Volume 77, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Ciguatera is a tropical disease caused by seafood poisoning, for which the duration of symptoms remains to be determined. The objectives of this prospective study were to determine the prevalence of symptoms at different time points and to identify factors associated with chronic symptoms observed in adults suffering from this disease. At the time of onset, we observed a dose–response relationship including a strong association between the delay of appearance of symptoms and a severity index ( < 0.001). Our results confirmed the key role of fish organs in the risk of contracting a more severe form of ciguatera. In the chronic stage, only the severity score based on information recorded in the acute phase is related to the persistence of symptoms ( < 0.001). Our findings suggest that several symptoms observed in the acute phase of the disease are still experienced 15 days after onset. This supports previous observations based on isolated case reports.


Article metrics loading...

Loading full text...

Full text loading...



  1. Champetier De Ribes G, Rasolofonirina RN, Ranaivoson G, Razafimahefa N, Rakotoson JD, Rabeson D, 1997. Intoxication by marine animal venoms in Madagascar (ichthyosarcotoxism and chelonitoxism): recent epidemiological data. Bull Soc Pathol Exot 90 : 286–290.
  2. Swift AE, Swift TR, 1993. Ciguatera. J Toxicol Clin Toxicol 31 : 1–29.
  3. Van Dolah FM, 2000. Marine algal toxins: origins, health effects, and their increased occurrence. Environ Health Perspect 108 (Suppl 1): 133–141.
  4. Pearn J, 2001. Neurology of ciguatera. J Neurol Neurosurg Psychiatry 70 : 4–8.
  5. Lehane L, Lewis RJ, 2000. Ciguatera: recent advances but the risk remains. Int J Food Microbiol 61 : 91–125.
  6. 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 : 448–454.
  7. Morris JG Jr, Lewin P, Smith CW, Blake PA, Schneider R, 1982. Ciguatera fish poisoning epidemiology of the disease on St. Thomas, U.S. Virgin Islands. Am J Trop Med Hyg 31 : 574–578.
  8. Geller RJ, Benowitz NL, 1992. Orthostatic hypotension in ciguatera fish poisoning. Arch Intern Med 152 : 2131–2133.
  9. Czernichow P, Droy JM, Ezelin F, Leroy J, 1984. Epidemiology of ciguatera in the Iles Saintes (Guadeloupe). Rev Epidemiol Sante Publique 32 : 315–321.
  10. Morris JG Jr, Lewin P, Hargrett NT, Smith CW, Blake PA, Schneider R, 1982. Clinical features of ciguatera fish poisoning: a study of the disease in the US Virgin Islands. Arch Intern Med 142 : 1090–1092.
  11. 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 : 1067–1073.
  12. Ting JY, Brown AF, Pearn JH, 1998. Ciguatera poisoning: an example of a public health challenge. Aust NZ J Public Health 22 : 140–142.
  13. Czernichow P, Droy JM, Ezelin F, Leroy J, 1984. Ciguatera in the Iles des Saintes (Guadeloupe). A disease transmitted by fish. Presse Med 13 : 222 (Letter).
  14. Glaziou P, Martin PM, 1993. Study of factors that influence the clinical response to ciguatera fish poisoning. Toxicon 31 : 1151–1154.
  15. Lange WR, Snyder FR, Fudala PJ, 1992. Travel and ciguatera fish poisoning. Arch Intern Med 152 : 2049–2053.
  16. Cameron J, Capra MF, 1993. The basis of the paradoxical disturbance of temperature perception in ciguatera poisoning. J Toxicol Clin Toxicol 31 : 571–579.
  17. Stommel EW, Jenkyn LR, Parsonnet J, 1993. Another case of polymyositis after ciguatera toxin exposure. Arch Neurol 50 : 571 (Letter).
  18. Stommel EW, Parsonnet J, Jenkyn LR, 1991. Polymyositis after ciguatera toxin exposure. Arch Neurol 48 : 874–877.
  19. Sozzi G, Marotta P, Aldeghi D, Tredici G, Calvi L, 1988. Polyneuropathy secondary to ciguatoxin poisoning. Ital J Neurol Sci 9 : 491–495.
  20. De Haro L, Hayek-Lanthois M, Joossen F, Affaton MF, Jouglard J, 1997. [Mass ciguatera poisoning after eating barracuda in Mexico: prognostic and therapeutic implications]. Med Trop 57 : 55–58 (original article in French).
  21. Farstad DJ, Chow T, 2001. A brief case report and review of ciguatera poisoning. Wilderness Environ Med 12 : 263–269.
  22. Chan TY, 1998. Lengthy persistence of ciguatoxin in the body. Trans R Soc Trop Med Hyg 92 : 662.
  23. Kuczmarski RJ, Flegal KM, 2000. Criteria for definition of overweight in transition: background and recommendations for the United States. Am J Clin Nutr 72 : 1074–1081.
  24. Mou Y, Gleize L, Nguyen Ngoc L, 1998. Enquéte sur les maladies non transmissibles en Polynésie Française. Report. Papeete, Tahiti: Direction de la Santé en Polynésie Française, Institut Territorial de Recherche Médicale Louis Malardé, 1–87.
  25. Lange WR, 1993. Severity rating scales for ciguatera fish poisoning. Toxicon 31 : 777–781.
  26. Greeland S, Rothman KJ, 1998. Introduction to stratified analysis. Rothman KJ, Greeland S, eds. Modern Epidemiology, 2nd edition. Philadelphia: Lippincott-Raven, 253–280.
  27. Liang K, Zeger S, 1986. Longitudinal data analysis using generalized linear models. Biometrika 73 : 13–22.
  28. Zeger SL, Liang KY, 1986. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42 : 121–130.
  29. Legrand A-M, Teai T, Cruchet P, Bracchi T, 1997. Toxins involved in ciguatera fish poisoning in French Polynesia: ciguatoxin profiles of herbivorous and carnivorous fish muscles from highly endemic areas. Toxicon 35 : 1667.
  30. Tosteson TR, 1995. The diversity and origins of toxins in ciguatera fish poisoning. P R Health Sci J 14 : 117–129.
  31. Pearn JH, 1997. Chronic fatigue syndrome: chronic ciguatera poisoning as a differential diagnosis. Med J Aust 166 : 309–310.
  32. Schnorf H, Taurarii M, Cundy T, 2002. Ciguatera fish poisoning: a double-blind randomized trial of mannitol therapy. Neurology 58 : 873–880.
  33. Bagnis RA, 1979. [Ciguatera fish poisoning in New Caledonia. Clinical and epidemiological aspects (author’s transl)]. Rev Epidemiol Sante Publique 27 : 17–29.
  34. 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 : 584–590.

Data & Media loading...

  • Received : 26 May 2005
  • Accepted : 15 Aug 2007

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