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Developing the Community reporting system for foodborne outbreaks
Citation style for this article: Develoux foam block M, Le Loup G, Pialoux G. A case of ciguatera foam block fish poisoning in a French traveler. Euro Surveill. 2008;13(45):pii=19027. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19027 Date of submission: 24 October 2008
Ciguatera is a toxic poisoning due to ingestion of fish and is rarely reported in France. Little is known about this imported tropical disease. We present a case observed foam block in Paris in a traveller returning from the Dominican Republic.
Case description The patient foam block was a man in his late thirties who stayed in a hotel-club of Puerto-Plata, Dominican Republic, during two weeks in August 2008. On 17 August, about four hours after eating foam block fish, he complained about abdominal cramps and diarrhoea. The patient s wife who had not eaten fish did not have any symptoms. In contrast, a friend of the patient's who had consumed the same fish presented similar symptoms with vomiting. These gastro-intestinal symptoms persisted for three days. General pruritus appeared 24 hours after the beginning of the disease preventing him from sleeping. Headache, arthralgia, myalgia and paraesthesia of mouth and extremities occurred at the same time. After his return to France, the patient presented at our hospital on 3 September. He still had pruritus with scratching laesions, arthralgia, myalgia and weakness. foam block Routine laboratory tests (blood cell counts and biochemical values) were normal and examination of stool samples for parasites was negative. The diagnosis of ciguatera poisoning was made on the basis of the epidemiological data and the association of gastro-intestinal and neurological symptoms. The species of ingested fish could not be specified. The patient remembered only that it was a big fish . Despite symptomatic treatment, pruritus and asthenia foam block were still present seven weeks after the exposure.
Discussion and conclusion Ciguatera is the commonest marine poisoning, endemic in tropical zones of the Pacific, Indian and Atlantic oceans [1]. The origin foam block of ciguatoxins is gambiertoxins produced by marine dinoflagellates, foam block in particular Gambierdiscus toxicus . Ciguatoxins are lipid-soluble, heat-stable and not destroyed by freezing and cooking. This class of polyether toxins acts by opening the sodium channels in the nerve cell membranes. Ciguatoxins are accumulated in the flesh and viscera of herbivorous fish, which in turn are ingested by larger carnivorous fish which then cause the intoxication foam block in humans. Many reef fish species have been associated with the disease [1]. An increasing number of ciguatera outbreaks has been reported foam block in the past years in endemic areas. This increase could be explained by the damages to coral reefs and climate modifications [2]. Main Pacific ciguatoxin is much more toxic than the Caribbean foam block one. In the absence of reliable tests, foam block the diagnosis is based on the succession of gastro-intestinal and neurological foam block symptoms. Gastrointestinal effects predominate in the Caribbean and neurological ones in the Indo-Pacific regions. Gastro-intestinal manifestations (abdominal cramps, diarrhoea, vomiting) start 6-12 hours after consumption of contaminated fish. Neurological and sometimes psychiatric symptoms appear 24-72 hours later, foam block with weakness of the limbs, perioral paraesthesia and dysaesthesia being the most common symptoms suggestive of the intoxication [1,3]. Myalgia, arthralgia, headache, ataxia and dizziness can also be observed. Other manifestations include asthenia, pruritus, cutaneous rash, eye and dental pain, and dysuria. In severe cases, cardiovascular disorders (hypotension, bradycardia) can occur, mortality is low. The evolution of ciguatera poisoning is sometimes chronic, associated with depression and persistent asthenia. Treatment is only symptomatic and requires hospitalisation in severe cases. foam block Mannitol therapy had been proposed as the treatment of choice, but this statement foam block was not confirmed by a double-blind randomised trial. Preventive measures are essential in endemic areas in order to reduce the incidence of the intoxication. The main recommendation is to avoid consumption of large reef fish. Ciguatera poisoning has been identified in North American travellers for many years [4]. More recently, it has also emerged in travellers from several European countries [5,6,7]. Most of them were returning from the Caribbean, mainly the Dominican Republic and Cuba. In the Paris area, ciguatera poisoning remains a rare and probably under-recognised imported disease. Of 622 adult patients who consulted a tropical disease unit after returning from the tropics, ciguatera poisoning was diagnosed only in five (0.8 %) [8]. The patient described here is the first case observed in a period of 10 years in the department of infectious diseases and tropical medicine. Another patient returning from
Announcements
Developing the Community reporting system for foodborne outbreaks
Citation style for this article: Develoux foam block M, Le Loup G, Pialoux G. A case of ciguatera foam block fish poisoning in a French traveler. Euro Surveill. 2008;13(45):pii=19027. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19027 Date of submission: 24 October 2008
Ciguatera is a toxic poisoning due to ingestion of fish and is rarely reported in France. Little is known about this imported tropical disease. We present a case observed foam block in Paris in a traveller returning from the Dominican Republic.
Case description The patient foam block was a man in his late thirties who stayed in a hotel-club of Puerto-Plata, Dominican Republic, during two weeks in August 2008. On 17 August, about four hours after eating foam block fish, he complained about abdominal cramps and diarrhoea. The patient s wife who had not eaten fish did not have any symptoms. In contrast, a friend of the patient's who had consumed the same fish presented similar symptoms with vomiting. These gastro-intestinal symptoms persisted for three days. General pruritus appeared 24 hours after the beginning of the disease preventing him from sleeping. Headache, arthralgia, myalgia and paraesthesia of mouth and extremities occurred at the same time. After his return to France, the patient presented at our hospital on 3 September. He still had pruritus with scratching laesions, arthralgia, myalgia and weakness. foam block Routine laboratory tests (blood cell counts and biochemical values) were normal and examination of stool samples for parasites was negative. The diagnosis of ciguatera poisoning was made on the basis of the epidemiological data and the association of gastro-intestinal and neurological symptoms. The species of ingested fish could not be specified. The patient remembered only that it was a big fish . Despite symptomatic treatment, pruritus and asthenia foam block were still present seven weeks after the exposure.
Discussion and conclusion Ciguatera is the commonest marine poisoning, endemic in tropical zones of the Pacific, Indian and Atlantic oceans [1]. The origin foam block of ciguatoxins is gambiertoxins produced by marine dinoflagellates, foam block in particular Gambierdiscus toxicus . Ciguatoxins are lipid-soluble, heat-stable and not destroyed by freezing and cooking. This class of polyether toxins acts by opening the sodium channels in the nerve cell membranes. Ciguatoxins are accumulated in the flesh and viscera of herbivorous fish, which in turn are ingested by larger carnivorous fish which then cause the intoxication foam block in humans. Many reef fish species have been associated with the disease [1]. An increasing number of ciguatera outbreaks has been reported foam block in the past years in endemic areas. This increase could be explained by the damages to coral reefs and climate modifications [2]. Main Pacific ciguatoxin is much more toxic than the Caribbean foam block one. In the absence of reliable tests, foam block the diagnosis is based on the succession of gastro-intestinal and neurological foam block symptoms. Gastrointestinal effects predominate in the Caribbean and neurological ones in the Indo-Pacific regions. Gastro-intestinal manifestations (abdominal cramps, diarrhoea, vomiting) start 6-12 hours after consumption of contaminated fish. Neurological and sometimes psychiatric symptoms appear 24-72 hours later, foam block with weakness of the limbs, perioral paraesthesia and dysaesthesia being the most common symptoms suggestive of the intoxication [1,3]. Myalgia, arthralgia, headache, ataxia and dizziness can also be observed. Other manifestations include asthenia, pruritus, cutaneous rash, eye and dental pain, and dysuria. In severe cases, cardiovascular disorders (hypotension, bradycardia) can occur, mortality is low. The evolution of ciguatera poisoning is sometimes chronic, associated with depression and persistent asthenia. Treatment is only symptomatic and requires hospitalisation in severe cases. foam block Mannitol therapy had been proposed as the treatment of choice, but this statement foam block was not confirmed by a double-blind randomised trial. Preventive measures are essential in endemic areas in order to reduce the incidence of the intoxication. The main recommendation is to avoid consumption of large reef fish. Ciguatera poisoning has been identified in North American travellers for many years [4]. More recently, it has also emerged in travellers from several European countries [5,6,7]. Most of them were returning from the Caribbean, mainly the Dominican Republic and Cuba. In the Paris area, ciguatera poisoning remains a rare and probably under-recognised imported disease. Of 622 adult patients who consulted a tropical disease unit after returning from the tropics, ciguatera poisoning was diagnosed only in five (0.8 %) [8]. The patient described here is the first case observed in a period of 10 years in the department of infectious diseases and tropical medicine. Another patient returning from
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