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The Ciguatera Poisoning Syndrome from Farm-Raised Salmon
- Mark J. DiNubile, MD; and
- Yoshitsugi Hokama, MD
- From Cooper Hospital, University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, Camden, New Jersey; and John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii. Requests for Reprints: Mark DiNubile, MD, Division of Infectious Diseases, Education and Research Building, Cooper Hospital/University Medical Center, 401 Haddon Avenue, Camden, NJ 08103.
Ciguatera poisoning causes a distinct clinical syndrome characterized primarily by gastrointestinal and neurologic manifestations [1]. Although frequently unrecognized, ciguatera may be the most common type of fish poisoning in the United States [2-5]. Fish causing ciguatera poisoning are thought to be restricted to oceans within a 30-degree latitude on either side of the equator. Cold-water fish have almost never been associated with ciguatera poisoning [1-5].
At least four distinct toxins can produce the clinical manifestations of ciguatera poisoning [1, 6, 7]. These toxins originate in dinoflagellates, and the toxins become more concentrated as they move up the food chain [1]. The classic ciguatoxins (for example, ciguatoxin-1 from the liver of the moray eel) increase the permeability of sodium channels in excitatory membranes [6].
Symptoms typically begin within a few hours after fish containing ciguatoxins are ingested [1]. Although gastrointestinal complaints are common early in the illness, the most pronounced and persistent symptoms are neurosensory. A sensation of loose teeth and problems with temperature differentiation are almost pathognomonic of ciguatera intoxication, but some patients have neither of these symptoms [1, 2]. With severe poisonings, neurologic complaints persist for as long as 6 months [1, 2].
We describe a patient with the ciguatera poisoning syndrome acquired from a farm-raised salmon. Neurosensory symptoms persisted for more than 2 years. …
