CIGUATERA POISONING AFTER INGESTION OF IMPORTED JELLYFISH - DIAGNOSTIC APPLICATION OF SERUM IMMUNOASSAY

Ciguatera fish poisoning is an important public health problem whereve r humans consume tropical and subtropical fish. It accounts for over h alf of fish-related poisonings in the United States but is uncommonly diagnosed and underreported. Produced by dinoflagellates, ciguatoxin a ccumulates up the food chain in herbivorous and carnivorous fishes. Cn idaria (jellyfish and related invertebrates) have not previously been associated with direct ciguatera intoxication in humans. We report the first case of ciguatera fish poisoning associated with cnidarian inge stion. A 12-year-old Tongan female presented to our Emergency Departme nt with mid-abdominal pain, nausea, change in mental status, and new-o nset movement disorder after ingestion of jellyfish imported from Amer ican Samoa. Clinical diagnosis was confirmed by strongly positive seru m identification of ciguatoxin and related polyether toxins (including okadaic acid) with a rapid extraction method (REM) and highly reliabl e solid-phase immunobead assay (S-PIA) performed by the Food Toxicolog y Research Group, University of Arizona. Ciguatera pathophysiology, cl inical presentation, differential diagnosis (including consideration o f palytoxin poisoning), and treatment are briefly reviewed. We emphasi ze the growing incidence of ciguatera fish poisoning outside ''high-ri sk'' areas, In regions with immigrant populations, privately imported exotic fish may be toxin vectors. Marine species other than carnivorou s fish are now suspect in human ciguatera intoxication, Reliable tests can aid in premarket fish testing, diagnosis, and follow-up of ciguat era fish poisoning. The global prevalence of marine toxins demands fis hermen, consumers, and physicians maintain a high index of suspicion f or ciguatera fish poisoning.