20 April 2012

Toxic marine poisoning – Ciguatera: Lanzarote, The Canary Islands

On 16 April 2012, the Department of Health of the Canary Islands reported two separate outbreaks of Ciguatera Fish Poisoning (CFP) in Lanzarote. In the first outbreak, 10 cases were confirmed between 28 January and 28 February. Hours after eating yellowtail fish, individuals experienced vomiting, diarrhoea and abdominal pain followed by paresthesia and myalgia. This outbreak was linked to two restaurants.

In early April 2012, a further six suspected cases were reported; each case had eaten amberjack (a fish species) at a local restaurant. All CFP confirmed and suspected cases are being monitored by the Department of Health of the Canary Islands and both outbreaks remain under investigation [1].

The Canary Islands Archipelago reported their first cases of CFP in 2004; further outbreaks occurred in 2008 and 2009 [2].

Ciguatera Fish Poisoning

CFP is contracted by consumption of reef fish that have an accumulation of ciguatoxin in their flesh and viscera. This toxin is produced by microscopic algae (dinoflagellates), on which smaller fish species feed; these fish then become the food source for larger species of finfish.  

CFP is the most common cause of marine toxic poisoning in tropical zones of the Pacific, Indian and Atlantic oceans. Illness also occurs in non-endemic areas after eating imported fish that is contaminated with ciguatoxin [3].

Symptoms generally occur within one to four hours after eating toxic fish. They include flushing, paresthesias, urticaria, headache, nausea and vomiting. Rarely CFP can result in more severe symptoms including coma, cardiac arrhythmias and death [3-5]. Symptoms usually resolve over one to four weeks, however, chronic debilitating illness has been reported [6].

Advice for travellers

Travellers can reduce their risk of toxic poisoning by avoiding consumption of contaminated fish including:

•  grouper, snapper, barracuda, jacks, sea bass, and moray eels
•  reef fish that weigh more than three kilograms
•  head, viscera and roe of reef fish

Toxins responsible for causing poisoning are able to survive normal cooking procedures.

There are other forms of toxic marine poisoning that include scromboid, puffer fish poisoning and paralytic shellfish poisoning. Travellers should be aware of the risk of marine toxins.  

References

1. Gobierno de Canarias. Consejería de Sanidad. Casos aislados de intoxicación por ciguatera en Lanzarote [in Spanish]. Available at: http://www.gobcan.es/noticias/index.jsp?module=1&page=

nota.htm&id=148453.

2. Boada LD, Zumbado M, Luzardo OP et al. Ciguatera fish poisoning on the West Africa Coast: An emerging risk in the Canary Islands (Spain) Toxicon 56:1516–9, 2010.

3. Isbister GK, Kiernan MC. Neurotoxic marine poisoning. Lancet Neurol. 4:219-28, 2005.

4. Dickey RW, Plakas SM. Ciguatera: A public health perspective. Toxicon 56:123-36, 2010.

5. Field VF, Ford L, Hill DR eds. Marine Poisoning. Health Information for Overseas Travel. NaTHNaC, 2010.

6. Develoux M, Le Loup G, Pialoux G. A case of ciguatera fish poisoning in a French traveler. Euro Surveill. 13(45):pii=19027, 2008. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19027

Links

Centers for Disease Control and Prevention: Marine toxins

NaTHNaC: Toxic Marine Poisoning

NaTHNaC: Information for travellers: Fish and shellfish poisoning