• 1

    Hughes JM, Merson MH, 1976. Current concepts fish and shellfish poisoning. N Engl J Med 295 :1117–1120.

  • 2

    Rakita RM, 1995. Ciguatera poisoning. J Travel Med 2 :252–254.

  • 3

    Schnorf H, Taurarii M, Cundy T, 2002. Ciguatera fish poisoning: a double-blind randomized trial of mannitol therapy. Neurology 58 :873–880.

    • Search Google Scholar
    • Export Citation
  • 4

    Raikhlin-Eisenkraft B, Bentur Y, 2002. Rabbitfish (“aras”): an unusual source of ciguatera poisoning. Isr Med Assoc J 4 :28–30.

  • 5

    Ting JY, Brown AF, 2001. Ciguatera poisoning: a global issue with common management problems. Eur J Emerg Med 8 :295–300.

  • 6

    Bagnis R, Kuberski T, Laugier S, 1979. Clinical observations on 3009 cases of ciguatera (fish poisoning) in the South Pacific. Am J Trop Med Hyg 28 :1067–1073.

    • Search Google Scholar
    • Export Citation
  • 7

    Pottier I, Vernoux JP, Lewis RJ, 2001. Ciguatera fish poisoning in the Caribbean islands and Western Atlantic. Rev Environ Contam Toxicol 168 :99–141.

    • Search Google Scholar
    • Export Citation
  • 8

    Yasumoto Y, 1991. Ciguateric toxins. Food Hygiene Examination Manual. Tokyo: Japan Food Hygiene Association, 309–312.

  • 9

    Lewis RJ, Sellin M, 1991. Purification and characterization of ciguatoxins from moray eel (Lycodontis javanicus, Muraenidae). Toxicon 29 :1115–1127.

    • Search Google Scholar
    • Export Citation
  • 10

    Lehane L, Lewis RJ, 2000. Ciguatera: recent advances but the risk remains. Int J Food Microbiol 61 :91–125.

  • 11

    Butera R, Prockop LD, Buonocore M, Locatelli C, Gandini C, Manzo L, 2000. Mild ciguatera poisoning: Case reports with neurophysiological evaluations. Muscle Nerve 23 :1598–1603.

    • Search Google Scholar
    • Export Citation
  • 12

    Miller RM, Pavia S, Keary P, 1999. Cardiac toxicity associated with ciguatera poisoning. Aust N Z J Med 29 :373–374.

  • 13

    Karalis T, Gupta L, Chu M, Campbell BA, Capra MF, Maywood PA, 2000. Three clusters of ciguatera poisoning: clinical manifestations and public health implications. Med J Aust 172 :160–162.

    • Search Google Scholar
    • Export Citation










View More View Less
  • 1 Division of Nephrology, Department of Medicine, and Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung; Division of Nephrology, E-Da Hospital, I-Shou University, Kaohsiung; Department of Food Science, National Taiwan Ocean University, Keelung; and National Yang-Ming University, School of Medicine, Taipei, Taiwan

We report an outbreak of ciguatoxin poisoning after barracuda fish ingestion in southern Taiwan. Three members of a family developed nausea, vomiting, watery diarrhea, and myalgias about 1 hour after eating three to ten eggs of a barracuda fish. Numbness of the lips and extremities followed the gastrointestinal symptoms about 2 hours after ingestion. Other manifestations included hyperthermia, hypotension, bradycardia, and hyperreflexia. Bradycardia persisted for several days, and one patient required a continuous infusion of intravenous atropine totaling 40 mg over 2 days. Further follow-up of the patients disclosed improvement of neurologic sequelae and bradycardia, but sensory abnormalities resolved several months later. In conclusion, ciguatoxin poisoning causes mainly gastrointestinal and neurologic effects of variable severity. In two patients with ciguatoxin poisoning after barracuda fish egg ingestion, persistent bradycardia required prolonged atropine infusion.

Author Notes

Reprint requests: Yao-Min Hung, Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan. Telephone: 886-7-3422121 ext 2050, Fax: 886-7-3455412, E-mail: ymhung1@doctor.com.