ciguatoxins and Vomiting

The major impediment to the thorough study of Ciguatera in human populations has been the lack of definitive diagnostic ability. However, recently an ELISA test was developed which can diagnose Ciguatera qualitatively and quantitatively in human fluids, as well as in contaminated fish tissue. This study proposes to evaluate this new ELISA test in human subjects with the clinical diagnoses of acute and chronic Ciguatera Poisoning. The contaminated fish from exposed subjects, and the blood and urine of exposed and controls, will be examined using the new ELISA. The ELISA performance will be compared to traditional bioassays for the fish testing. In addition, a distinct diagnostic profile will be developed using serial questionnaires, physical examinations, and nerve conduction tests. Ultimately this ELISA test can be used not only in establishing the correct diagnosis of Ciguatera Poisoning, but also in the treatment and clinical prognosis, and in epidemiologic studies of Ciguatera Poisoning in human populations. We hope that this protocol will serve as a model for the study of the effects of other marine toxins on human populations.

Topics: Adult; Animals; Body Fluids; Ciguatera Poisoning; Ciguatoxins; Enzyme-Linked Immunosorbent Assay; Female; Fishes; Humans; Male; Vomiting

Clinical data were obtained on 33 patients involved in 27 episodes of ciguatera fish poisoning occurring during a 14-week period on St Thomas in the US Virgin Islands. All patients had gastrointestinal tract symptoms, with 30 patients (91%) complaining of diarrhea and 23 patients (70%) complaining of vomiting; these symptoms occurred early in the disease and were of short duration. Twenty-three patients (70%) complained of malaise, and 19 patients (58%) had pain and weakness in the lower extremities. Dysesthesias were noted by 19 patients (58%); the median duration of dysesthesias was two weeks or more, with symptoms present is some cases for more than two months. Cardiovascular signs and symptoms, including both hypotension and bradycardia were noted in some acute cases. Therapy included antidiarrheal and antiemetic agents, intravenous fluids, atropine, and pralidoxime chloride. Efficacy of pralidoxime therapy could not be established on the basis of our data.

Topics: Adolescent; Adult; Aged; Animals; Blood Pressure; Child; Child, Preschool; Ciguatoxins; Diarrhea; Dinoflagellida; Disease Outbreaks; Female; Fishes; Foodborne Diseases; Heart Rate; Humans; Infant; Male; Marine Toxins; Middle Aged; Neurologic Manifestations; United States Virgin Islands; Vomiting