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• W2153455666 abstract "Ciguatera fish poisoning is a clinical syndrome caused by the ingestion of fish containing ciguatoxin. It is considered the most common food-borne illness related to fish consumption [1]. The disease is endemic in tropical and subtropical regions of the Pacific and Indian oceans and Caribbean, although sporadic outbreaks have been known to occur in temperate areas. Ciguatoxin is manufactured by the dinoflagellate Gambierdiscus toxicus, and becomes concentrated upwards throughout the food chain [1]. Fish commonly implicated in transmission of the toxin include mackerel, barracuda, red snapper, amberjack, sea bass and grouper. The toxin is stable in gastric juice and is not inactivated by freezing or cooking. It induces prolonged opening of voltage-gated sodium channels in nerves and muscles [2, 3]. The manifestations of poisoning fall into four categories: gastrointestinal, neuropathic, cardiovascular and a diffuse pain syndrome [1]. The neurological manifestations include peripheral sensory or motor symptoms, severe headache and autonomic dysfunction, which in severe cases might lead to bradycardia and hypotension. Paresthesia and dysesthesia are very common, and ‘reversal of thermal sensation’ (cold stimuli being felt as painful or burning) is considered a pathognomonic symptom. Other signs include pruritus, a metallic taste in the mouth, insomnia and cerebellar signs. The symptoms can recur intermittently over a period of several months, sometimes accompanied by fatigue, weakness and hypersomnolence [2]. Management is primarily supportive, because no antitoxin is available. Amitriptyline has been used for relief of the neurological symptoms [3]. Mannitol produced immediate resolution of symptoms in an uncontrolled trial, an effect that was not seen in a later randomized trial [1]. Gabapentin was used successfully to treat two patients with neuropathic pain [4]. We report the case of a female patient presenting with neurological symptoms after a trip to Central America. A 32-year-old Caucasian female was seen 4 weeks after returning from a trip to Mexico and Guatemala. On the 10th day of her visit, she experienced sore throat, followed several hours later by paresthesia of the right arm and leg. The paresthesia spread to her face, affecting the entire left side by the following day. She also felt cold and had difficulty falling asleep. The patient was seen by a doctor, and treatment with a combination of clarithromycin and ibuprofen was initiated. The symptoms failed to improve, causing her to end her vacation prematurely. She reported eating seafood on several occasions during her trip, but could not recall a specific type of fish consumed, nor did she recall a temporal relation between any meal and the beginning of her illness. Her symptoms, which had continued for at least 5 weeks, consisted of pruritus, paresthesia, myalgia, fatigue and sleepiness. A neurological examination carried out a week after her return was unremarkable; however, a magnetic resonance imaging study was ordered to rule out multiple sclerosis. The imaging did not reveal any pathology. Blood chemistry and C-reactive protein were normal, and CBC revealed 7% eosinophils, a finding documented 6 months earlier. Our patient presented with a neurological syndrome consisting of paresthesia and muscle pain after travelling to Central America. Although a history of travel brings to mind various infectious aetiologies, fish poisoning is an underreported cause of morbidity in travellers. Ciguatera fish poisoning is a common illness affecting 50–500 per 10 000 population in endemic areas [5]. The manifestations are variable, with some symptoms often taking weeks or months to resolve. The diagnosis is usually a clinical one, although an enzyme immunoassay for ciguatera toxin can be performed on the implicated fish tissues and possibly human fluids. Our patient reported eating several species of fish and crustaceans, but was unable to indicate a specific type of fish or to relate a particular meal to the appearance of her illness. The late presentation, 5 weeks after she became ill precluded the use of an immunoassay. Ciguatera fish poisoning has a variety of presentations. However, many of the symptoms are subjective and a definitive laboratory diagnosis is lacking. Doctors should be aware of the symptoms associated with ciguatera poisoning and the possibility of their persistence. Although no specific therapy is available, recognizing this clinical entity may prevent an unnecessary work-up for a neurological disorder. Travellers should be advised about the risk of consuming certain types of predatory reef fish, and the consumption of fish with which the traveller is unfamiliar should be discouraged. No conflict of interest was declared." @default.
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• W2153455666 date "2004-08-01" @default.
• W2153455666 modified "2023-09-26" @default.
• W2153455666 title "Neurological symptoms in a traveller returning from Central America" @default.
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• W2153455666 doi "https://doi.org/10.1111/j.1365-2796.2004.01362.x" @default.
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