By NANCY YOUNG, The Virginian-Pilot
March 17, 2007

It seemed like a great breakfast. Boiled fresh grouper, a staple in the Bahamas.

"It was yummy. I ate every bite," said Terree Neal of Norfolk.

Within an hour, she thought she was having a stroke. Her extremities went numb, she had vertigo and trouble breathing. Two months later, her right arm still doesn't work well enough to put a clip in her hair.

It wasn't a stroke, though. And it was definitely something she ate.

Neal had contracted ciguatera, an illness caused by a toxin found in some tropical fish that inhabit waters near coral reefs.

"The fish looks great, tastes good, but these people get very ill," said Dr. Lora Fleming, a professor at the University of Miami School of Medicine and the Rosenstiel School of Marine and Atmospheric Science who studies ciguatera.

Because the condition is often misdiagnosed or goes unreported, estimates on how many people get ciguatera vary widely, Fleming said. Some estimates are as high as 500,000 people a year. Most are living in or visiting tropical areas in the Caribbean or Pacific. It's rarely fatal.

The trouble for tourists is that while the illness is well-known in the tropics, back in the States it's more of an unknown. Neal said once she became ill just about everyone in the Bahamas recognized the affliction.

However, finding doctors in Hampton Roads who knew about it was like going on an "archaeological dig," Neal said.

The toxin is found in algae blooms that coat coral reefs. The algae is eaten by small fish, which in turn are eaten by carnivorous fish like grouper, snapper, barracuda, hogfish and kingfish, Fleming said. Those fish, particularly the larger ones, can then accumulate enough of the toxin - it doesn't take much - to make humans sick when they eat those fish.

The illness usually begins with gastrointestinal symptoms, but the toxin chiefly acts on the nervous system, Fleming said. So while the nausea and vomiting will usually subside in a few days, neurological symptoms may linger for "weeks to months, some people even say years," she said.

While Neal looks healthy, she still feels the effects of the January breakfast. She's extremely sensitive to temperature and it feels like "my nerves are on the tops of my skin."

The toxin can be counteracted by intravenously administering Mannitol - basically a thick sugar water, Fleming said - within 72 hours of eating the fish. But if too much time passes, people, like Neal, are stuck with the symptoms until they resolve naturally.

"It will get better," Fleming said.

In the meantime, people with ciguatera seem to do better if they avoid alcohol, fish of any kind, caffeine, chocolate and nuts. No one really knows why those things seem to aggravate the condition, Fleming said.

Prevention is the best defense, but that can be tricky, Fleming said. The toxin does not affect taste of the fish, is not the result of improper food storage or preparation and cannot be killed by cooking. Restaurants that serve the fish have no way of knowing there's a problem with it.

"The key to avoiding ciguatera is if you're going to eat fish, eat them small. The fish should fit on your plate and you should know what you're eating," said Fleming, who added that fillets from tropical reef fish greater than 20 pounds are more likely to have the toxin.

Of course, Fleming adds, eating fish when they're smaller is worse for keeping fish populations strong, "so you still have to eat with guilt."

Neal is an experienced world traveler and lives part time in the Bahamas, but she hadn't heard of the illness until she got it. She wants to prevent other tropical tourists from being in the same boat.

"When you are traveling in foreign places, be aware of what's indigenous to the area," she said. "I'm just saying this is out there."

# Reach Nancy Young at(757) 446-2947 or This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .