Ciguatera intoxication - Growing importance for differential diagnosis in an area of long distance tourism

Background: In the tropic sea there are carnivore fishes, e.g. the "peak ba ss", that incorporate toxin producing seaweed and can cause the ciguatera i ntoxication. Due to the frequent tourism to tropic regions even more cases of ciguatera intoxication can be seen in Europe. The late phase of ciguater a intoxication has hardly been recognized due to its different unspecific s ymptoms. In some cases ciguatera intoxication can even grow a vital threate ning. Case Description: Four patients from a travel group addressed us 4 and 14 d ays after breaking off their holidays in the Dominican republic. They prese nted complex neurological symptoms including paraesthesia, nervousness, inv erse temperature perception, muscle cramps, headache and dizziness. The phy sical and apparative investigation of the patients, whose age ranged betwee n 22 and 31 years, was totally unobtrusive. Essential for the diagnosis of ciguatera intoxication was the clue to the symptom causing dinner at their holiday location existing of "peak bass and lemon sauce". First symptoms in all members of the travel group were diarrhea, sickness and sweatening. In this late phase only a symptomatic therapy could be offered. Conclusion: The here described cases show the importance of a comprehensive information for tropic travellers as for physicians accounted to in the ac ute phase of ciguatera intoxication, because recognized early enough (withi n the first 24 hours) the total symptomatology of ciguatera intoxication ca n be prevented effectively by intravenous infusions of mannitol.