Abstract
Ciguatera fish poisoning (CFP), the most prevalent seafood poisoning worldwide, is caused by the consumption of tropical and subtropical fish contaminated with potent neurotoxins called ciguatoxins (CTXs). Ciguatera is a complex clinical syndrome in which peripheral neurological signs predominate in the acute phase of the intoxication but also persist or reoccur long afterward. Their recognition is of particular importance in establishing the diagnosis, which is clinically-based and can be a challenge for physicians unfamiliar with CFP. To date, no specific treatment exists. Physiopathologically, the primary targets of CTXs are well identified, as are the secondary events that may contribute to CFP symptomatology. This review describes the clinical features, focusing on the sensory disturbances, and then reports on the neuronal targets and effects of CTXs, as well as the neurophysiological and histological studies that have contributed to existing knowledge of CFP neuropathophysiology at the molecular, neurocellular and nerve levels.
Highlights
Ciguatera fish poisoning (CFP), the most prevalent seafood poisoning worldwide, is caused by the consumption of tropical and subtropical fish contaminated with potent neurotoxins called ciguatoxins (CTXs)
Associated with the knowledge of a fish meal followed by a digestive syndrome, these sensory disturbances allow for the diagnosis of ciguatera poisoning, i.e., are pathognomonic symptoms of CFP
A functional magnetic resonance imaging study showed that brain areas responding to cold following intracutaneous injection of P-CTX-1 in human volunteers were located in the medial insula, the medial cingulate cortex, the secondary somatosensory cortex, frontal areas and the cerebellum [73]
Summary
An Underreported and Misdiagnosed Disease Lacking Effective Prevention and Treatment. Under the influence of poorly understood factors, these microalgae can proliferate and produce precursors of the congeners that intoxicate humans Among these microalgal CTXs, which are called gambiertoxins (GTXs), CTX-4A [4,5], CTX-4B [5,6] and CTX-3C (Figure 1) [7,8] have been isolated from Pacific strains of Gambierdiscus spp. and herbivorous fish species involved in CFP outbreaks. There are no portable assays available to detect CTXs in fish in the field prior to consumption To achieve this goal, the development of an enzyme-linked immunoassay (ELISA) is attractive for its accuracy, sensitivity, routine and portable use, and recent progress is promising [18,19,20,21]. The second part reports the neuronal targets and effects of CTXs, and the neurophysiological and histological studies that have contributed to the knowledge related to CFP neuropathophysiology at the molecular, neurocellular and nerve levels, which could be the basis for the development of specific treatments
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