By J.K. Sims, MD Emergency Medical Systems Branch
State of Hawaii, Department of Health

Human ciguatera fish poisoning (i.e. ciguatera) usually results from consumption of ordinary edible predominantly reef fish bearing a multiplicity of toxins, including ciguatoxin.  Poisonings resembling ciguatera have resulting from the ingestion of marine snails (e.g. turban shell Turban pica, formerly Livonia pics, or “cigua”) and shellfish in areas endemic for ciguatera fish poisoning (particularly during ciguatera outbreaks), so it has been recommended that shellfish from the involved waters be avoided also.  For example, in 1978 a young woman with severe bradycardia hypotensive ciguatera fish poisoning was flown to Honolulu from Wake Island and several weeks later a man on Wake Island developed a ciguatera-like illness following ingestion of turban shells and crabs from involved waters.  

I acute ciguatera, the clinical manifestations are varies and can include nausea, vomiting, oropharyngeal paresthesias, acral paresthesias, extremity paresthesias, diarrhea, urtioaria, weakness, “carbonation” sensation upon drinking non-carbonated liquids, temperature sensation reverson phenomenom, myalgias, arthralgias, bradycardia, hypotension, and many other signs and symptoms.  Features suggest hypovolemia, hypocalcemia, and allergic reaction may be present.  A number of these acute manifestations can persist in the condition known as chronic ciguatera fish poisoning for which remissions and exacerbations may occur.  The purpose of the diet in ciguatera fish poisoning  is to promote recovery from the poisoning and to reduce recurrent poisoning during the acute, chronic, and/or post-recovery phases.