Article Category:
Research Article

Clinicoepidemiological Profile of Ciguatera Cardiotoxicity: A Systematic Review

Clarke Morihara Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, Hawaii;

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Thanaboon Yinadsawaphan Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, Hawaii;

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Christian John Capirig Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, Hawaii;

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Bradley Fujiuchi Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, Hawaii;

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Yusuke Hirao Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, Hawaii;

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Joshua Hu Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, Hawaii;

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Reed McCardell Malone Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, Hawaii;

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Jadon Neuendorf Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, Hawaii;

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Sable Neuendorf Medical Education, California University of Science and Medicine, Colton, California

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Sorawit Ongsupankul Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, Hawaii;

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Kazushige Shiraishi Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, Hawaii;

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Kevin Benavente Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, Hawaii;

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Yoshito Nishimura Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, Hawaii;

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DOI:
https://doi.org/10.4269/ajtmh.24-0207
Volume/Issue:
Volume 111: Issue 3
Page(s):
671–675
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ABSTRACT.

Patients with ciguatera poisoning commonly present with gastrointestinal and neurologic symptoms, but its cardiotoxicity has been largely unrecognized. This systematic review is the first to summarize the evidence regarding clinical characteristics of cardiotoxicity from ciguatera poisoning to provide the illness script and pertinent knowledge for clinicians. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including “ciguatera” and “cardiotoxicity” from their inception to January 2024. We included 20 articles, including 148 cases, in this systematic review. Among the included cases, the median age was 54 years with male predominance (62.2%). Based on the WHO designation, 68.5% were reported from the Western Pacific Region. Common symptoms included hypotension (75.0%) and bradycardia (67.6%), and chest pain or syncope were less commonly reported (2.7% and 1.4%, respectively). Sinus bradycardia was the most common electrocardiogram abnormality (35.9%), followed by atrioventricular blocks (15.4%). Symptomatic treatments such as atropine, dopamine, and epinephrine were commonly used, and only 4.1% required intensive care unit admission. None expired due to cardiotoxicity from ciguatera. This review summarizes the current evidence and the characteristics of cardiotoxicity from ciguatera. Although ciguatera cardiotoxicity is currently underrecognized, increased awareness of the condition in clinicians is crucial because the clinical outcomes of the patients could be benign as long as it is identified and intervened early.

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Author Notes

Authors’ contributions: Y. Nishimura searched the literature, assessed the quality of the studies, drafted and revised the manuscript, and supervised the process. C. Morihara conceived the study, searched the literature, assessed the quality of the studies, and drafted the manuscript. C. J. Capirig, B. Fujiuchi, R. M. Malone, S. Ongsupankul, and K. Shiraishi searched the literature and assessed the quality of the studies. T. Yinadsawaphan analyzed the data and drafted the manuscript. Y. Hirao, J. Hu, J. Neuendorf, S. Neuendorf, and K. Benavente revised the manuscript.

Current contact information: Clarke Morihara, Thanaboon Yinadsawaphan, Christian John Capirig, Bradley Fujiuchi, Yusuke Hirao, Joshua Hu, Reed McCardell Malone, Jadon Neuendorf, Sorawit Ongsupankul, Kazushige Shiraishi, Kevin Benavente, and Yoshito Nishimura, Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI, E-mails: clarkemo@hawaii.edu, tyin@hawaii.edu, capirig@hawaii.edu, blf@hawaii.edu, hiraoy@hawaii.edu, jthu@hawaii.edu, reedmm@hawaii.edu, jadonjn@hawaii.edu, sorawit@hawaii.edu, kshira@hawaii.edu, kevinb33@hawaii.edu, and yoshiton@hawaii.edu. Sable Neuendorf, Medical Education, California University of Science and Medicine, Colton, CA, E-mail: neuendorfs@cusm.org.

Address correspondence to Yoshito Nishimura, 1356 Lusitana St., Rm. 715, Honolulu, HI 96813. E-mail: yoshiton@hawaii.edu
Copyright:
© American Society of Tropical Medicine and Hygiene 2024
Received:
29 Mar 2024
|
Accepted:
29 Apr 2024
|
Published Online:
09 Jul 2024
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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