title: Short report: persistent bradycardia caused by ciguatoxin poisoning after barracuda fish eggs ingestion in southern Taiwan.
abstract: We report an outbreak of ciguatoxin poisoning after barracuda fish ingestion in southern Taiwan. Three members of a family developed nausea, vomiting, watery diarrhea, and myalgias about 1 hour after eating three to ten eggs of a barracuda fish. Numbness of the lips and extremities followed the gastrointestinal symptoms about 2 hours after ingestion. Other manifestations included hyperthermia, hypotension, bradycardia, and hyperreflexia. Bradycardia persisted for several days, and one patient required a continuous infusion of intravenous atropine totaling 40 mg over 2 days. Further follow-up of the patients disclosed improvement of neurologic sequelae and bradycardia, but sensory abnormalities resolved several months later. In conclusion, ciguatoxin poisoning causes mainly gastrointestinal and neurologic effects of variable severity. In two patients with ciguatoxin poisoning after barracuda fish egg ingestion, persistent bradycardia required prolonged atropine infusion.
authors.affiliation: Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Taiwan. ymhung1@doctor.com
authors.forename: Yao-Min
authors.initials: YM
authors.lastname: Hung
authors.forename: Shih-Yuan
authors.initials: SY
authors.lastname: Hung
authors.forename: Kang-Ju
authors.initials: KJ
authors.lastname: Chou
authors.forename: Neng-Chyan
authors.initials: NC
authors.lastname: Huang
authors.forename: Chung-Ni
authors.initials: CN
authors.lastname: Tung
authors.forename: Deng-Fwu
authors.initials: DF
authors.lastname: Hwang
authors.forename: Hsiao-Min
authors.initials: HM
authors.lastname: Chung
mesh_terms: D000368:Aged; D000818:Animals; D001919:Bradycardia / Q000209:etiology*; D036841:Ciguatera Poisoning / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D002922:Ciguatoxins / Q000032:analysis; D003937:Diagnosis, Differential; D004196:Disease Outbreaks; D005260:Female; D005399:Fishes; D005506:Food Contamination; D006801:Humans; D008297:Male; D008875:Middle Aged; D017747:Seafood; D013624:Taiwan / Q000453:epidemiology
chemical_list: D002922:Ciguatoxins