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.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  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. [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  4. Chan TYK, , 2013. Ciguatera caused by consumption of humphead wrasse. Toxicon 76: 255259.[Crossref] [Google Scholar]
  5. Chan TYK, , 2014. Large outbreaks of ciguatera after consumption of brown marbled grouper. Toxins (Basel) 6: 20412049.[Crossref] [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  8. Chan TYK, , 2015. Ciguatera fish poisoning in East Asia and Southeast Asia. Mar Drugs 13: 34663478.[Crossref] [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  11. Dickey RW, Plakas SM, , 2010. Ciguatera: a public health perspective. Toxicon 56: 123136.[Crossref] [Google Scholar]
  12. Chan TYK, , 2014. Epidemiology and clinical features of ciguatera fish poisoning in Hong Kong. Toxins (Basel) 6: 29892997.[Crossref] [Google Scholar]
  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] [Google Scholar]
  14. Rongo T, Bush M, van Woesik R, , 2009. Did ciguatera prompt the late Holocene Polynesian voyages of discovery? J Biogeogr 36: 14231432.[Crossref] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  20. Radke EG, Reich A, Morris JG, Jr, 2015. Epidemiology of ciguatera in Florida. Am J Trop Med Hyg 93: 425432.[Crossref] [Google Scholar]
  21. Quod JP, Turquet J, , 1996. Ciguatera in Reunion Island (SW Indian Ocean): epidemiology and clinical patterns. Toxicon 34: 779785.[Crossref] [Google Scholar]
  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] [Google Scholar]
  23. Lewis RJ, , 2006. Ciguatera: Australian perspectives on a global problem. Toxicon 48: 799809.[Crossref] [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  27. Bagnis R, , 1970. Concerning a fatal case of ciguatera poisoning in the Tuamotu Islands. Clin Toxicol 3: 579583.[Crossref] [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  31. Khlentzos CT, , 1950. Seventeen cases of poisoning due to ingestion of an eel, Gymnothorax flavimarginatus . Am J Trop Med Hyg 30: 785793. [Google Scholar]
  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. [Google Scholar]
  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. [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  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. [Google Scholar]
  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. [Google Scholar]
  41. Ghigliotty J, , 1981. Death at the dinner table. In: Sunday Magazine. San Juan, Puerto Rico: The San Juan Star, 26. [Google Scholar]
  42. Doorenbos N, Ragelis EP, , 1984. Ciguatera toxins: where do we go from here? , ed. Seafood Toxins. Washington, DC: American Chemical Society, 6973.[Crossref] [Google Scholar]
  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. [Google Scholar]
  44. Habermehl GG, Krebs HC, Rasoanaivo P, Ramialiharisoa A, , 1994. Severe ciguatera poisoning in Madagascar: a case report. Toxicon 32: 15391542.[Crossref] [Google Scholar]
  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] [Google Scholar]
  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. [Google Scholar]
  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. [Google Scholar]
  48. Olsen DA, , 1988. The impact of ciguatera fish poisoning within a changing Caribbean environment. Popul Environ 10: 1431.[Crossref] [Google Scholar]
  49. Chan TYK, , 2015. Emergence and epidemiology of ciguatera in the the coastal cities of Southern China. Mar Drugs 13: 11751184.[Crossref] [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  52. Cooper MJ, , 1964. Ciguatera and other marine poisoning in the Gilbert Islands. Pac Sci 18: 411440. [Google Scholar]
  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. [Google Scholar]
  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. [Google Scholar]
  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] [Google Scholar]
  56. Chan TYK, , 2013. Severe bradycardia and prolonged hypotension in ciguatera. Singapore Med J 54: e120e122.[Crossref] [Google Scholar]
  57. Lewis ND, , 1986. Epidemiology and impact of ciguatera in the Pacific: a review. Mar Fish Rev 48: 613. [Google Scholar]

Data & Media loading...

  • Received : 18 Sep 2015
  • Accepted : 08 Dec 2015
  • Published online : 06 Apr 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error