Here's what I have gathered....
Subject: Fish Poisoning Treatment
Hello List
Came across the first ever effective treatment for Ciguatera
Poisoning and
thought that it could be of great benefit to all fish eating
Islanders,
visitors and sailors. This report is by Carlos Perez, MD,
Patricia Vasquez,
MD, Celia Perret, MD, Hospital Clinico Universidad Catolica
de Chile, in
Santiago. It appears in New England Journal Of Medicine,
March 1, 2001.
Ciguatera poisoning is caused by the Dinoflagelate
Gambierdiscus toxicus, the
toxin is absorbed by the smaller herbivorous fish on the
reefs, and magnified
biologically in the tissues of the larger carnivorous fish
like Barracuda,
King Fish, Jack, Snapper, Grouper, Rock Fish etc. The
Ciguatoxin is a
Neurotoxin and can range from just mild abdominal cramps and
diarrhea to
dehydration, shock, severe pain, hot cold flashes, numbness,
respiratory
failure and death. Until now all that was done was to treat
symptoms and hope
for the best.
The Drug used here is Gabapentin, in the US its NEURONTIN
100mg, 300mg,
400mg. This medication is used to treat partial Seizures and
various types of
painful nerve conditions like Diabetic Neuropathy etc. Any
way as the study
reports if has been very successful in totally reversing
symptoms over a
period of 2-3 weeks. They report the incidence to be about
50- 500 cases per
10,000 population in the Caribbean and South Pacific
Islands.
On another note I would expect this to increase as the
demand for food by and
ever increasing population through out the Islands makes
impossible to throw
any thing back. As a kid growing up on Roatan I was warned
about the
devastating danger of eating a beautiful Barracuda that I
might have caught,
my dear mother God bless her soul, had lost all of her teeth
to Amber Jack in
Utila Keys and would not let us eat any lage fish before
placing a piece in
Ant's nest. If the ant's ate the fish and lived it was good
so went the tale.
I have some serious doubts about the validity of this test
today, but I'm
still here. Another test was to feed it first to your Cat,
or Dog. Needless
to say no one worried about the SPCA. Lastly, a fisherman
from west told be
the best test was to feed it first to your Wife.
Well, along with the Antimalarials, Antidiarrheals,
Antibacterials, etc, etc,
I think some tablets of Neurontin might be a good investment
for the Next
Trip South.
==============================
As far as I know, the only treatment for Ciguatera ever
studied using a
double blind clinical trial has been IV Mannitol (1 g/kg)
for Acute
Ciguatera (Bagnis et al "Efficacite du Mannitol dans le
Traitement dela
Ciguatera. Bulletin de la Societe de Pathologie Exotique.
1992;68-73). We
have shown that there is limited effectiveness of IV
Mannitol after 3 days
from first symptoms ----- although if used within the first
3 days, it is
highly effective in not only decreasing the acute symptoms
but also in
preventing the very debilitating Chronic Ciguatera (Blythe
D, et al Mannitol
Treatment for Acute and Chronic Ciguatera fish Poisoning.
Memoirs
Queensland Museum 1994;34:465-470.).
As you probably know, a multitude of medications have been
tried to treat
especially Chronic Ciguatera -- steroids, vitamins, and
anti-histamines have
NOT been shown to work ---- more recently, there have been
case reports of
individuals responding to tricyclic anti-depressants, Prozac
and similar
medications, non steroidal anti inflammatories, and calcium
channel blockers
----- however, I know of no published double blinded
clinical trials for
these interventions, only anecdotal case reports concerning
the use of these
medications.
We also recommend avoiding consumption of alcohol, caffeine,
nuts,
chocolate, and all types of fish in persons with chronic
ciguatera based on
anecdotal reports of many patients that these substances can
make the
paresthesias return or increase. In the Caribbean we
recommend avoiding the
consumption of large reef fish, particularly fillets (since
you don't always
know what you are eating), and if consuming reef fish, of a
size such that
the entire fish fits on your plate (based on historical data
for example
that 50% of local barracuda over 20 lbs were ciguatoxic many
years ago). Of
note, baracuda cannot be sold legally in Miami-Dade County,
probably based
on these historical data.
We have a recent review that might be of interest:
Blythe DG, Hack E, Washington G, Fleming LE. The Medical
Management of
Seafood Poisoning. Hui, Kits, Stanfield. Seafood and
Environmental Toxins.
Marcel Dekker, 2000, pg. 311-319.
best regards
Lora E Fleming MD PhD
Associate Professor
NIEHS Marine and Freshwater Biomedical Sciences Center
University of Miami School of Medicine
Dept of Epidemiology & Public Health
PO Box 016069 (R-669)
Miami, FL
33101
tel 305-243-5912
FAX 305-243-3384
email:
[email protected]