Doctors Need Fish School

MSNBC.COM has a fascinating article today about a condition known as ciguatera fish poisoning. From MSNBC.COM:

“It’s horrible, I’m telling you,” said Schroeder, 65, a retired Beaumont, Texas, realtor, who is only now recovering from ciguatera fish poisoning, an exotic foodborne illness that health officials say may be dramatically under-recognized in the United States.

The malady afflicts at least 50,000 people a year worldwide — and the real number may be 100 times that many. While ciguatera fish poisoning is largely unknown in most of the U.S., several recent cases have attracted growing concern, officials say. They hope a greater awareness will help alert consumers and doctors and improve treatment of the incurable illness caused by coral algae toxins that accumulate in large tropical reef fish.

Within hours of the July dinner, Schroeder was stricken not only with typical nasty food poisoning symptoms — diarrhea, vomiting and fatigue — but also with a dangerously slow heart rate and neurological problems that caused her hands and feet to tingle painfully and, oddest of all, reversed her sense of hot and cold. Some patients also say they feel like their teeth are falling out — and the symptoms can linger for years.

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Ciguatera fish poisoning often is missed, even though it is the most common seafood-toxin illness reported in the world, said Richard Weisman, a toxicologist and director of the Florida Poison Information Center.

“If you go to the Caribbean Islands, you can’t find anybody who hasn’t had it,” he said.

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The actual toxin is produced by microscopic sea plants, which are eaten by smaller fish that are, in turn, eaten by larger fish such as barracuda, grouper, sea bass and snapper. The toxins become increasingly concentrated as they move up the food chain.

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Part of the problem is that ciguatera fish poisoning is hard to detect for seafood suppliers and consumers alike, said Melissa Friedman, a neuropsychologist at Mount Sinai Medical Center in Miami who studied victims of the illness.

“You can’t tell from the way it looks. You can’t tell from the way it tastes. There’s nothing you can do in terms of storage. There’s nothing you can do in terms of cooking,” she said.

Instead, people simply eat the toxic fish and become ill. Baffled doctors often confuse ciguatera symptoms with those of multiple sclerosis, or else they come away empty-handed, Weisman said.

“There are people having CT scans, MRIs, all these tests.” he said. “They do million-dollar workups, but no test will ever come back positive.”

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That can delay one of the only treatments for the illness: an intravenous dose of a drug called mannitol, which can reduce or prevent the neurological symptoms. The drug is most effective, however, within the first 72 hours of illness, Weisman said.

The worst of the illness usually lasts for a week or two, and it's rarely fatal. But in some victims, the effects linger much longer, or never really go away. Many patients find that certain foods such as other fish, nuts or alcohol trigger relapses, and that overexertion can send the symptoms flooding back.

Yikes!

26 February 2009