Clinical presentation of ciguatoxin poisoning (ciguatera)

Effects of ciguatera occur between 1 to 48 hours after ingestion of fish that contains ciguatoxin. Ciguatera is characterised by:

• moderate to severe gastrointestinal effects—vomiting, diarrhoea and abdominal cramps usually occur early and resolve within 12 hours
• neurological effects—distal and perioral paraesthesia, cold allodynia¹, numbness, myalgia, ataxia. Symptoms usually develop over 24 hours, and are associated with objective signs of a predominantly sensory polyneuropathy
• other effects—pruritus, other nonspecific effects (rarely).

Subacute and chronic forms of ciguatera have been described, but are poorly defined. Reported symptoms include fatigue, loss of energy, arthralgia (especially affecting the knees, ankles, shoulders and elbows), myalgia, headache, depression and pruritus.

Diagnosis of ciguatera and clearly ascribing the symptoms to the ingestion of fish is difficult.