An Updated Review of Ciguatera Fish Poisoning: Clinical, Epidemiological, Environmental, and Public Health Management.
Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs), diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future directions, and recommendations for clinicians and patients. It updates and expands upon the previous review of CFP published by Friedman et al. (2008) and addresses new insights and relevant emerging global themes such as climate and environmental change, international market issues, and socioeconomic impacts of CFP. It also provides a proposed universal case definition for CFP designed to account for the variability in symptom presentation across different geographic regions. Information that is important but unchanged since the previous review has been reiterated. This article is intended for a broad audience, including resource and fishery managers, commercial and recreational fishers, public health officials, medical professionals, and other interested parties.
Mount Sinai Medical Center, Miami Beach, FL 33140, USA. melissafried@yahoo.com.
Melissa A
MA
Friedman
Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL 33314, USA. mf934@nova.edu.
Mercedes
M
Fernandez
National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. lfb9@cdc.gov.
Lorraine C
LC
Backer
Marine Science Institute, University of Texas at Austin, Port Aransas, TX 78373, USA. robt.dickey@austin.utexas.edu.
Robert W
RW
Dickey
Jackson Memorial Medical Center, Department of Medicine, University of Miami, Miami, FL 33136, USA. jbernstein@med.miami.edu.|Florida Poison Information Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA. jbernstein@med.miami.edu.
Jeffrey
J
Bernstein
Jackson Memorial Medical Center, Department of Medicine, University of Miami, Miami, FL 33136, USA. kschrank@med.miami.edu.
Kathleen
K
Schrank
NOAA-National Ocean Service, Center for Coastal Fisheries and Habitat Research, Beaufort, NC 28516, USA. steve.kibler@noaa.gov.
Steven
S
Kibler
Florida Poison Information Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA. wstephan@med.miami.edu.
Wendy
W
Stephan
Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA. matt.gribble@emory.edu.
Matthew O
MO
Gribble
Oceanography Department, University of Hawaii, Honolulu, HI 96822, USA. bienfang@soest.Hawaii.edu.
Paul
P
Bienfang
School for the Environment, University of Massachusetts Boston, Boston, MA 02125, USA. bob.bowen@umb.edu.
Robert E
RE
Bowen
Food and Drug Administration, College Park, MD 20740, USA. stacey.degrasse@fda.hhs.gov.
Stacey
S
Degrasse
Food and Drug Administration, Dauphin Island, AL 36528, USA. harold.floresquintana@fda.hhs.gov.
Harold A
HA
Flores Quintana
Food and Drug Administration, Dauphin Island, AL 36528, USA. christopher.loeffler@fda.hhs.gov.
Christopher R
CR
Loeffler
Florida Poison Information Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA. rweisman@med.miami.edu.
Richard
R
Weisman
Private Practice, Miami, FL 33133, USA. blythedrdiva@aol.com.
Donna
D
Blythe
Institut de Ciències del Mar (CSIC), 08003 Barcelona, Spain. berdalet@icm.csic.es.
Elisa
E
Berdalet
Department of Neurology, University of Miami, Miami, FL 33136, USA. dayyar@med.miami.edu.
Ram
R
Ayyar
Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA. danielle.clarkson-townsend@emory.edu.
Danielle
D
Clarkson-Townsend
Food and Drug Administration, College Park, MD 20740, USA. karen.swajian@fda.hhs.gov.
Karen
K
Swajian
Food and Drug Administration, Dauphin Island, AL 36528, USA. ronald.benner@fda.hhs.gov.
Ronald
R
Benner
Northern Institute, Charles Darwin University, Darwin 0909, Australia and Australian Institute of Marine Science, Darwin 0811, Australia. tom.brewer@cdu.edu.au.
Tom
T
Brewer
European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall Tr1 3HD, UK. l.e.fleming@exeter.ac.uk.
Lora E
LE
Fleming
D000818:Animals; D036841:Ciguatera Poisoning / Q000453:epidemiology*; D002922:Ciguatoxins / Q000633:toxicity*; D004196:Disease Outbreaks; D005399:Fishes / Q000378:metabolism*; D006801:Humans; D011634:Public Health; D017747:Seafood / Q000506:poisoning*
D002922:Ciguatoxins
Gambierdiscus; algae; ciguatera fish poisoning; ciguatoxin; climate change; diagnosis; environmental change; food poisoning; harmful algal bloom; human health; natural toxins; neurology; neuropsychology; neurotoxin; seafood poisoning; treatment