Volume 94, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



In this review, the main objective was to describe the characteristic features of fatal ciguatera fish poisoning and identify contributory factors, with a view to promote prevention and public education. Ciguatera-related deaths, although rare, have been reported from the Pacific, Caribbean, and Indian Ocean regions. The clinical features were generally dominated by convulsions and coma, with various focal neurological signs. Several contributory factors could be identified, including consumption of ciguatoxin (CTX)-rich fish parts (viscera and head) in larger amounts, the most ciguatoxic fish species (e.g., ) and reef fish collected after storms and individuals' susceptibility. Mass ciguatera fish poisoning with mortalities also occurred when and other ciguatoxic fish species were shared in gatherings and parties. The characteristic features of fatal ciguatera fish poisoning must be recognized early. The public should be repeatedly reminded to avoid eating the most ciguatoxic fish species and the CTX-rich parts of reef fish. To prevent mass poisoning in gatherings and parties, the most ciguatoxic fish species and potentially toxic fish species must be avoided. Particularly after hits by disastrous storms, it is important to monitor the toxicity of reef fish and the incidence rates of ciguatera.


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  1. FAO, 2004. Ciguatera fish poisoning. Marine Biotoxins. FAO Food and Nutrition Paper 80. Rome, Italy: Food and Agriculture Organization of the United Nations, 185218.
  2. Friedman MA, Fleming LE, Fernandez M, Bienfang P, Schrank K, Dickey R, Bottein MY, Backer L, Ayyar R, Weisman R, Watkins S, Granade R, Reich A, , 2008. Ciguatera fish poisoning: treatment, prevention and management. Mar Drugs 6: 456479.[Crossref]
  3. Mak YL, Wai TC, Murphy MB, Chan WH, Wu JJ, Lam JCW, Chan LL, Lam PKS, , 2013. Pacific ciguatoxins in food web components of coral reef systems in the Republic of Kiribati. Environ Sci Technol 47: 1407014079.[Crossref]
  4. Chan TYK, , 2013. Ciguatera caused by consumption of humphead wrasse. Toxicon 76: 255259.[Crossref]
  5. Chan TYK, , 2014. Large outbreaks of ciguatera after consumption of brown marbled grouper. Toxins (Basel) 6: 20412049.[Crossref]
  6. Chan TYK, , 2015. Ciguatoxic potential of brown-marbled grouper in relation to fish size and geographical origin. Am J Trop Med Hyg 93: 11171121.[Crossref]
  7. Vernoux JP, Lahlou N, Abbad el Andaloussi S, Riyeche N, Magras LP, , 1985. A study of the distribution of ciguatoxin in individual Caribbean fish. Acta Trop 42: 225233.
  8. Chan TYK, , 2015. Ciguatera fish poisoning in East Asia and Southeast Asia. Mar Drugs 13: 34663478.[Crossref]
  9. Gingold DB, Strickland MJ, Hess JJ, , 2014. Ciguatera fish poisoning and climate change: analysis of National Poison Center Data in the United States, 2001–2011. Environ Health Perspect 122: 580586.
  10. Litaker RW, Vandersea MW, Faust MA, Kibler SR, Nau AW, Holland WC, Chinain M, Holmes MJ, Tester PA, , 2010. Global distribution of ciguatera causing dinoflagellates in the genus Gambierdiscus . Toxicon 56: 711730.[Crossref]
  11. Dickey RW, Plakas SM, , 2010. Ciguatera: a public health perspective. Toxicon 56: 123136.[Crossref]
  12. Chan TYK, , 2014. Epidemiology and clinical features of ciguatera fish poisoning in Hong Kong. Toxins (Basel) 6: 29892997.[Crossref]
  13. Oshiro N, Yogi K, Asato S, Sasaki T, Tamanaha K, Hirama M, Yasumoto T, Inafuku Y, , 2010. Ciguatera incidence and fish toxicity in Okinawa, Japan. Toxicon 56: 656661.[Crossref]
  14. Rongo T, Bush M, van Woesik R, , 2009. Did ciguatera prompt the late Holocene Polynesian voyages of discovery? J Biogeogr 36: 14231432.[Crossref]
  15. Chinain M, Darius HT, Ung A, Fouc MT, Revel T, Cruchet P, Pauillac S, Laurent D, , 2010. Ciguatera risk management in French Polynesia: the case study of Raivavae Island (Australes Archipelago). Toxicon 56: 674690.[Crossref]
  16. Skinner MP, Brewer TD, Johnstone R, Fleming LE, Lewis RJ, , 2011. Ciguatera fish poisoning in the Pacific Islands (1998 to 2008). PLoS Negl Trop Dis 5: e1416.[Crossref]
  17. Tester PA, Feldman RL, Nau AW, Kibler SR, Wayne Litaker R, , 2010. Ciguatera fish poisoning and sea surface temperatures in the Caribbean Sea and the West Indies. Toxicon 56: 698710.[Crossref]
  18. Celis JS, Pineda M, Ernesto J, , 2015. Historical analysis of ciguatera incidence in the Caribbean islands during 31 years: 1980–2010. Boletin de Investigaciones Mainas y Costeras 44: 732.
  19. Radke EG, Grattan LM, Cook RL, Smith TB, Anderson DM, Morris JG, Jr, 2013. Ciguatera incidence in the US Virgin Islands has not increased over a 30-year time period despite rising seawater temperatures. Am J Trop Med Hyg 88: 908913.[Crossref]
  20. Radke EG, Reich A, Morris JG, Jr, 2015. Epidemiology of ciguatera in Florida. Am J Trop Med Hyg 93: 425432.[Crossref]
  21. Quod JP, Turquet J, , 1996. Ciguatera in Reunion Island (SW Indian Ocean): epidemiology and clinical patterns. Toxicon 34: 779785.[Crossref]
  22. Chan TYK, Wang AYM, , 1993. Life-threatening bradycardia and hypotension in a patient with ciguatera fish poisoning. Trans R Soc Trop Med Hyg 87: 71.[Crossref]
  23. Lewis RJ, , 2006. Ciguatera: Australian perspectives on a global problem. Toxicon 48: 799809.[Crossref]
  24. Tonge JI, Battey Y, Forbes JJ, Grant EM, , 1967. Ciguatera poisoning: a report of two outbreaks and a probable fatal case in Queensland. Med J Aust 2: 10881090.
  25. Hamilton B, Whittle N, Shaw G, Eaglesham G, Moore MR, Lewis RJ, , 2010. Human fatality associated with Pacific ciguatoxin contaminated fish. Toxicon 56: 668673.[Crossref]
  26. Yasumoto T, Raj U, Bagnis R, , 1984. Symposium on Seafood Toxins in Tropical Regions. Symposium on Seafood Toxins from Tropical Regions, 174. Laboratory of Food Hygiene, Faculty of Agriculture, Tohoku University, Sendai, Japan.
  27. Bagnis R, , 1970. Concerning a fatal case of ciguatera poisoning in the Tuamotu Islands. Clin Toxicol 3: 579583.[Crossref]
  28. Bagnis R, Kuberski T, Laugier S, , 1979. Clinical observations on 3,009 cases of ciguatera (fish poisoning) in the South Pacific. Am J Trop Med Hyg 28: 10671073.
  29. Gatti C, Oelher E, Legrand AM, , 2008. Severe seafood poisoning in French Polynesia: a retrospective analysis of 129 medical files. Toxicon 51: 746753.[Crossref]
  30. Anderson BS, Sims JK, Wiebenga NH, Sugi M, , 1983. The epidemiology of ciguatera fish poisoning in Hawaii, 1975–1981. Hawaii Med J 42: 326334.
  31. Khlentzos CT, , 1950. Seventeen cases of poisoning due to ingestion of an eel, Gymnothorax flavimarginatus . Am J Trop Med Hyg 30: 785793.
  32. Ralls RJ, Halstead BW, , 1955. Moray eel poisoning and a preliminary report on the action of the toxin. Am J Trop Med Hyg 4: 136140.
  33. Inoue A, Edward A, , 1995. The growth of G. toxicus, a toxic dinoflagellate in Pohnpei Island and Ant Atoll, the Federated States of Micronesia. Kagoshima Univ Res Center S Pac Occasional Papers 26: 2529.
  34. Rapson AM, , 1968. Ichthyosarcotoxism (Fish Poisoning) in New Guinea. SPC Seminar on Ichthyosarcotoxism, 16–22 August, 1968. Available at: http://www.spc.int/DigitalLibrary/Doc/FAME/Meetings/Meetings_on_Ciguatera/Seminar_Ichthyosarcotoxism_68/WP10.pdf. Accessed November 30, 2015.
  35. Hsieh CH, Hwang KL, Lee MM, Lan CH, Lin WF, Hwang DF, , 2009. Species identification of ciguatoxin-carrying grouper implicated in food poisoning. J Food Prot 72: 23752379.[Crossref]
  36. Lin WF, Hwang DF, , 2012. Analysis of poisoning cases, monitoring and risk warning for marine toxins (TTX, PSP and CTXs) in Taiwan. J Food Drug Anal 20: 764771.
  37. Sierra-Beltrán AP, Cruz A, Núñez E, Del Villar LM, Cerecero J, Ochoa JL, , 1998. An overview of the marine food poisoning in Mexico. Toxicon 36: 14931502.[Crossref]
  38. Pumariega RBH, Mullings AOH, Escandón AS, del Corral García J, , 2005. Evolución fatal por ciguatera. A propósito de un brote. Availabe at: http://www.bvsde.paho.org/bvsacd/cd27/ciguareta.pdf. Accessed November 30, 2015.
  39. Taylor FJR, , 1984. Human and domestic animal fatalities as well as skin reactions associated with the ‘rough triggerfish’, Canthidermis maculatus (Bloch) in Dominica, West Indies, following Hurricane David. Rev Int Océanogr Méd 73/74: 3540.
  40. Caribbean Fishery Management Council, 1985. Fishery Management Plan, Final Environmental Impact Statement, and Draft Regulatory Impact Review for the Shallow-Water Reeffish Fishery of Puerto Rico and the U.S. Virgin Islands. Available at: http://www.caribbeanfmc.com/fmp%20REEF%20FISH/RF%20FMP.pdf. Accessed November 30, 2015.
  41. Ghigliotty J, , 1981. Death at the dinner table. In: Sunday Magazine. San Juan, Puerto Rico: The San Juan Star, 26.
  42. Doorenbos N, Ragelis EP, , 1984. Ciguatera toxins: where do we go from here? , ed. Seafood Toxins. Washington, DC: American Chemical Society, 6973.[Crossref]
  43. Wasay M, Sarangzai A, Siddiqi A, Nizami Q, , 2008. Ciguatera fish poisoning with elevated muscle enzymes and abnormal spinal MRI. Southeast Asian J Trop Med Public Health 39: 307309.
  44. Habermehl GG, Krebs HC, Rasoanaivo P, Ramialiharisoa A, , 1994. Severe ciguatera poisoning in Madagascar: a case report. Toxicon 32: 15391542.[Crossref]
  45. Boisier P, Ranaivoson G, Rasolofonirina N, Andriamahefazafy B, Roux J, Chanteau S, Satake M, Yasumoto T, , 1995. Fatal mass poisoning in Madagascar following ingestion of a shark (Carcharhinus leucas): clinical and epidemiological aspects and isolation of toxins. Toxicon 33: 13591364.[Crossref]
  46. Rege UG, Tilve GH, Juvale NI, Jayakar VV, Nair KG, , 1979. Ciguatera (a variety of fresh fish poisoning) (a case report). J Postgrad Med 25: 112114.
  47. Copeland NK, Palmer WR, Bienfang PK, , 2014. Ciguatera fish poisoning in Hawaii and the Pacific. Hawaii J Med Public Health 73 (Suppl 2): 2427.
  48. Olsen DA, , 1988. The impact of ciguatera fish poisoning within a changing Caribbean environment. Popul Environ 10: 1431.[Crossref]
  49. Chan TYK, , 2015. Emergence and epidemiology of ciguatera in the the coastal cities of Southern China. Mar Drugs 13: 11751184.[Crossref]
  50. Gillespie NC, Lewis RJ, Pearn JH, Bourke AT, Holmes MJ, Bourke JB, Shields WJ, , 1986. Ciguatera in Australia. Occurrence, clinical features, pathophysiology and management. Med J Aust 145: 584590.
  51. Pennotti R, Scallan E, Backer L, Thomas J, Angulo FJ, , 2013. Ciguatera and scombroid fish poisoning in the United States. Foodborne Pathog Dis 10: 10591066.[Crossref]
  52. Cooper MJ, , 1964. Ciguatera and other marine poisoning in the Gilbert Islands. Pac Sci 18: 411440.
  53. Katz AR, Terrell-Perica S, Sasaki DM, , 1993. Ciguatera on Kauai: investigation of factors associated with severity of illness. Am J Trop Med Hyg 49: 448454.
  54. Chateau-Degat ML, Huin-Blondey MO, Chinain M, Darius T, Legrand AM, Nguyen NL, Laudon F, Chansin R, Dewailly E, , 2007. Prevalence of chronic symptoms of ciguatera disease in French Polynesian adults. Am J Trop Med Hyg 77: 842846.
  55. Chan WH, Mak YL, Wu JJ, Jin L, Sit WH, Lam JC, Sadovy de Mitcheson Y, Chan LL, Lam PK, Murphy MB, , 2011. Spatial distribution of ciguateric fish in the Republic of Kiribati. Chemosphere 84: 117123.[Crossref]
  56. Chan TYK, , 2013. Severe bradycardia and prolonged hypotension in ciguatera. Singapore Med J 54: e120e122.[Crossref]
  57. Lewis ND, , 1986. Epidemiology and impact of ciguatera in the Pacific: a review. Mar Fish Rev 48: 613.

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  • Received : 18 Sep 2015
  • Accepted : 08 Dec 2015

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