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May 05, 2011

The Perils of Ciguatera

Will your next fresh-caught fish dinner be a toxic time bomb?

You know the cliché: "You won't die; you'll just wish you had." If there were ever an ailment for which this adage rings far too true, it's ciguatera.

Ironically, this most common form of nonbacterial fish poisoning around the world remains a mystery to most people - including those who particularly need to know: saltwater anglers.

And while few might know about ciguatera (pronounced sigWAHterra), no one who's ever contracted the ailment, symptoms of which can recur for years, will ever forget it.

"A living hell" - that's the phrase that Palm Beach Post staff writer Kevin Deutsch used to describe the "agony at sea" that a group of anglers went through for eight days after eating a meal of delicious yellowfin grouper. "Stuck out at sea, the men wasted away for eight days before feeling well enough to venture back," the reporter writes. He quotes one angler, who dropped 14 pounds, as saying, "It was the worst I ever felt" and "If I touched anything cold, it burned my skin."

A Texas woman who contracted ciguatera told that the symptoms were "horrible ? I couldn't walk on the tile floor; it felt like it was burning me."

Nervous System Gone Haywire
"It was a great lunch," recalls Julian Pepperell of his coral trout dinner in a northeastern Australian restaurant. He rates the colorful Indo-Pacific grouper as "one of the ­best­-eating (and highest-priced) fish on the reef."

That night at about 1 a.m., he "awoke with intense muscle aching in my thighs and buttocks. I felt like I had run a marathon and could hardly get out of bed." But staying in bed wasn't an option: Pepperell also suffered acute nausea and diarrhea. Then his palms and soles began to itch ­excruciatingly, turning bright red.

By the next evening, a weak Pepperell had recovered enough to stop for a beer at the local watering hole. "Soon, my palms and soles started to itch and turn red again, and then the penny dropped! Alcohol triggers symptoms of ciguatera poisoning. And I had eaten coral trout, a species implicated in the disease."

Pepperell would know of ciguatera since he's one of Australia's pre-eminent fisheries scientists. Most victims - and physicians - don't have a clue, however, when they find themselves blindsided by a double whammy of gastrointestinal explosions coupled with a nervous system gone haywire.

Bizarre Symptoms
Although 50,000 or so ciguatera cases are reported worldwide each year, health officials estimate several times that number go unreported or misdiagnosed. Frequently, neurological symptoms lead physicians to diagnose the onset of multiple sclerosis.

One reason Pepperell didn't guess what ailed him on that first night: the absence of the prevalent, most "classic" ciguatera symptom - hot and cold reversal. That means a victim senses an ice cube as if were a burning-hot coal or, conversely, a warm bath as a tub of ice water.

But ciguatera presents with a confounding variety of (sometimes bizarre) symptoms, especially neurologically. In Pepperell's case, "a weird thing I experienced for the next several months was a sensation when I stood up and took a few steps - I felt as if I'd stepped into a hole, so my body didn't seem to register that my feet were actually making contact with the ground!" Pepperell says he learned later that "this definitely can be another symptom of ciguatera, [stemming from its] effect on peripheral nerves."