Abstract
Ciguatera poisoning (CP) results from the consumption of seafood contaminated with ciguatoxins (CTXs). This disease is highly prevalent in French Polynesia with several well-identified hotspots. Rapa Island, the southernmost inhabited island in the country, was reportedly free of CP until 2007. This study describes the integrated approach used to investigate the etiology of a fatal mass-poisoning outbreak that occurred in Rapa in 2009. Symptoms reported in patients were evocative of ciguatera. Several Gambierdiscus field samples collected from benthic assemblages tested positive by the receptor binding assay (RBA). Additionally, the toxicity screening of ≈250 fish by RBA indicated ≈78% of fish could contain CTXs. The presence of CTXs in fish was confirmed by liquid chromatography tandem mass spectrometry (LC-MS/MS). The potential link between climate change and this range expansion of ciguatera to a subtropical locale of French Polynesia was also examined based on the analysis of temperature time-series data. Results are indicative of a global warming trend in Rapa area. A five-fold reduction in incidence rates was observed between 2009 and 2012, which was due in part to self-regulating behavior among individuals (avoidance of particular fish species and areas). Such observations underscore the prominent role played by community outreach in ciguatera risk management.
Highlights
Increasing numbers of poisonings linked to the consumption of seafood contaminated with marine toxins are being reported worldwide [1,2,3,4]
According to observations made by the nurse on site, first symptoms appeared between 1 and 72 h following the ingestion of the toxic meal (Table 2), except for one female patient, aged 52, who developed symptoms within minutes after consumption of the viscera of a seagrass parrotfish (Leptoscarus vaigiensis)
The field study conducted in Rapa Island following an unprecedented toxic episode among its resident population allowed confirming that ciguatera poisoning (CP) is no longer confined to the tropical part of French Polynesia, which is a long-standing endemic area, but should be considered to be well established in subtropical zones
Summary
Increasing numbers of poisonings linked to the consumption of seafood contaminated with marine toxins are being reported worldwide [1,2,3,4]. Ciguatera results from the consumption of fish contaminated with lipid soluble toxins known as ciguatoxins (CTXs), which originate from assemblages of epiphytic dinoflagellates of the genera. Gambierdiscus and Fukuyoa [6,7,8] (for reviews, and references therein). Gambierdiscus and Fukuyoa spp. algal ciguatoxins are readily transferred through the food web from algae to herbivorous and carnivorous fish, and to humans [15,16]. The most commonly reported symptoms include diarrhea, vomiting, paresthesia of extremities, circumoral paresthesia, cold allodynia, generalized pruritus, myalgia, arthralgia, bradycardia, hypotension, extreme fatigue, etc. Ciguatera-related fatalities are rare (
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