An Updated Review of Ciguatera Fish Poisoning: Clinical, Epidemiological, Environmental, and Public Health Management

• Type of Material: Article
• Authors: Melissa A. Friedman, Mount Sinai Medical Center; Mercedes Fernandez, Nova Southeastern University; Lorraine C. Backer, Centers for Disease Control and Prevention; Robert W. Dickey, University of Texas at Austin; Jeffrey Bernstein, University of Miami; Kathleen Schrank, University of Miami; Steven Kibler, NOAA-National Ocean Service; Wendy Stephan, University of Miami; Matthew Gribble, Emory University; Paul Bienfang, University of Hawaii; Robert E. Bowen, University of Massachusetts Boston; Stacey Degrasse, Food and Drug Administration; Harold A. Flores Quintana, Food and Drug Administration; Christopher R. Loeffler, Food and Drug Administration; Richard Weisman, University of Miami; Donna Blythe, Private Practice; Elisa Berdalet, Institut de Ciències del Mar; Ram Ayyar, University of Miami; Danielle Clarkson-Townsend, Emory University; Karen Swajian, Food and Drug Administration; Ronald Benner, Food and Drug Administration; Tom Brewer, Charles Darwin University; Lora E. Fleming, University of Exeter
• Language: English
• Date: 2017-03
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2017 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/md15030072
• Title of Journal or Parent Work: Marine Drugs
• ISSN: 1660-3397
• Volume: 15
• Issue: 3
• Start Page: 72
• End Page: 72
• Grant/Funding Information: Funding was also provided by The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Environmental Change and Health at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (PHE), and in collaboration with the University of Exeter, University College London, and the Met Office; the UK Medical Research Council and the UK Natural Environment Research Council (NERC).; In addition, this study contributes to the implementation of the objectives of the GlobalHAB project, supported by NSF grant OCE-1243377 to SCOR, and by the IOC/UNESCO.; This work was funded in part by the National Institutes of Health (NIH) training grant at University of Southern California (T32 ES013678) and by an NIH center grant at Emory University (P30 ES019776).
• Keywords: ciguatoxin; neurotoxin; ciguatera fish poisoning; natural toxins; food poisoning; neuropsychology; environmental change; diagnosis; neurology; human health; treatment; harmful algal bloom; climate change; Gambierdiscus; seafood poisoning; algae
• Research Categories: Biology, Neuroscience; Psychology, General

Abstract

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.