Ciguatera - Chronic Debility: One cause of the CFS
John Pearn
Professor
of Paediatrics & Child Health
Consultant to Queensland Poisons Information Centre
Consultant to Poisindex (International)
c/- Department of Paediatrics & Child Health
Royal Children's Hospital
Brisbane Qld 4029.
Acute ciguatera is a foodchain poisoning which is of particular public health and clinical significance in all parts of the tropical and sub-tropical world. The acute syndrome results from eating ciguatoxic fish. Most fish species are highly prized gourmet foods. Toxic fish cannot be detected by colour, taste or smell; and at this stage all attempts to produce a rapid, sensitive, specific and practical market-place test have been to no avail.
After an individual is poisoned, or a mini outbreak occurs, surviving fish samples can be tested (using mice, or cats) in biological test systems. From Queensland, the symptoms include:
- gastrointestinal tract symptoms (diarrhoea, vomiting, abdominal pain, etc) - 65%;
- loss of energy - 90%;
- myalgia - 83%;
- skin dysesthesia (reversal of thermal sensation) - 76%;
- arthralgia - 79%;
- headache - 62%;
- neck stiffness -27%;
- skin rashes - 25%;
- and abnormalities of perspiration, salivation and dysuria.
Some 5% of sufferers progress to chronic symptoms which may be incapacitating. A small proportion of such cases manifest symptoms which last for years, rather than months.
Management consists of graded exercise set against the confidence that the symptoms will ultimately disappear completely.
Depression, particularly in the face of chronic symptoms, is almost universal.
The toxin effects cells at the molecular level, affixing sodium channels in an "open" configuration, thus destabilising cell metabolism in many body cells.
Prevention of ciguatera consists of being aware of the risk, eating relatively small quantities of gourmet, at-risk species, and being aware of particular geographic locations where high-risk species occur.
Treatment in the acute phase (within 48 hours or so of intoxication) using intravenous mannitol, produces significant reversal or, in some cases, complete relief of symptoms, in approximately 60% of cases.
There is no known treatment for the subacute or chronic symptoms other than watchful expectancy.
The importance of chronic ciguatera is its role as a model as a probable channelopathy for the more protean symptoms of chronic fatigue, and the identical nature of the chronic ciguatera syndrome with those of some other causes of the chronic fatigue syndrome.
Professor
of Paediatrics & Child Health, and Consultant to Queensland Poisons
Information Centre, and Consultant to Poisindex (International);
c/- Department of Paediatrics & Child Health
Royal Children's Hospital
Brisbane Old 4029.
Acute ciguatera is a foodchain poisoning which is of particular public health and clinical significance in all parts of the tropical and sub-tropical world. The acute syndrome results from eating ciguatoxic fish. Most fish species are highly prized gourmet foods. Toxic fish cannot be detected by colour, taste or smell; and at this stage all attempts to produce a rapid, sensitive, specific and practical market-place test have been to no avail.
After an individual is poisoned, or a mini outbreak occurs, surviving fish samples can be tested (using mice, or cats) in biological test systems. From Queensland, the symptoms include:
- gastrointestinal tract symptoms (diarrhoea, vomiting, abdominal pain, etc) - 65%;
- loss of energy - 90%;
- myalgia - 83%;
- skin dysesthesia (reversal of thermal sensation) - 76%;
- arthralgia - 79%;
- headache - 62%;
- neck stiffness -27%;
- skin rashes - 25%;
- and abnormalities of perspiration, salivation and dysuria.
Some 5% of sufferers progress to chronic symptoms which may be incapacitating. A small proportion of such cases manifest symptoms which last for years, rather than months.
Management consists of graded exercise set against the confidence that the symptoms will ultimately disappear completely.
Depression, particularly in the face of chronic symptoms, is almost universal.
The toxin effects cells at the molecular level, affixing sodium channels in an "open" configuration, thus destabilising cell metabolism in many body cells.
Prevention of ciguatera consists of being aware of the risk, eating relatively small quantities of gourmet, at-risk species, and being aware of particular geographic locations where high-risk species occur.
Treatment in the acute phase (within 48 hours or so of intoxication) using intravenous mannitol, produces significant reversal or, in some cases, complete relief of symptoms, in approximately 60% of cases.
There is no known treatment for the subacute or chronic symptoms other than watchful expectancy.
The importance of chronic ciguatera is its role as a model as a probable channelopathy for the more protean symptoms of chronic fatigue, and the identical nature of the chronic ciguatera syndrome with those of some other causes of the chronic fatigue syndrome.
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