Ciguatera
| Classification according to ICD-10 | |
|---|---|
| T61 | Toxic effect of harmful substances ingested with edible marine animals |
| T61.0 | Ciguatera fish poisoning |
| ICD-10 online (WHO version 2019) | |
Ciguatera is a common type of fish poisoning that occurs epidemically at irregular intervals, especially in tropical and subtropical marine areas between 35 ° north and 35 ° south latitude and is caused by the consumption of food fish .
The disease is mainly caused in these regions by old, large, carnivorous reef-dwelling fish, which accumulate toxic metabolic end products of marine protozoa in their tissues via the food chain.
Worldwide, 50,000 to 500,000 cases are to be expected each year. The mortality rate in people who contract Ciguatera is around 0.1 percent.
The name of the fish poisoning is derived from the name "cigua", which is common in Cuba, for the snail Cittarium pica , which was initially mistakenly regarded as the cause of the disease.
distribution
Ciguatera occurs outside of the main distribution area in the area of the tropical and subtropical Pacific islands also in the temperate climatic zones . In European and bordering coastal areas, the causative unicellular organisms occur in the Canary Islands , Madeira , the Azores , the central eastern Atlantic ( FAO fishing area 34) and the eastern Mediterranean region ( Israel ). Between 2008 and 2014, for example, there were eleven autochthonous outbreaks in the Canary Islands, which were caused there. The import of contaminated tropical fish products occasionally results in outbreaks of the disease in Europe.
In the high-risk areas of the Pacific, 10 to 400 illnesses per 100,000 inhabitants are to be expected; Epidemic outbreaks occurred on individual Pacific islands with infection rates of more than 20 percent of the population.
The increase in the number of cases in the area of 20 Pacific islands, which has been documented for 20 years, is attributed to disturbances and destruction of the environment caused directly or indirectly by humans, in particular by cyclones and by bleaching (“ coral bleaching ”) and destroyed coral reefs .
trigger
The ciguatoxin and maitotoxin , which are among the strongest known toxins, are responsible for the poisoning . Ciguatoxin acts on the voltage-dependent sodium channels of the nerve cells, maitotoxin on the calcium channels ; they prevent the transmission of electrical signals in the nervous system.
These toxins come from dinoflagellates - certain flagellates such as Gambierdiscus toxicus - which live epiphytically on algae and seaweed from coral reefs . Since they are enriched in the food chain , predatory fish such as barracudas , groupers and moray eels are particularly contaminated, and more rarely coral polyp- eating parrotfish and herbivores .
The toxins do not harm the fish. They are heat-resistant, so they cannot be destroyed when cooking. Even 80 grams of contaminated fish meat can lead to severe symptoms.
Symptoms
After 1 to 24 hours (usually 5 to 6 hours), skin rashes, numbness in the lips and oral mucosa , diarrhea , abdominal pain , nausea and vomiting develop - not in all people .
The symptoms, sometimes with characteristic neurological symptoms, such as painful hypersensitivity to cold (cold allodynia), which can occur when coming into contact with normally pleasantly cool air or when swallowing cold food or cold drinks, can last for weeks and occasionally for months.
The causes of death were respiratory depression , heart attacks, or severe impaired consciousness .
The detection of ciguatoxin is complex and only possible in a few laboratories worldwide. In Germany, the method for detecting ciguatoxin has not yet been established (2017). The European Reference Laboratory for Marine Biotoxins (EU-RL-MB), which is responsible as an alternative , is based in Vigo ( Spain ).
therapy
A specific therapy or an antidote does not yet exist. After the patient is rehydrated , an infusion of mannitol and colestyramine can be given to accelerate the excretion of the toxin ; however, their effectiveness is not sufficiently well secured statistically.
literature
- Dietrich Mebs: Poisons in the reef. Wissenschaftliche Verlags-Gesellschaft, Stuttgart 1989, ISBN 3-8047-1053-0 , pp. 80-82.
- Schaper et al: fish poisoning . In: Dtsch Arztebl. 2002; 99 (17), pp. A-1151 / B-958 / C-901
- MA Friedman, LE Fleming, M. Fernandez et al: Ciguatera fish poisoning: treatment, prevention and management. In: Marine Drugs . 2008; 6 (3), pp. 456-479. Review. PMID 19005579
Web links
- Ciguatera - the invisible danger. Experience report about a Ciguatera disease
- What is ciguatoxin poisoning (Ciguatera)? Leaflet of the Federal Institute for Risk Assessment (BfR)
Individual evidence
- ↑ a b Food Poisoning from Marine Toxins. On: .cdc.gov , accessed January 22, 2017
- ↑ a b c d e f g h i Miriam Friedemann: First Ciguatera outbreak in Germany 2012. In: Federal Health Gazette. Volume 59, No. 12, 2016, pp. 1556-1565.
- ↑ Matthias Wjst: Ciguatera: case report of a mysterious illness. Persistent neurological symptoms after eating fish. In: MMW - Advances in Medicine. Volume 158, No. 21, 2016, pp. 76-78, doi: 10.1007 / s15006-016-9108-x .
- ↑ Already eleven fish poisonings. Vomiting, dizziness: Red snapper contains algae toxins. From: dmz-web.de , accessed on March 23, 2017
- ↑ Cold pain after eating fish: mechanism of hypersensitivity in ciguatoxin poisoning. On: idw-online.de from September 14, 2012.
- ↑ Ciguatrea . Information sheet from the German Foreign Office dated May 28, 2014 (PDF)
