Bradley A. Zlotnick (Stanford University, USA), Susan Hintz (Stanford University Hospital, Lucile S. Packard Children’s Hospital, USA), Douglas L. Park (Louisiana State University, USA), Paul S. Auerbach (Stanford University Hospital, USA)
Abstract: Ciguatera fish poisoning is an important public health problem wherever humans consume tropical and subtropical fish. It accounts for over half of fish-related poisonings in the United States but is uncommonly diagnosed and underreported. Produced by dinoflagellates, ciguatoxin accumulates up the food ehain in herbivorous and carnivorous fishes. Cnidaria (jellyfish and related invertebrates) have not previously been associated with direct ciguatera intoxication in humans. We report the first casc of ciguatera fish poisoning associated with cnidarian ingestion. A 12-year-old Tongan femalc presented to our Emergency Department with mid-abdominal pain, nausea, change in mental status, and new-onset movement disorder aftcr ingcstion of jellyfish importcd from American Samoa. Clinical diagnosis was confirmed by strongly positive serum identification of ciguatoxin and relatcd polyether toxins (including okadaic acid) with a rapid extraction method (REM) and highly reliable solid-phase immunobead assay (S-PIA) performed by the Food Toxicology Research Group, University of Arizona. Ciguatera pathophysiology, clinical presentation, differential diagnosis (including consideration of palytoxin poisoning), and treatment are briefly reviewed. We emphasize the growing incidence of ciguatera fish poisoning outside “high-risk” areas. In regions with immigrant populations, privately imported exotic fish may be toxin vectors. Marine species other tan carnivorous fish are now suspect in human ciguatera intoxication. Reliable tests can aid in premarket fish testing, diagnosis, and follow-up of ciguatera fish poisoning. The global prevalence of marine toxins demands fishermen, consumers, and physicians maintain a high index of suspicion for ciguatera fish poisoning.
Key words: case report, ciguatera, ciguatoxin, cnidaria, diagnostics, okadaic acid, palytoxin, pediatric, solid-phase immunoassay (S-PIA)