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.
glenp
Hi glenp
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/
and this
Symptoms
Hallmark symptoms of ciguatera include
gastrointestinal and
neurological effects.
[4][5] Gastrointestinal symptoms include
nausea,
vomiting, and
diarrhea usually followed by neurological symptoms such as
headaches, muscle aches,
paresthesia, numbness,
ataxia, and
hallucinations.
[1][5] 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).
[4] Doctors are often at a loss to explain these symptoms and ciguatera poisoning is frequently misdiagnosed as
Multiple Sclerosis.
[6]
Dyspareunia 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.
[7] 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.
[8]
The symptoms can last from weeks to years, and in extreme cases as long as 20 years, often leading to long term disability.
[9] Most people do recover slowly over time.
[10] 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.
[1] The symptoms of ciguatera may vary with ethnicity with Filipino or Chinese people possibly being more susceptible.
[1]
Detection methods
Modern scientific detection
Currently, multiple laboratory methods are available to detect ciguatoxins, including
liquid chromatography-mass spectrometry (
LCMS), 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.
[edit] 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.
[edit] Treatment
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 and
Verapamil 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[5][11][12][13] 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.
[5] Some medications such as the use of
Amitriptyline may reduce some symptoms of ciguatera, such as
fatigue and
paresthesia,
[14] although benefit does not occur in every case.
[15] Also used are
steroids and
vitamin supplements, but these merely support the body's recovery rather than directly reducing the toxic effects.
Previously
mannitol was used for poisoning after one study reported the reversal of symptoms following its use.
[5][16] Followup studies in animals
[17] and case reports in humans
[18] 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,
[19] and based on this result mannitol is no longer recommended.
[4]
that was from
http://en.wikipedia.org/wiki/Ciguatera
)
