Last update: Oct. 4, 2020

Ciguatera fish poisoning

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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Ciguatera is food poisoning caused by ingesting tropical and subtropical carnivorous fish that in turn have ingested herbivorous fish contaminated with toxins (ciguatoxins, maitotoxins) produced by dinoflagellate organisms (Gambierdiscus toxicus) that live in detritus and algae of coral and rocky reefs, forming part of phytoplankton (Traylor 2019, Armstrong 2016, Valiente 2011, CDC 2009, FAO 2004).
Among the fish species most affected by these toxins are needlefish, barracuda, caranx latus (Galician, horse mackerel), serranus decimalis, grouper, sailfish, dorado, wahoo, seabream, moray eels, greater amberjack, sturgeon (Maya 2007, FAO 2004).
It is the most common food poisoning from eating fish in the world, being endemic in tropical and subtropical areas: the Caribbean, Indian Ocean, South Pacific and Atlantic (Traylor 2019, Armstrong 2016, Valiente 2011).

Ciguatoxins are lipid compounds of very high molecular weight, between 1,023 and 1,157 daltons (Soliño 2018). They are heat and freeze stable (Thompson 2017, FAO 2004) and do not affect fish that contain them which appear healthy. Ciguatoxins result from the biotransformation in fish of their precursors, gambiertoxins (Lehane 2000). They accumulate more in the brain, viscera, gonads and skin of fish.

Poisoning manifests itself within a few hours of having consumed contaminated fish in the form of gastrointestinal symptoms (vomiting, diarrhea, abdominal pain), neurological symptoms (paresthesia in the mouth, face, hands and feet with tingling, pain, asthenia and thermal cold-heat confusion ), cutaneous symptoms (severe itching and skin rash) and, less frequently, cardiovascular symptoms (hypotension, bradycardia). Symptoms typically last one to three weeks but can persist for months, leading to chronic fatigue and are worsened by alcohol consumption (Thompson 2017, Armstrong 2016, Valiente 2011, CDC 2009, Maya 2007).

Treatment is symptomatic. In the acute phase, it consists of oral or intravenous rehydration and intravenous infusion of mannitol and calcium gluconate. Subsequently, antihistamines, calcium salts and amitriptyline are used for paresthesias (Traylor 2019, Valiente 2011, Maya 2007, FAO 2004).

The high molecular weight of ciguatoxins makes its excretion in clinically significant amounts in breastmilk unlikely.
Children also appear to be less sensitive to ciguatoxin than adults (Maya 2007).

Only 5 cases have been reported, some poorly documented and all prior to 1990, of infants of mothers with ciguatera who continued to breastfeed and their babies presented mild diarrhea, colic, and/or moderate spontaneously resolving rashes (Blythe 1990, Anon 1989 and Bagnis 1987 in Swift 1991).

There is a more recently published case of a mother with ciguatera whose 8-month-old breastfed baby did not present any symptoms and no ciguatoxins were found in breastmilk (CDC 2009).
We have been informed of a case of a mother with ciguatera living in Cuba and treated with calcium carbonate who continued to breastfeed throughout the disease and whose 5-month-old infant did not present symptoms.
Increased tenderness has been described in the nipples of breastfeeding mothers with ciguatera (Lehane 2000).

Given the high frequency of this type of food poisoning, the scarcity of reported cases and complications during breastfeeding is noteworthy.

If the mother is not affected in a very acute way, breastfeeding can possibly continue, while monitoring possible symptoms in the infant (diarrhea, rash...) and temporarily suspending it only if these raise concern.

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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José María Paricio, founder of e-lactancia.

Other names

Ciguatera fish poisoning is also known as Ciguatera.


Group

Ciguatera fish poisoning belongs to this group or family:

References

  1. Traylor J, Singhal M. Ciguatera Toxicity. 2019 Apr 9. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Abstract Full text (link to original source) Full text (in our servers)
  2. Soliño L, Costa PR. Differential toxin profiles of ciguatoxins in marine organisms: Chemistry, fate and global distribution. Toxicon. 2018 Aug;150:124-143. Abstract
  3. Thompson CA, Jazuli F, Taggart LR, Boggild AK. Ciguatera fish poisoning after Caribbean travel. CMAJ. 2017 Jan 9;189(1):E19-E21. Abstract Full text (link to original source) Full text (in our servers)
  4. Armstrong P, Murray P, Nesdale A, Peckler B. Ciguatera fish poisoning. N Z Med J. 2016 Oct 28;129(1444):111-114. Abstract
  5. Valiente CA, Del Corral J, del Corral E, Castañeda JA, Mora I, Piñeiro L. Ciguatera. Avances 2011;21(8):21-32. Full text (link to original source) Full text (in our servers)
  6. Centers for Disease Control and Prevention (CDC).. Cluster of ciguatera fish poisoning--North Carolina, 2007. MMWR Morb Mortal Wkly Rep. 2009 Mar 27;58(11):283-5. Abstract Full text (link to original source) Full text (in our servers)
  7. Maya Entenza CM, Martín Labrador M, Monteagudo Torres M. Intoxicación por ciguatera. Estudio de 227 pacientes durante el periodo 1999 al 2005. Rev Cubana Hig Epidemiol. 2007;45(2) Full text (link to original source) Full text (in our servers)
  8. FAO: Food and Agriculture Organization of the United Nations. 7. Ciguatera Fish Poisoning (CFP). In: Marine Biotoxins 2004. Full text (link to original source) Full text (in our servers)
  9. Lehane L, Lewis RJ. Ciguatera: recent advances but the risk remains. Int J Food Microbiol. 2000 Nov 1;61(2-3):91-125. Review. Abstract
  10. Swift AE, Swift TR. The transmission of ciguatera toxicity: another first isn't. JAMA. 1991 May 8;265(18):2339. No abstract available. Abstract
  11. Blythe DG, de Sylva DP. Mother's milk turns toxic following fish feast. JAMA. 1990 Oct 24-31;264(16):2074. No abstract available. Abstract
  12. Anon. Ciguatera in a young baby (Letter to the editor). Vet Hum Toxicol. 1989 Feb;31(1):71. No abstract available. Abstract
  13. Bagnis RA, Legrand AM. Clinical features on 12,890 cases of ciguatera (fish poisoning) in French Polynesia. In, Gopalakrishnakone P, Tan CK, eds. Progress in venom and toxin research: Proceedings of the First Asia-Pacific Congress on Animal, Plant, and Microbial Toxins. Singapore. June 24-27, 1987.372-84. 1987

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