Symptoms of Ciguatera

 
        

 

Ciguatera fish poisoning distinguish itself by the quantity and diversity of its symptoms, which are generally grouped into 5 main categories: gastrointestinal, neurological, cardiovascular, rheumatological and general symptoms. In practice, more than 175 different symptoms have been reported in the medical literature.

At present, the diagnosis of ciguatera is based solely on the history of intoxication, the nature of the consumed fish and the symptoms. To date, there is no duly validated biological test allowing the diagnosis of ciguatera in patients. In fact, some symptoms such as parasthesias (itching, burning, numbness) in the extremities (hands, feet …), face, mouth as well as pain on contact with cold liquids or objects, can be considered as characteristic features of ciguatera..

Usually, ciguatera has a low mortality rate (<0.1%) and so far it has not been associated with the onset of critical illness (cancer…). Rare fatal cases occur within several hours or days after poisoning and are usually due to a cardiovascular failure worsened by a severe dehydration caused by diarrhea and vomiting.

 

In the chronic phase of CFP no fatal cases were observed.

Even if this illness could be very debilitating for a long period, up to several decades, in most cases, the symptoms subside spontaneously. Today, our research also aims to understand this phenomenon and to identify which factors facilitate the disappearance of these symptoms.


In addition, even if ciguatera is not “contagious”, it has, by some features, a “communicable” nature either by sexual contact (which could explain the occurence of vulvar pruritus in women during intercourse with a partner suffering from ciguatera, or pelvic pains in men during ejaculation); or by mother to child transplacental or breast milk transmission. In the latter case, it is strongly advised that mothers stop breastfeeding their child for at least 1 month.

Finally, in rare cases, ciguatera may cause premature births and miscarriages in case of poisoning during pregnancy. 

 
 
 

List of gastrointestinal symptoms

 

 

List of cardiovascular symptoms

 

 

List of neurological symptoms

   

List of rheumatologic symptoms

 

 

 

Symptoms eng PTMain organs and systems affected

by Ciguatera


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Chrnology of the disease

 
   

In the normal illness process, the ”incubation period”, i.e. period between consumption of toxic fish and the onset of symptoms, ranges from 6 to 12h, in most cases.

Gastrointestinal symptoms, such as abdominal cramps, nausea, diarrhea and vomiting occur first, and usually resolve after 24h. Some neurological symptoms (itching, headaches, parasthesia, dysesthesia…) can also appear in the first few hours.

Cardiovascular symptoms, hypotension, regular or irregular sinus bradycardia, T wave abnormalities and rarely tachycardia, occur within the first 24-48h. These cardiovascular disorders are generally indicative of the severity of the CFP. And without a fast and appropriate medical care, those may lead to the patient’s death, usually caused by dehydration, shock (due to cardiocirculatory failure) …

Fever is not a symptom of ciguatera. On the contrary, within the first 14-48h of intoxication, the subject may experience mild hypothermia and chills.

Gastrointestinal symptoms resolve quickly, spontaneously or in response to treatment. They are then replaced by a “state phase”, more specific, marked by the onset of pronounced rheumatological, general and neurological symptoms, such as parasthesia (tingling in extremities, mouth and pharynx) accompanied by dysesthesia and/or cold allodynia (causing burning sensations on contact with cold objects or liquid).

 

 

Unlike gastrointestinal symptoms, neurological symptoms may last for several weeks, months or even years following the acute phase of CFP. 

Pruritis, dizziness, parasthesia, dysesthesia, ataxia, generalized weakness and mood disorders (i.e. depression…) are known to last for a longer period.

In addition to the main symptoms listed above, a generalized weakness evoking the Chronic Fatigue Syndrome (CFS) is also commonly reported in endemic ciguatera areas. This persistent weakness, is proposed as an explanation for the depressive tendencies observed in some patients, this without excluding a more direct action of ciguatoxins.

Chronology eng TR

Chronology and level of discomfort of CFP’s main symptoms