TITLE:
Marine Fish Toxins in Thailand: Report of 6 Suspected Ciguatera Cases
AUTHORS:
Abhinbhen Saraya, Chirapol Sintunawa, Supaporn Wacharapluesadee, Kusuma Swangpun, Supaluck Dumrongchua, Henry Wilde, Thiravat Hemachudha
KEYWORDS:
Component, Ciguatera, Marine Toxins, Ciguatoxin, Food-Borne Diseases
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.5,
May
15,
2014
ABSTRACT: Food poisoning or
gastroenteritis is a common diagnosis for individuals who have nausea, vomiting
and diarrhea after ingestion of fish. When also manifesting neurological
symptoms, these are blamed on puffer fish poisoning, but ciguatera fish
poisoning (CFP) can also manifest only with gastroenteritis, without
neurological complications and remain undiagnosed. We report patients who
fulfilled criteria of CFP suffering from severe GI disturbances, neurological
manifestations, compromised cardiovascular status and autonomic dysfunction.
All recovered within 1 - 3 days with supportive treatment. There were two small
outbreaks: one in Bangkok in 2007 (2 patients) and another (2009) in Phuket (4
patients). All patients consumed the same unidentified fish portion and had
severe GI symptoms. One had acute ventilatory failure requiring intubation
whereas the remaining had neurological disturbances consisting of paresthesia,
severe vertigo and ataxia. Absence of reflex tachycardia was noted in all
patients who had severe volume depletion and shock. The most severe patient
could be extubated within 24 hours and was discharged in 48 hours. All of the
remaining recovered completely within 48 hours. Severe abdominal pain, nausea
and vomiting and autonomic dysfunction in the form of bradycardia in the
presence of hypotension were seen. Dramatic recovery within 48 hours occurred
in all cases. None of the fish considered to have been responsible was
available for testing. Physicians should be aware of CFP intoxication in the
differential diagnosis of gastroenteritis-like syndromes after eating seafood.