I had an email from the group in Hawaii studying ciguatera, stating that most with CFS have ciguatera and that it is very important that a specific protocol be followed when administering anaesthetic - I would make sure that the anaesthetist is aware.
I'm putting this link in from MSNBC for CIGUATERA, intresting that a fish poisoning can be confused for MS. PEM seems to be in there as well.
I wonder what in the fish poison causes the neuro problems. anyway heres the link http://www.msnbc.msn.com/id/29392319/
Hallmark symptoms of ciguatera include gastrointestinal
Gastrointestinal symptoms include nausea
, and diarrhea
usually followed by neurological symptoms such as headaches
, muscle aches, paresthesia
, numbness, ataxia
, and hallucinations
Severe cases of ciguatera can also result in cold allodynia
, which is a burning sensation on contact with cold (commonly incorrectly referred to as reversal of hot/cold temperature sensation).
Doctors are often at a loss to explain these symptoms and ciguatera poisoning is frequently misdiagnosed as Multiple Sclerosis
and other ciguatera symptoms have developed in otherwise-healthy males and females following sexual intercourse
with partners suffering ciguatera poisoning, signifying that the toxin that produces ciguatera poisoning may be sexually transmitted.
As diarrhea and facial rashes have been reported in breastfed infants of mothers with ciguatera poisoning, it is likely that ciguatera toxins are also transferred into the breast milk.
The symptoms can last from weeks to years, and in extreme cases as long as 20 years, often leading to long term disability.
Most people do recover slowly over time.
Often patients recover but redevelop symptoms in the future. Such relapses can be triggered by consumption of nuts, alcohol, fish or fish-containing products, chicken or eggs, or by exposure to fumes such as those of bleach
and other chemicals. Exercise is also a possible trigger.
The symptoms of ciguatera may vary with ethnicity with Filipino or Chinese people possibly being more susceptible.
Modern scientific detection
Currently, multiple laboratory methods are available to detect ciguatoxins, including liquid chromatography-mass spectrometry
), receptor binding assays (RBA
), and neuroblastoma assays (N2A
). Although testing is possible, in most cases liquid chromatography-mass spectrometry
is insufficient to detect clinically relevant concentrations of ciguatoxin in crude extracts of fish.
 Folk science detection
In Northern Australia
, where ciguatera is a common problem, two different folk science
methods are widely believed to be available for determining that fish harbors significant levels of ciguatoxin. The first method is that if a piece of fish is contaminated with the toxin, flies
will not land on it. The second is that the toxin can be detected by feeding a piece of fish to a cat
, as cats are allegedly highly sensitive to ciguatoxin and will display symptoms. There is a third, less common method for ciguatera testing that involves putting a silver coin under the scales of the suspect fish. If the coin turns black, reportedly, the fish is contaminated; but if it does not turn black then it should be safe. It is not known whether any of these tests produce results that are actually accurate.
There is no effective treatment or antidote for ciguatera poisoning. The mainstay of treatment is supportive care. There is some evidence that calcium channel blocker
type drugs such as Nifedipine
are effective in treating some of the symptoms that remain after the initial sickness passes, such as poor circulation and shooting pains through the chest. These symptoms are due to the cramping of the arterial walls caused by maitotoxin
Ciguatoxin lowers the threshold for opening voltage-gated sodium channels in synapses of the nervous system. The effect of opening a sodium channel will cause depolarization, which could sequentially cause paralysis, heart contraction, and changing the senses of hearing and cold. Nifedipine is a calcium channel blocker
Some medications such as the use of Amitriptyline
may reduce some symptoms of ciguatera, such as fatigue
although benefit does not occur in every case.
Also used are steroids
supplements, but these merely support the body's recovery rather than directly reducing the toxic effects.
was used for poisoning after one study reported the reversal of symptoms following its use.
Followup studies in animals
and case reports in humans
also found benefit from mannitol. However, a randomized, controlled, double-blind clinical trial of mannitol for ciguatera poisoning did not find any difference between mannitol and normal saline
and based on this result mannitol is no longer recommended.
that was from http://en.wikipedia.org/wiki/Ciguatera