat-stable toxin | *Caused by fish eating dinoflagellates that grow on and around coral reefs and contain a heat-stable toxin | ||
*Suspected cases should be reported to local department of health | |||
== | ==Clinical Features== | ||
*GI symptoms | *GI symptoms | ||
**vomiting, diarrhea, and abdominal cramping | **vomiting, diarrhea, and abdominal cramping | ||
| Line 12: | Line 13: | ||
*Cardiovascular symptoms | *Cardiovascular symptoms | ||
**Bradycardia, heart block, and hypotension. | **Bradycardia, heart block, and hypotension. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Marine envenomation DDX}} | {{Marine envenomation DDX}} | ||
== | ==Diagnosis== | ||
*Clinical diagnosis | |||
==Management== | |||
*Symptomatic | *Symptomatic | ||
**[[Mannitol]] | **[[Mannitol]] | ||
| Line 32: | Line 32: | ||
*Prevent recurrances | *Prevent recurrances | ||
**Do not ingest alcohol, caffeine, nuts or fish for 6 months | **Do not ingest alcohol, caffeine, nuts or fish for 6 months | ||
==Disposition== | |||
*Generally may be discharged | |||
==Prognosis== | ==Prognosis== | ||
| Line 39: | Line 42: | ||
==See Also== | ==See Also== | ||
*[[Marine toxins and envenomations]] | *[[Marine toxins and envenomations]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Environ]] | [[Category:Environ]] | ||
Revision as of 06:29, 7 March 2016
Background
- Most cases tropics and subtropics, between 35 degrees north and south latitudes
- Most common fish are barracuda, moray eel, amberjack, and certain types of grouper, mackerel, parrotfish, and red snapper
- Caused by fish eating dinoflagellates that grow on and around coral reefs and contain a heat-stable toxin
- Suspected cases should be reported to local department of health
Clinical Features
- GI symptoms
- vomiting, diarrhea, and abdominal cramping
- 3-30hrs after eating contaminated fish
- Neurologic symptoms
- Paresthesias, painful teeth, painful urination, blurred vision, nerve palsies, and hot/cold temperature reversal
- Cardiovascular symptoms
- Bradycardia, heart block, and hypotension.
Differential Diagnosis
Marine toxins, envenomations, and bites
- Toxins
- Ciguatera
- Scombroid
- Tetrodotoxin (e.g. pufferfish)
- Shellfish poisoning
- Amnesic shellfish poisoning
- Diarrheal shellfish poisoning
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Stingers
- Venomous fish
- Cone shell
- Lionfish
- Sea urchins
- Crown-of-Thorns Starfish
- Stonefish
- Other: Catfish, zebrafish, scorpion fish
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
Diagnosis
- Clinical diagnosis
Management
- Symptomatic
- Mannitol
- Neuropathic pain
- Amitriptyline reported effective in several case series[3] [4]
- Gabapentin[5] and Pregabalin [6] also reported to control neurologic symptoms
- Antiemetics and IVF for hypotension
- Atropine for bradycardia
- Prevent recurrances
- Do not ingest alcohol, caffeine, nuts or fish for 6 months
Disposition
- Generally may be discharged
Prognosis
- Neurologic symptoms typically persist from a few days to several weeks
- ~20% of patients have symptoms that persist for months
- <2% have symptoms that last for years
See Also
References
- ↑ Friedman MA et al. Ciguatera Fish Poisoning: Treatment, Prevention, and Management. Marine Drugs 2008; 6:456-479
- ↑ Schnorf H et al. Ciguatera Fish Poisoning. A double-blind randomized trial of mannitol therapy. Neurology 2002; 58(6):873
- ↑ Lange W et al. Travel and ciguatera fish poisoning. Arch. Int. Med. 1992; 152:2049-2052
- ↑ Davis RT and Villar LA. Symptomatic improvement with amitriptyline in ciguatera fish poisoning. N Engl J Med 1986; 315:65
- ↑ Perez CM et al. Treatment of ciguatera poisoning with gabapentin. N Engl J Med 2001; 344:692
- ↑ Brett J and Murnion B. Pregabalin to treat ciguatera fish poisoning. Clinical toxicology 2015; 53(6):588.