• Epidemiology: the most common fish-associated nonbacterial food poisoning in the United States, with most cases occurring in Florida and

Hawaii – Almost exclusively involves tropical and semitropical marine coral fish common in the Indian Ocean, the South Pacific, and the

Caribbean Sea – 75% of non-Hawaiian cases involve barracuda, snapper, jack, or grouper.

  • Pathogenesis: Ciguatera syndrome is associated with at least five toxins that originate in photosynthetic dinoflagellates and accumulate in the food chain. Three major ciguatoxins—CTX-1, -2, and -3—are found in the flesh and viscera of ciguateric fish, are typically unaffected by external factors (e.g., heat, cold, freeze-drying, gastric acid), and do not generally affect the fish (e.g., odor, color, or taste).
  • Clinical Features: Virtually all pts is affected within 24 h; most experience symptoms within 2–6 h. The diagnosis is made on clinical grounds.

– Symptoms can be numerous (>150 reported) and include diarrhea, vomiting, abdominal pain, neurologic signs (e.g., paresthesias, weakness, fasciculations, ataxia), maculopapular or vesicular rash, and hemodynamic instability.

– A pathognomonic symptom—reversal of hot and cold tactile perception

—Develops within 3–5 days and can last for months.

– Death is rare.



The medicines that can be thought of use are:-

Arsenic album

Veratrum album