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Fish Poisoning

What is fish poisoning?

At certain times of the year, various species of fish and shellfish contain poisonous biotoxins, even if well cooked. The most common type of fish poisoning in travelers is ciguatera fish poisoning. The most toxic fish causing ciguatera fish poisoning is the barracuda, and should always be avoided, according to the Centers for Disease Control and Prevention (CDC). Other types of fish which may contain the toxin at unpredictable times include red snapper, grouper, amberjack, sea bass, and a wide range of tropical reef fish.

The risk of ciguatera poisoning exists in all tropical and subtropical waters of the West Indies, the Pacific Ocean, and the Indian Ocean, where these reef fish are eaten.

Two other forms of poisoning can occur from naturally occurring toxins in fish: tetrodotoxin, sometimes called pufferfish poisoning or fugu poisoning, and scomboid poisoning.

Where is the risk of ciguatera poisoning the greatest?

Reef fish from the tropical and subtropical waters of the West Indies, the Pacific Ocean, and the Indian Ocean pose the greatest threat. Cases have been reported in the United States both in California and Florida, and a few isolated cases of ciguatera poisoning have even been noted along the eastern seaboard of the United States.

More than 400 species of fish, particularly reef fish, are thought to contain the toxin for ciguatera poisoning.

What are the symptoms of ciguatera poisoning?

Symptoms of ciguatera poisoning generally appear within three to five hours after the toxic fish has been eaten. The following are the most common symptoms of ciguatera poisoning. However, each individual may experiences symptoms differently. Symptoms may include:

  • nausea
  • vomiting
  • watery diarrhea
  • numbness and tingling about the mouth and extremities

In more severe cases, the person may suffer muscle pains, dizziness, and sensations of temperature reversal, where hot things seem cold and cold things seem hot. The symptoms of ciguatera poisoning may resemble other medical conditions. Always consult your physician for a diagnosis.

Treatment for ciguatera poisoning:

Treatment for ciguatera poisoning consists mainly of relieving symptoms and treating complications. Generally, recovery takes from several days to several weeks. Specific treatment for ciguatera poisoning is based on:

  • your overall health and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, and therapies
  • your opinion or preference

What is tetrodotoxin?

Tetrodotoxin, also called pufferfish poisoning or fugu poisoning, is a much more rare form of fish poisoning, but is potentially very serious. This is almost exclusively associated with the consumption of the pufferfish from waters of the Indo-Pacific regions, but there have been several reported cases of poisonings, including fatalities, from pufferfish in the Atlantic Ocean, Gulf of Mexico, and Gulf of California. Pufferfish poisoning is a continuing problem for Japan.

What are the symptoms of pufferfish poisoning?

Symptoms generally appear between 20 minutes to three hours after eating the poisonous pufferfish. The following are the most common symptoms of pufferfish poisoning. However, each individual may experience symptoms differently. Symptoms may include:

  • numbness of lips and tongue
  • numbness of face and extremities
  • sensations of lightness or floating
  • dizziness
  • headache
  • vomiting
  • abdominal pain
  • diarrhea
  • slurred speech
  • difficulty walking
  • extensive muscle weakness
The symptoms of pufferfish poisoning may resemble other medical conditions. Always consult your physician for a diagnosis.

Treatment for pufferfish poisoning:

Treatment for pufferfish poisoning consists of limiting the body's absorption of the toxin, relieving symptoms, and treating life-threatening complications. There is no known antidote for tetrodotoxin. Specific treatment will be determined by your physician based on:

  • your overall health and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, and therapies
  • your opinion or preference

What is scromboid poisoning?

Scromboid poisoning occurs after eating fish that contain high levels of histamine. These fish, which include mahi mahi (dolphin fish), albacore tuna, bluefin and yellowfin tuna, mackerel, and sardines, have high amounts of histidine. As a result of inadequate refrigeration or preservation, bacteria convert the histidine to histamine, and this leads to scromboid poisoning.

This form of fish poisoning occurs worldwide in temperate and tropical waters.

What are the symptoms of scromboid poisoning?

Symptoms generally appear within minutes to an hour after eating affected fish. The following are the most common symptoms of scromboid poisoning. However, each individual may experience symptoms differently. Symptoms may include:

  • tingling or burning sensation in the mouth
  • rash on the face and upper body
  • throbbing headache
  • hives and itching of skin
  • nausea
  • vomiting
  • diarrhea

The symptoms of scromboid poisoning may resemble other medical conditions. Always consult your physician for a diagnosis.

Treatment for scromboid poisoning:

Treatment for scromboid poisoning includes antihistamines, such as diphenhydramine (Benadryl) and cimetidine (Tagamet). The symptoms generally only last a few hours and are rarely life-threatening. Specific treatment will be determined by your physician based on:

  • your overall health and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, and therapies
  • your opinion or preference

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