Ciguatera: Poison on Your Plate?


ST. LOUIS, Mo. (Ivanhoe Newswire) — We’ve all heard the advice to eat more fish for our hearts, but in some cases, what we eat may be hazardous to our health. Ciguatera is a type of fish toxin that most of us have probably never heard of, but this poison on the plate can make someone very sick.

Last Thanksgiving during a trip to the U.S. and British Virgin Islands, Mary Ann Reis became seriously ill.

She told Ivanhoe, “I spent the whole day lying down and I started getting this incredible burning and itching in my earlobes.”

Mary Ann thought it was food poisoning or the flu, until her symptoms dragged on for months. Her doctors couldn’t pinpoint a cause, until one made the connection between her sickness and the tropics.

“He mentioned since I had been down there and asked me if I ate fish, and I said ‘yes,’ and he told me about this fish toxic poisoning called ciguatera,” Mary Ann said.

Evan Schwarz, MD, FACEP, medical toxicologist at Washington University of St. Louis, said, “The danger is you can’t really taste it. If you cook it properly it doesn’t destroy the poison.”

Experts say you should avoid eating large fish like eel, swordfish, red snapper, sea bass and barracuda. Treatment is an IV drip of a medication called Mannitol.

Mary Ann said, “Within the first few seconds of those drops coming through it was a like a cool wash in my brain just moving down …”

Mary Ann is back to normal and says while she plans to travel again this year, fish won’t be on the menu.

The medical toxicology and addiction clinic at Washington University of St. Louis just opened last year and they have already treated several cases of ciguatera. According to the CDC, there are 30 cases reported in the United States every year, but many cases may go unreported because the poisoning is so hard to diagnose.

Contributors to this news report include: Cyndy McGrath, Field Producer; Brogan Morris, Assistant Producer; Brent Sucher, Videographer; and Tony Dastoli, Editor.


REPORT #2344

(Sources:,, About 50,000 people suffer from Ciguatera poisoning each year. Found in the tropical and subtropical areas, most commonly the Pacific Ocean, the Indian Ocean and the Caribbean Sea, Ciguatera is caused by eating fish containing toxins that are produced by Gambierdiscus toxicus, a marine microalgae. It is most often found in reef fish, but other species include barracuda, grouper, red snapper, moray eel, amberjack, parrotfish, hogfish, sturgeonfish, kingfish, coral trout and sea bass. Symptoms include nausea and vomiting, as well as neurologic symptoms such as tingling fingers and toes. Some patients have also reported a pathneumonic symptom, where they reverse hot and cold. Fatality from Ciguatera ranges from 0.1 percent to 12 percent and is usually due to respiratory failure, circulatory collapse or arrhythmias. There is no cure for Ciguatera. The symptoms typically subside within a few days or weeks, although it can last for years. But, symptoms may be treated. Dr. Evan Schwarz, a medical toxicologist who runs one of the few U.S. clinics that specialize in metal and environmental poisonings says, “Treatment is controversial. Some will say mannitol has not been proven to be beneficial. I see it as a cheap, low risk treatment that may have some benefit.” Other medical treatments that have been tried with limited success include vitamins, antihistamines, anticholinesterases, steroids and tricyclic antidepressants. Although the excessive vomiting and diarrhea may prevent this treatment, gut emptying and decontamination with charcoal has been recommended. Amitriptyline, and medications similar, has shown success in relieving symptoms such as fatigue and paresthesia. There are also over 64 local remedies in the Indo-Pacific and West Indies regions, however, none of these have been evaluated in clinical trials. Mannitol, on the other hand, has had two controlled trials for treatment and has shown some success.

MORE FROM MARY ANN RUND: “My primary care person first mentioned ciguatera when he heard that I was in the islands.  However, this was not pursued as there is currently no definitive test for ciguatera poisoning. Other lab tests were performed that were all normal and negative. So, I began to do my own research and elimination diet which led me to a self-diagnosis of ciguatera. However, I found no treatments mentioned online except for that which is administered within 24-72 hours after the ingestion of the fish. After a few months, my sister advocated for me and found online a case study by Dr. Mullins and Dr. Schwarz, Medical Toxicologists at Washington University School of Medicine, who then confirmed the diagnosis.  They were willing, as a trial, to treat me five months after the incident with the infusion that is normally given 24-72 hours afterwards. After two treatments of mannitol, I am doing much better! Since this is a neurotoxin that stays in my system, I need to be ultra-responsible with my health as the symptoms can resurface with certain stressors including certain food, alcohol, lack of sleep, etc. Yes, I am no longer able to eat finned reef fish … sad but true.”

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Diane Duke Williams



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