Ciguatoxin and Ciguatera

Abstract

Ciguatera is a disease caused by the consumption of fishes from tropical and subtropical waters that have accumulated lipophilic sodium channel activator toxins known as ciguatoxins (CTXs) to levels sufficient to cause human poisoning. Consumption of these temperature-stable, orally active polycyclic ether compounds leads to the activation of neuronal sodium channels that produces a range of characteristic neurological, gastrointestinal, and cardiovascular signs and symptoms that clinically define the illness. Ciguatera is estimated to affect similar to 50,000 people annually worldwide after accounting for misdiagnosis and non-reporting. Currently there are no clinically validated treatments and no routine tests that can cost-effectively detect ciguatoxins prior to consumption, with government bans on capture or personal avoidance of risk fish species providing the only effective means to mitigate the risk currently. A recently developed rapid extraction method for ciguatoxins coupled to LC/MS/MS detection has potential for surveillance and confirmation of ciguatera outbreaks.