What is Ciguatera?

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Ciguatera is a form of food poisoning which is caused by ingestion of ciguatoxin, a toxin present in certain tropical fish. This form of food poisoning is not curable, but it is usually survivable, depending on how much the patient has ingested and how healthy he or she was to begin with. Incidence of ciguatera has radically declined thanks to closer inspection of tropical waters and prompt shut downs of fishing in areas suspected to be contaminated; people who eat a lot of seafood may want to keep an eye on seafood recalls to avoid ciguatera and other forms of seafood poisoning.

Ciguatoxin acts on the gastrointestinal tract, causing cramping, vomiting, diarrhea, and similar symptoms. It also causes neurological symptoms such as confusion, lack of balance, and nervous system malfunctions, like the perception of cold as heat. Symptoms often emerge very rapidly, thereby ensuring that the patient doesn't ingest any more fish, because he or she feels too ill to eat.

This toxin appears to originate in dinoflagellates, microscopic organisms found throughout the ocean. Research on ciguatera suggests that that ciguatoxin is most commonly found in the Pacific tropics and in the Caribbean, concentrated in fish which frequent coral reefs. Ciguatoxin is often subject to biomagnification, becoming more concentrated as it moves up the food chain, and since people often eat fish which are high on the food chain, they can be at risk of ciguatera poisoning.


Supportive care is usually the focus of treatment for ciguatera. Doctors address the individual symptoms of the patient to help him or her recover. Symptoms can flare up again up to 20 years later, often in response to eating potential allergens like nuts and shellfish, and ciguatera can also cause long-term neurological damage. People who have experienced ciguatera should be aware of this, and pass information about their illness on to care providers whenever possible.

The first reported cases of ciguatera appear to date to the 16th century, when mariners wrote about getting sick after eating tropical fish. By the 18th century, ciguatera had become fairly well-known, especially in the Caribbean, although the cause was not fully understood. The condition can be confusing, because fish may be safe to eat at some times, and not safe to eat at others, making it hard to link a specific species with ciguatera. Furthermore, ciguatoxin can be present in fish which frequent very distant areas, making it tricky to pin down the geological focus on the toxin and issue a warning or recall.


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Post 27

We are now in Costa Rica Mal Pais and my partner and I suffered similar symptoms as above: cramps, diarrhea, nausea, headache, joint pain and numbness in arm or feet. The temperature has not changed. It continued for one week. We are now eating very carefully as it seems to be triggered by some food. This kept us stable for two days.

However, today we both again have that toxic feeling, cramps, headaches and fatigue. As medical help is limited here, we would need to go to the capital (six hour drive) for decent help. People never heard about ciguatera here and actually many (local) people fish here and eat a lot of it. We also don't know if we have ciguatera but this is day 10 and we're still seeing symptoms. I saw someone else mentioning Costa Rica, where exactly? All recommendations are welcome.

Post 26

I was exposed to ciguatera poison during a trip to the Bahamas. I had an awful month or two.

Now, a couple of years later, I have been diagnosed with Polymyositis. I have been on prednisone which I have finally gotten off of and am now on methotrexate to control the disease. I have been fortunate that it is working so far, for the most part.

I know there are some much worse off than me. Those of you suffering from extreme fatigue, muscle pain, weakness, muscle cramping, etc., you may want to get tested for Polymyositis.

Post 25

I am a French citizen who is 99 percent sure diagnosed with ciguatera after two years of pain and wrong diagnosis of stress and symptoms similar to multiple sclerosis.

I have contracted the disease in French West Indies where I worked and live. There is just a light prevention starting, but nothing is really done to make the population aware, nor the tourists. The French West Indies, as well as the French Polynesian islands populations are in danger because of the coral population but French government doesn't really care.

The medical world in France isn't concerned either, while there is a huge social and medical issue comparable to malaria. Nothing is done, while huge money was spent over the Flu

A. Nothing is spent on chikungunya or ciguatera. Why? Because the populations in the West Indies or French Polynesia are second class citizens in France.

I am calling for Monsieur Hollande, our new president, to take action and open a national case for ciguatera patients to set up a prevention and information campaign.

Post 22

Ciguatera also causes Polymyositis. The toxin remains in your body stored in your fat tissue. It causes ion channel depolarization which causes muscle and nerve degeneration and neurological symptoms.

Most of you will agree that exercise, extreme temperature changes, and foods cause flare ups. Why? because you have a neurotoxin in your body!

Only us who have ciguatera know the extent of the agony because the symptom are so varied and often indescribable. I have gone to doctors stating I feel miserable. I can't explain it. It's just mierable. My everything is zinging!

Post 21

Want to let everyone know Neurontin helps with the pressure headaches and nerve pain. I got Ciguatera in 1994 and have been on many different medications over the years. I started Neurontin in 2009 with 300mg 3 x per day and went up to 1200mg then 2400mg then 3600mg. It has helped me and I also take Vistaril as needed it helps with the itching and also helps with pain. Ciguatera is an anticholinesterase. Have your vitamin D and calcium checked - blood calcium even 1 point over the range is not good. Ask for a bone density scan if you have had ciguatera for years. I request a CBC every three months to see my sodium, potassium, etc. Try medication

to lower cholesterol if it is high. The meds may also help with other symptoms caused by ciguatera. Insist on a liver function test periodically also.

Pay attention to your symptom and ask for testing even when your doctor says, "We can only treat the symptoms!" I am 50 and I now have CFID, osteoporosis, osteoporosis, scoliosis, scoliosis, and disk degeneration. I have high/low bp, high cholesterol, pre diabetic. Are all these illnesses caused by the the ciguatoxin in my body? I will never know but all those years when doctors were just treating my symptoms I should have been demanding appropriate test for the symptoms I was experiencing. Be your own best advocate by researching and seeking answers to your symptoms. Peace and love!

Post 20

I became ill in 2008 after eating grouper in south florida that my wife purchased at a fish market. Initially, my symptoms were nausea, vomiting, diarrhea. Over three years later, I am still experiencing dizziness, tightness in my throat, hands go numb and cold and fatigue. I am currently at mayo clinic in Rochester undergoing a neuro workup. I know its chronic ciguatera poisoning, and I'm learning to cope with it. Hang in there, fellow cigs.

Post 19

Ciguatera testing is available through the University of Hawaii. You can go to the National CFIDS Foundation's web site and search their library for details. Good luck all! --JohnBit

Post 10

I posted previously that I got ciguatera in 1994 while living on St. Croix. I am very sick now with many of the symptoms mentioned here. I have learned a lot about ciguatera and polymyosits as well as CFID the past two years. I recently received SSDI for chronic ciguatera and anxiety caused by chronic ciguatera.

Why isn't our government putting out warnings about Ciguatera? There have been recent cases in Texas, the gulf, North Carolina, and St. Louis. The world needs to know!

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Post 9

IN 1997 while holidaying at Airlie Beach, North Queensland, I ate Coral Trout at a local restaurant. I woke at around 1 a.m. with diarrhea, and noticed when I washed my hands that the cold water tingled. I made the trip to the toilet several times more until my partner woke at 6 a.m. He asked did I want a cup of coffee, and I said that what I wanted was a doctor because I felt like I had been poisoned.

we eventually got to a local doctor, and by this time my face felt like cardboard, paresthesia, and I could barely make my legs walk. My spine ached from the base of my skull to the coccyx. He immediately

reached for his book on tropical poisons. He knew exactly what was wrong and had me in hospital within the space of a half hour. There I received Mannitol infusions interspersed with normal saline, for 36 hours.

On discharge I walked like a drunken sailor. All the normal symptoms of Ciguatera poisoning were present.

It is now thirteen years since that experience and the residual effects have affected me. I have very little reflex action in my right ankle/foot, and a decreasing reflex in my left. Muscular aches, peculiar pains and lethargy still haunt me. Incontinence is expected in older people, but I know that mine started with the Ciguatera. There are still days when I experience a tingling around the genitals, and have no control over my bladder. But mostly the incontinence is just that i have to 'go' quickly. There is no holding on. My GP is giving me B12 injections monthly in the hope that the residual symptoms will not worsen.

Post 8

I, too, have been diagnosed with ciguatera after spending 16 days in Costa Rica and eating lots of fish, thinking that was healthy eating.

My symptoms began on our flight home in mid-May and have *not* ceased, except when I'm sleeping. My symptoms are numbness, tingling, at times severe prickling of skin, itching, extreme skin sensitivity to touch (clothing hurts my skin at times), sensitivity to temperature changes and joint pain.

It feels like I have my finger stuck in an electric outlet and I am receiving an electric charge through my body.

I have seen a neurologist who did MRIs and then diagnosed me with ciguatera because of the history I gave him, the rapid onset and relentless symptoms

. I am taking Neurontin which calms the symptoms to some degree. He said I have to wait until the toxin leaves my body. No time frame given.

Why aren't people warned about this? Fish is *not* healthy and should be removed from everyone's diet immediately. Heaven knows what eating the fish from the gulf will do to us in the future. --Judy

Post 7

My brother also suffers with chronic ciguatera. He is miserable with fatigue and joint aching. Anyone have any suggestions please help.

Post 5

Well thanks for your comments. I have seen a neurologist who has been helpful. the Hospital of Tropical Disease was useless.

Now I have noticed my cholesterol and kidney readings are both extremely high as a result of the Ciguatera. This also concurs with the pain I have been feeling in my kidneys. Do you have any further advice to give me on dealing with this? --DK

Post 4

The only tests that can be confirm that it is Cigautera is one that's taken directly from the fish that you consumed. There are no other blood tests or lab work that can verify it as of yet.

The only thing you can do now is treat the symptoms. Generally if it's Cigautera, you will experience several neurological issues. Myself I have had severe headaches, neuropathies, daily nausea, just to name a few. They say that for most people the symptoms only last a few weeks to a couple of months, but in my case it has lasted over 11 months. If you have not seen a neurologist yet you should do so. Good luck

Post 3

I ate some fish off the coast of Zanzibar, red snapper or Jack fish. I had severe diarrhea for five days and felt terrible really. Now a month later I am absoultely exhausted....Why? They believe it is ciguatera. There are apparently no tests, and no cures...Somebody help me understand this better! DK

Post 2

I got Ciguatera while living on St. Croix over 10 years ago. I still have flare ups - recently I believe gaining a few pounds reactivated the toxin. Ciguatoxin is one of the most potent marine toxins. As I type this my entire left side is numb, my face is numb, my lips are numb, and the headaches are awful. I could go on and on but I can't bare to type out all the crazy symptoms I live with including nerve damage.

Anyone with Ciguatera should be in the care of a Neurologist. Also checkout CFIDS Foundation website as well Florida Dept. of Health Aquatic Toxins Program.

Post 1

I was on a diving and fishing vacation last August on the island of Roatan. During that trip I ate a large portion of fish that was tainted with Ciguatera toxin. Symptoms started about six hours later and included nausea, diarrhea, chilling, and just overall sick.

The next morning I awoke in my own hell. My vision was completely whited out, only able to see outlines of objects. My body ached as if I had been hit by a truck, I had a headache like I had never experienced before. My heart rate felt like it had tripled, my hands and feet had gone numb and I had sharp spiking pain shooting through my extremities. Within the hour I was

out again.

The next thing I remember was waking up a day later, completely delirious and still experiencing all of these symptoms. I got myself a glass of cold water to take some pain relievers with, but was barely able to drink it due to a sensation that felt of hot and acidic.

Several hours later I was awoken by the property's owner, telling me I was supposed to be on my flight back to the states within the hour. I seriously had no sense of time, and completely lost two days. They got me to the airport just in time to board the plane. As you can imagine The trip home was probably the worst experience of my life.

When I arrived home my son took me straight to the ER. They initially drew some blood and gave me medication for the nausea, and Dilodid for my extreme headache. The doctor came in shortly after and told me I was in complete kidney failure. So it go's, I spent several days in the ICU, and thankfully regained function of my kidneys.

Well it's been ten months now since I ate this fish and I am still experiencing the effects of it. I spent two weeks at the Mayo clinic in Scottsdale AZ, having test after test before finally being diagnosed with Ciguatera poisoning. I have been admitted to the hospital a couple more times, and have made several trips to the ER for the headaches. I experience the bad headaches at least three to four times a week. I have bouts with nausea most days. I always feel off balance and light headed. The toxin gave me a peripheral neuropathy in my extremities causing numbness and pain, and I now live with extreme fatigue.

From most articles that I have come across, they state that most symptoms subside within days or weeks. Unfortunately I believe I'm the exception to that belief.

So is there anybody else here living with this diagnosis. I wouldn't wish this upon anyone, but I would also like to think that I'm not the exception.

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