2010-2011 NYC Ciguatera outbreak ‘might reflect changing sources and diversity of fish species marketed in NYC and elsewhere’
A Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) released today looked at the several ciguatera outbreaks in New York City from August 2010–July 2011.
During that time span, six outbreaks and one single case of ciguatera fish poisoning (CFP) affected a total of 28 persons.
Barracuda
Public domain image/Albert Kok at the wikipedia project.
The patients contracted the toxic food poisoning after eating barracuda and grouper at purchased at different retail stores and restaurants in New York, New Jersey, and Connecticut . The 28 total cases represented more cases seen in NYC than in the entire previous decade.
The editor of the report writes, “This increase of reported cases in NYC might reflect changing sources and diversity of fish species marketed in NYC and elsewhere. The increase might also indicate improved awareness and capacity for investigation by the medical and public health community.”
Barracuda and grouper are just two of the 400+ species of fish implicated in ciguatera food poisoning. It’s a relatively common type of food poisoning in several areas of the world.
This toxin is the result of the accumulation of marine algae and the toxins they produce passing up the food chain. These marine algae hang on to dead coral and seaweed. They are then eaten by herbivore fish which are subsequently eaten by predatory reef fish which concentrates the toxin in its tissue. People get this food borne toxin from eating these contaminated larger fish. The reef fishes are more likely to get contaminated during storms and other turbulence.
After eating the affected fish (by the way the fish does not get sick from the toxin and its taste is not affected) in as little as a couple of hours symptoms may appear. Gastrointestinal symptoms like diarrhea, nausea and vomiting tend to appear early. Then a feeling of weakness and hypertension may occur in addition to complaints of intense itching.
Some mild to severe neurological symptoms are common with ciguatera; dizziness, impaired coordination, blurred vision and even coma may be seen in severe cases.
An unusual characteristic that is common in ciguatera is temperature reversal. This may be seen from 2 to 5 days after eating the fish. Hot objects seem cold and cold objects can give a shock-like sensation. There have been serious injuries because a person was unable to recognize extremely hot sensations. Other odd symptoms are food may taste metallic and teeth may seem painful or loose.
The gastrointestinal symptoms usually resolve in a couple days; however neurological symptoms may last for months or years. Symptoms may come back after ingesting certain foods and drinks; alcohol, caffeine, nuts and fish.
There are no laboratory tests to diagnose this disease and it’s based on clinical symptoms and a history of eating an offending fish. Some studies have shown that IV mannitol is effective in providing relief and recovery if taken within the first 72 hours of intoxication. Other than that most treatment is for the various symptoms the person may have.
So how can you prevent getting this potentially serious toxin? Prevention can be difficult since the toxin in the fish cannot be killed by cooking and there is no offensive odor or appearance to the fish. So the only way to truly try to prevent this intoxication is to avoid eating large reef fish or getting your fish through a reputable supplier.
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