Marine Fish Toxins in Thailand: Report of 6 Suspected Ciguatera Cases

Abstract

Food poisoning or gastroenteritis is a common diagnosis for individuals who have nausea, vomiting and diarrhea after ingestion of fish. When also manifesting neurological symptoms, these are blamed on puffer fish poisoning, but ciguatera fish poisoning (CFP) can also manifest only with gastroenteritis, without neurological complications and remain undiagnosed. We report patients who fulfilled criteria of CFP suffering from severe GI disturbances, neurological manifestations, compromised cardiovascular status and autonomic dysfunction. All recovered within 1 - 3 days with supportive treatment. There were two small outbreaks: one in Bangkok in 2007 (2 patients) and another (2009) in Phuket (4 patients). All patients consumed the same unidentified fish portion and had severe GI symptoms. One had acute ventilatory failure requiring intubation whereas the remaining had neurological disturbances consisting of paresthesia, severe vertigo and ataxia. Absence of reflex tachycardia was noted in all patients who had severe volume depletion and shock. The most severe patient could be extubated within 24 hours and was discharged in 48 hours. All of the remaining recovered completely within 48 hours. Severe abdominal pain, nausea and vomiting and autonomic dysfunction in the form of bradycardia in the presence of hypotension were seen. Dramatic recovery within 48 hours occurred in all cases. None of the fish considered to have been responsible was available for testing. Physicians should be aware of CFP intoxication in the differential diagnosis of gastroenteritis-like syndromes after eating seafood.