Circumcision

toxicus, which contains "ciguatoxin," an odorless, tasteless poison that cannot be destroyed by either heating or freezing.

Ciguatera poisoning occurs most often in the Caribbean Islands, Florida, Hawaii, and the Pacific Islands. Recent reports documented 129 cases over a two-year period in Dade County alone. It appears to be occurring more often, probably because of the increased demand for seafood around the world.

Ciguatera poisoning usually goes away on its own, and symptoms often subside within several days. However, in severe cases the neurological symptoms can persist for months. In a few isolated cases neurological symptoms have persisted for several years, and in other cases recovered patients have experienced recurrence of neurological symptoms years after recovery. Such relapses are most often associated with changes in diet or with drinking alcohol.

Cause

Ciguatera poisoning occurs after eating any of more than 300 species of fish that may contain ciguatoxin, which is found in greatest concentration in internal organs, but it cannot be detected by inspection, taste, or smell. Ciguatoxin more common among larger, predatory coral reef fish.

Symptoms

Eating a fish contaminated with ciguatoxin produces both stomach ailments and neurologic symptoms. Patients often report a curious type of sensory reversal, so that picking up a cold glass would cause a burning hot sensation. Other symptoms include a tingling sensation in the lips and mouth followed by numbness, nausea, vomiting, abdominal cramps, weakness, headache, vertigo, paralysis, convulsions, and skin rash. Coma and death from respiratory paralysis occur in about 12 percent of cases. Subsequent episodes of ciguatera may be more severe.

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