What is Ciguatera poisoning ? Introduction | Symptoms | Control Methods : Ciguatera poisoning affects people after they have eaten certain seafood, primarily fish, which contains the poison ciguatoxin. The poison is produced by microscopic algae known as dinoflagellates that are found in shallow coastal waters on the surfaces of seaweeds and other marine plants such as corals. Herbivorous fish that browse on the plants consume the dinoflagellates. These fish can then in turn be consumed by carnivorous fish. In this way, the toxin moves up the food chain, becoming more and more concentrated each time a larger fish eats a smaller fish. Other marine animals such as sea urchins and snails may also become contaminated with the toxin, but are less important than fish in terms of ciguatera poisoning. Knowledge about the global burden of disease is rather limited. Ciguatera poisoning (CP) is known to be underreported as doctors are often unaware of the obligation to report it, but also because CP is very often not correctly diagnosed. However, it is thought that 50 000–500 000 people each year are affected by the condition. In regions where the poison-producing dinoflagellates grow, such as the Pacific islands, estimates are that up to 10 per cent of the local population is affected each year. A technical document has been released by WHO explaining .What is Ciguatera poisoning ? Introduction | Symptoms | Control Methods
Key Symptoms for What is Ciguatera poisoning ? Introduction | Symptoms | Control Methods
- More than 175 symptoms have been reported for CP. Acute symptoms appear within 48 hours after consumption and are observed in almost all organ systems – gastrointestinal, cardiovascular and neurological. They include e.g. fatigue, any kind of pain, nausea, vomiting, diarrhoea, low blood pressure, and heart rhythm disorder. While most symptoms are unspecific and could also hint towards other food poisoning, a classic symptom for CP is cold allodynia – the sensation that cold things feel hot to the touch.
- In at least 20 per cent of CP-affected persons, symptoms persist for months or years after the initial poisoning; they are characterized by neurological, neuropsychiatric and systemic symptoms. These chronic symptoms include seizures, depression, anxiety, and memory disturbances.
- Symptoms may also recur from time to time, for months or years. Recurrence can be triggered by certain foods (e.g. alcohol, nuts, dairy products, fish, meat), by behavioural (e.g. intense physical activity, fatigue) or other external (e.g. sun exposure) factors.
- While the fatality rate of CP may exceed 10 per cent in some contexts, it is overall estimated to be less than 0.5 per cent. Death due to CTX exposure often follows cardiovascular and/or complications of the central nervous system
Controlling ciguatera poisoning: setting good practices
In some parts of the world fish are eaten whole, and good practices include developing guidance about what parts of the fish should not be eaten. Visceral organs, eggs, heads, eyes and bones should be avoided, as these tissues can contain high levels of CTXs and should be removed prior to consumption.
As fish flesh may become contaminated with visceral tissue during handling, good practices include providing guidance on the disposal of ciguatoxic fish, fish heads and viscera.
Good practices also include informing the consumer through public outreach programmes about the potential risks posed by consuming fish heads and viscera, and some invertebrates. Raising awareness is an important part of the risk management options, and risk communication needs to be tailored to the local situation regarding the consumption and trade of specific fish.
A potential problem in monitoring and CP prevention is the mislabelling of fish species. To allow trade from endemic areas, good practices include ensuring that seafood products are labelled accurately.
The World Health Organization (WHO) encourages national authorities to monitor and ensure that levels of the most relevant natural toxins in their food supply are as low as possible and comply with both national and international maximum levels, conditions and legislation. In conjunction with other organizations, WHO manages several bodies dealing with natural toxins and food safety events.
The Food and Agriculture Organization (FAO)/WHO Joint Expert Committee on Food Additives (JECFA) undertakes risk assessments of natural toxins, and these assessments are used by governments and the Codex Alimentarius Commission (the inter-governmental standards-setting body for food) to establish maximum levels in food or provide other risk management advice.
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