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Epidemiologic Notes and Reports Ciguatera Fish Poisoning -- Bahamas, Miami

On March 6, 1982, the U.S. Coast Guard in Miami, Florida, received a request for medical assistance from an Italian freighter located in waters off Freeport, Bahamas. Numerous crew members were ill with nausea, vomiting, and muscle weakness and required medical evacuation for hospitalization and treatment.

A total of 14 ill crew members were airlifted to three Florida hospitals. Three were seen in emergency rooms and later released. Eleven were hospitalized; seven required admission to intensive care units. All patients were Italian males, age 24-40 years; symptoms included diarrhea--12 patients (86%), vomiting--11 (79%), paresthesias--11 (79%), hypotension--10 (71%), peripheral muscular weakness--9 (65%), nausea--8 (57%), abdominal cramping--6 (43%), pruritis--4 (29%), and peripheral numbness--2 (14%). These findings were consistent with ciguatera fish poisoning, and an epidemiologic investigation was initiated.

The ship employed 26 crew members and is permanently based near Freeport, where it ferries petroleum products ashore from large tankers. On March 4, a crew member caught a 25-pound barracuda while fishing from the ship. On March 6, 14 crew members cooked and ate the barracuda; all became ill within 6 hours. None of the 12 crew members who did not eat the barracuda became ill. Six of the ill crew members reported becoming sick 45 minutes to 6 hours after the implicated meal (median: 2.5 hours). All 14 crew members eventually recovered without sequelae and returned to work. Median length of hospital stay was 6 days. Reported by SC Royal, Miami Quarantine Station, MA Poli, TJ Mende, DG Baden, Dept of Biochemistry, University of Miami, School of Medicine, RM Galbraith, TB Higerd, Dept of Clinical Immunology and Microbiology, Medical University of South Carolina, M Enriquez, MD, Dade County Health Dept, HJ Janowski, MPH, Acting State Epidemiologist, Florida Dept of Health and Rehabilitative Svcs; Field Services Div, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Ciguatera is a human intoxication syndrome associated with the consumption of marine tropical reef fishes. Although recent surveys indicate that poisonings are relatively uncommon in Florida (1,2), one investigator recorded 280 intoxications from January 1978 to June 1980 (2).

The ichthyosarcotoxins are thought to be accumulated through the food chain, the toxins being produced by microalgae known as dinoflagellates (3,4). The toxins are lipid-soluble and appear to accumulate in the flesh, fatty tissue, and viscera of large predatory species of fish, such as barracuda, grouper, and snapper (5,6). The isolation, purification, and characterization of the suspected toxins have been hampered by limited availability of authentic ciguatoxic fish, lack of a specific sensitive assay, and the low concentration and heterogeneity of toxins present in specimens.

The assessment of toxicity most often used is the mouse bio-assay. Based on signs elicited following intraperitoneal (IP) injection, it includes, but is not limited to inactivity, diarrhea, labored breathing, cyanosis, piloerection, tremors, paralysis, and staggering gait. Death occurs when the injection is given in higher doses, with a lethal dose, 50% kill (LD((50))), of 0.45 ug/kg for purified toxin (5). Thus, ciguatoxin is one of the most potent marine toxins known. The barracuda's head was toxic by mouse bio-assay with an LD((50)) (IP) of 2-5 gram equivalents of original fish meat. Thin-layer chromatographic separation of extracts revealed the presence of at least two major toxins. Further purification is under way to define more clearly the toxin(s) implicated in this outbreak.

References

  1. Lawrence DN, Enriquez MB, Lumish RM, Maceo A. Ciguatera fish poisoning in Miami. JAMA 1980;244:254-8.

  2. Poli MA. A review of ciguatera, with special reference to the Caribbean, and an investigation into its significance and incidence in Florida. Master's thesis, University of Miami, 1982.

  3. CDC. Ciguatera fish poisoning--St. Croix, Virgin Islands of the United States. MMWR 1981;30:138-9.

  4. Bagnis R, Chanteau S, Chunque E, Hurtel JM, Yasumoto T, Inoue A. Origins of ciguatera fish poisoning: a new dinoflagellate, Gambierdiscus toxicus Adachi and Fukuyo, definitely involved as a causal agent. Toxicon 1980;18:199-208.

  5. Withers NW. Ciguatera fish poisoning. Ann Rev Med 1982;3:97-111.

  6. Banner AH. Ciguatera: a disease from coral reef fish. In: Jones OA, Endean R, eds. Biology and geology of coral reefs. New York: Academic Press, 1975; III:177-213.

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