Outbreaks and Updates Travel Health

Ciguatera Poisoning in St. Louis

St. Louis, Missouri is the subject of FDA interest due to a recent outbreak of Ciguatera Poisoning. The article, from http://www.newsinferno.com/archives/2192, was featured by Pro Med Mail.

Ciguatera is a food borne illness, acquired from ingestion of predatory reef fish that are tainted with Gambierdiscus Toxicus. This is acquired when small fish eat algae and the predatory reef fish eat the smaller fish. The larger fish are then eaten by humans, who ingest the accumulation of toxins from the algae. These toxins are found in the flesh of the fish and cannot be destroyed or rendered inactive by cooking and there is not a test to indicate the substance is in the fish.

Symptoms of Ciguatera poisoning include GI problems such as nausea and diarrhea and generally begin the same day the fish is eaten. Over the next few days the toxins can cause leg and muscle weakness, which may progress to respiratory collapse and death. Usually, the patient recovers fully, within a few weeks.

The outbreak in St. Louis is traced to two restaurants and all cases ate a fish called Amberjack. Both restaurants purchased the tainted fish from the same supplier, who received the shipment from Louisiana.

In total, there are 10 cases reported, with no fatalities. The USA has a total of approx. 30 cases per year of ciguatera, so this represents a large number of cases.

Ciguatera poisoning is the most common food borne/fish related illness worldwide and is commonly found in the Caribbean. A few other food borne illnesses include scromboid and Fugu/puffer fish poisoning. Learn more about ciguatera and other food borne illnesses here at adventuredoc.org


  1. My husband continues affected by chronic ciguatera poisoning since 8/93…very challenging, lonely experience. Diagnosed within 2 months and no mannitol till 2 years later when we finally met a doc who knew something about marine toxins. Continues with extreme fatigue, paresthesias, visual problems, hypertension, cognitive difficulties. Ate grouper in a local restaurant in Richmond, VA.

  2. Hello,
    My name is Larry. Five years ago,my family and I went to Belize, South America. I caught a black-finned Snapper and ate the fish within one hour of capture. Within hours, I was throwing up, had diarrhea, and had sore muscles. The following month, I lost mobility in all four limbs and spent approximately eight to ten months in a wheelchair. Gradually regaining my arms and legs, I worked myself back onto crutches and eventually free of any aids for walking.
    It has now been five years and I have just spent the last eight days in a hospital with a failing respiratory system and had to have my heart injected four times with adrenaline. I am now home and have chronic bone, muscle,and skin pain. The pain runs from my toes all the way to the top of my spine. I also have had to begin wearing glasses since my vision has went. I am so tired of this poison ruining my everyday existence. Is their anything that I can do to help myself? There is not one day that goes by that I do not have to deal with this in one form or another……I appreciate any information you might be able to share with my family and I.

    Thank You,

  3. This sounds like a really difficult problem and I cannot imagine the difficulties you and your family are going through. Thank-you for sharing this information.

    I have heard of a cholesterol lowering agent called cholestyramine being used for chronic eye problems associated with ciguatera poisoning, especially in long term suffers. The medicine seems to block the same receptors that the poison effects and there has been some limited success.


    I will continue to look for some more information and would appreciate some updates, as you continue to look for treatment. Best of luck!

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