Numerous reports in the literature describe cases of fish poisoning occurring due to ingestion of several species, some of the most important being:

• Shellfish - Poisoning from this fish stems from the effects of saxitoxin, a compound found in butter clams, geoducks, mussels, and other bivalve mollusks that are eaten by shellfish [1] [2] [3]. It is a very potent molecule capable of producing symptoms within several hours after being introduced into the gastrointestinal tract [2] [3]. Because saxitoxin blocks voltage-gated sodium channels, neurological symptoms are a constitutive feature of this type of fish poisoning; circumoral paresthesia, numbness and a tingling sensation of the extremities, ataxia, weakness, and altered consciousness are principal findings [2] [3]. In severe cases, hypertension and tachycardia may be accompanied by a severe muscular and respiratory paralysis, thus the term paralytic shellfish poisoning is often used [2] [3]. In rare cases, the effects of another toxin found in shellfish (brevetoxin) can cause temperature-related dysesthesia [1].
• Pufferfish - Ingestion of pufferfish is a potentially life-threatening clinical entity and is known as fugu poisoning. Tetrodotoxin (TTX), similarly to saxitoxin, impairs the transmission of neuromuscular impulses [4] [5]. Lightheadedness, weakness, vomiting, and a rapidly ascending paralysis, eventually affecting respiratory muscles, may be fatal within 6-24 hours [5]. Diaphoresis, excessive salivation, dysphagia, convulsions, hypotension, bradycardia, and fixed dilated pupils are other notable symptoms of pufferfish poisoning [4] [5].
• Scombroid species - Initially described from tuna, mackerel, and other fish belonging to the Scombridae family, and later with sardines and anchovies, scombroid fish poisoning arises in the setting of improper storage or processing, resulting in the accumulation of histamine [6] [7]. Thus, typical symptoms resemble an acute allergic reaction - disseminated erythema (without wheals) and flushing are accompanied by abdominal cramping, diarrhea, and vomiting [6] [7]. Headaches, palpitation, and dizziness are frequently reported [7]. Furthermore, bronchospasm and respiratory distress in conjunction with an unstable blood pressure can appear as well [6]. Symptoms develop shortly after consuming the fish (in the first hour and a half) and resolve within 36 hours [6].
• Reef fish - Ciguatera fish poisoning (CFP), named after ciguatoxins that produce gastrointestinal (vomiting, diarrhea, abdominal pain), neurologic (paresthesias, pruritis), and musculoskeletal (myalgia, arthralgia, and weakness) symptoms in a period of hours, is primarily seen after consumption of fish species residing in coral reefs [1]. Dysesthesia is a constitutive feature of ciguatera fish poisoning as well, and it may be confused with shellfish poisoning [1].

• Fishing

  Fish poisoning can occur after ingestion of various fishes, such as reef fish, puffer fish, improperly processed or canned scombroid species (tuna), and shellfish. [symptoma.com]

  Scombrotoxic fish poisoning is preventable by the correct handling and refrigeration of these fish. [ncbi.nlm.nih.gov]

• Pain

  Among seven patients who were sexually active, six patients also complained of painful intercourse. This report highlights the potential risks of eating contaminated ocean fish. [ncbi.nlm.nih.gov]

  Put salt water or vinegar on the area for 30 minutes or until the pain stops. Do not use fresh water. That will make the tentacles sting again and give you more pain. Ice packs are good for easing the pain. [aafp.org]

  Symptoms include nausea, vomiting, diarrhea, muscle pain, numbness, tingling, abdominal pain, dizziness, and vertigo. The classic finding of hot and cold sensation reversal is actually a burning sensation on contact with cold (allodynia). [emedicinehealth.com]

  The symptoms for both can include weakness in the limbs and joints, headache, tingling and numbness of the extremities, reversal of hot versus cold sensations, nausea, vomiting, stomach pain, diarrhoea, breathing difficulties, and tightness or pain in [qm.qld.gov.au]

• Burning Pain

  The classic dysaesthesia is cold allodynia, often described as reversal of hot and cold sensation, but a more accurate description is burning pain on exposure to cold. [ncbi.nlm.nih.gov]

  For instance, ciguatera sufferers have reported that a refreshing dive in the ocean actually caused burning pain, or that drinking cool beer felt like too hot coffee. [nutritionfacts.org]

  Among the symptoms are a burning pain when drinking or touching water; teeth may feel numb; fingertips tingle and feel numb; arms and legs feel weak; dizziness; nausea, vomiting, abdominal cramping and diarrhea. [nytimes.com]

  "Ciguatoxins activate specific cold pain pathways to elicit burning pain from cooling". The EMBO Journal. 31 (19): 3795–3808. doi : 10.1038/emboj.2012.207. ISSN 0261-4189. PMC 3463840. PMID 22850668. ^ Swift A, Swift T (1993). "Ciguatera". J. [en.wikipedia.org]

• Asymptomatic

  A prolonged period of acute illness can result, and the neurologic symptoms can last months, with variable asymptomatic and symptomatic periods. [ncbi.nlm.nih.gov]

  Indeed, some might remain completely asymptomatic; others might take a (relatively) mild hit, with symptoms limited mostly to gastrointestinal distress for a day or two. [sportfishingmag.com]

• Inflammation

  Ongoing research has shown that people with chronic fatigue syndrome may actually be suffering the long-term effects of this fish food poisoning or a condition called polymyositis, which causes diffuse muscle aches, pains, and inflammation. [nutritionfacts.org]

  Histamine — A chemical found naturally in the body that produces inflammation and increases blood flow; the uncomfortable symptoms of an allergy attack or an allergic reaction are generally caused by the release of histamine. [medical-dictionary.thefreedictionary.com]

• Dyspnea

  A 25-year-old woman presented to the emergency department (ED) with one hour of tongue and face swelling, an erythematous pruritic rash, and dyspnea with wheezing after consuming a tuna sandwich. [ncbi.nlm.nih.gov]

• Vomiting

  Lightheadedness, weakness, vomiting, and a rapidly ascending paralysis, eventually affecting respiratory muscles, may be fatal within 6-24 hours. [symptoma.com]

  Abdominal cramps, nausea, vomiting, and diarrhea last 6 to 17 h; then, pruritus, paresthesias, headache, myalgia, reversal of hot and cold sensation, and face pain may occur. [merckmanuals.com]

  The diagnosis usually is made by the presence of gastrointestinal symptoms, nausea, vomiting, and diarrhea, and of neurological symptoms such as paresthesias, paresis, and pruritus. [ncbi.nlm.nih.gov]

  Do not induce vomiting or give syrup of Ipecac. Ipecac was formerly used to induce vomiting in poisoned patients where there was a chance to get the toxin out of the body. [medicinenet.com]

  After eating contaminated clams or mussels, you will most likely experience nausea, vomiting, and diarrhea. [medlineplus.gov]

• Nausea

  Abdominal cramps, nausea, vomiting, and diarrhea last 6 to 17 h; then, pruritus, paresthesias, headache, myalgia, reversal of hot and cold sensation, and face pain may occur. [merckmanuals.com]

  Symptoms of poisoning may include paralysis, respiratory failure, numbness, paraesthesia, nausea and ataxia. Health professionals should be aware of the condition so as to institute early and appropriate management. [ncbi.nlm.nih.gov]

  Barracudas are the most common carriers of ciguatera, a fish-borne illness that causes vomiting and nausea. [miamiherald.com]

• Diarrhea

  Thus, typical symptoms resemble an acute allergic reaction - disseminated erythema (without wheals) and flushing are accompanied by abdominal cramping, diarrhea, and vomiting. Headaches, palpitation, and dizziness are frequently reported. [symptoma.com]

  The diagnosis usually is made by the presence of gastrointestinal symptoms, nausea, vomiting, and diarrhea, and of neurological symptoms such as paresthesias, paresis, and pruritus. [ncbi.nlm.nih.gov]

• Food Poisoning

  What Is the Most Common Way to Get Food Poisoning From Fish? There are actually two ways in which you can get food poisoning from consuming fish. [healthguidance.org]

  Causes of fish food poisoning This type of food poisoning is caused by fish which has been contaminated by: Parasites Toxins Bacteria, e.g. [medic8.com]

  Food poisoning can occur if raw fish gets too warm before it is served. (Image: merc67/iStock/Getty Images) Different types of food poisoning can occur from the consumption of raw fish. One of the most common is referred to as Scromboid poisoning. [livestrong.com]

  The treatment of this food poisoning is supportive, although intravenous mannitol is reported to be safe and effective. The prognosis is good and complete recovery is to be expected. [ncbi.nlm.nih.gov]

• Abdominal Pain

  OBJECTIVE: We describe the case of a young man who suffered from diarrhea and abdominal pain after eating raw fish and who also developed severe ataxia with spontaneous downbeat and perverted head-shaking nystagmus. [ncbi.nlm.nih.gov]

  Reef fish - Ciguatera fish poisoning (CFP), named after ciguatoxins that produce gastrointestinal (vomiting, diarrhea, abdominal pain), neurologic (paresthesias, pruritis), and musculoskeletal (myalgia, arthralgia, and weakness) symptoms in a period of [symptoma.com]

• Muscle Cramp

  Muscle and joint pains, often felt in the thighs, calf, knees and ankles, are likened to muscle cramps after jogging and in severe cases, people cannot walk because of the pain. [nytimes.com]

• Sweating

  Symptoms Symptoms begin within 2 minutes to 2 hours after eating the fish, and may include rash, diarrhea, flushing of the face, and sweating, headache, dizziness, and vomiting. [bouldercounty.org]

  Muscle pain and cramping are features usually more associated with ciguatera poisoning, while very severe symptoms, combined with profuse sweating, dizziness, decreasing body temperature, low blood pressure, and reduced pulse rate are associated more [qm.qld.gov.au]

  Scombroid fish poisoning is an acute syndrome characterized by facial flushing, sweating, rash, a burning or peppery taste in the mouth, diarrhea, and abdominal cramps and usually resolve within several hours without medical intervention. [outbreaknewstoday.com]

  The most common symptoms include rash, diarrhea, flushing, sweating, headache, nausea, and vomiting. You may also feel abdominal cramping, burning or swelling of the mouth, or a metallic or peppery taste. If you have asthma, you may have wheezing. [fairview.org]

  Generally, gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain occur first, followed by neurological dysfunction including muscular aches and pain, pruritis (itching), dizziness, sweating, and numbness and tingling of the mouth and [whoi.edu]

• Pruritus

  Symptoms persisted for four hours and were followed by a generalized pruritus and paresthesias of the lips, tongue, palms, and soles of the feet. [ncbi.nlm.nih.gov]

• Erythema

  Thus, typical symptoms resemble an acute allergic reaction - disseminated erythema (without wheals) and flushing are accompanied by abdominal cramping, diarrhea, and vomiting. Headaches, palpitation, and dizziness are frequently reported. [symptoma.com]

  Erythema was noted over all their faces and trunk. The concurrent presentation of five such cases to A&E roused the suspicion of the attending registrar who diagnosed histamine fish poisoning. [emj.bmj.com]

• Headache

  Amitriptyline demonstrated resolution of most symptoms except for heat/cold reversal in one patient and heat/cold reversal, pruritus and headache in the second patient. [ncbi.nlm.nih.gov]

  Signs and symptoms Symptoms include: tingling and burning around the mouth facial flushing and sweating nausea, vomiting and diarrhoea headache palpitations and dizziness rash. [sahealth.sa.gov.au]

  Symptoms may include: Nausea Vomiting Watery diarrhea Headache Numbness and tingling about the mouth and extremities In more severe cases, the person may suffer muscle pains, dizziness, and sensations of temperature reversal, where hot things seem cold [hopkinsmedicine.org]

• Dizziness

  Symptoms included a bright red rash, tightness of the chest, palpitations, anxiety, mild headache and dizziness, all of which resolved spontaneously within 2-3 h. [ncbi.nlm.nih.gov]

  Headaches, palpitation, and dizziness are frequently reported. Furthermore, bronchospasm and respiratory distress in conjunction with an unstable blood pressure can appear as well. [symptoma.com]

• Vertigo

  Muscle weakness, dizziness, vertigo, nausea and vomiting were common complaints. Eighteen patients developed acute flaccid paralysis and respiratory failure requiring ventilatory support. [ncbi.nlm.nih.gov]

  Symptoms include: nausea, vomiting, diarrhea, muscle pain, numbness, tingling, abdominal pain, dizziness, and vertigo. Hot and cold sensation may be reversed. [medicinenet.com]

  Symptoms include nausea, vomiting, diarrhea, muscle pain, numbness, tingling, abdominal pain, dizziness, and vertigo. The classic finding of hot and cold sensation reversal is actually a burning sensation on contact with cold (allodynia). [emedicinehealth.com]

  The molecules open little holes in nerves, triggering an array of crazy symptoms: reversal of how you experience temperature, vertigo and the sensation that your teeth are falling out. [npr.org]

  It was not until I eliminated seed oils from my diet and from hair and skin products that I became essentially free of vertigo, mental fog, and visual disturbances. Symptoms of neuropathy may be somewhat improved. 1. [ambergriscaye.com]

• Seizure

  If you or someone you know has ingested a fish that you suspect might be contaminated with ciguatera toxin, and you or they have signs or symptoms, such as nausea, vomiting, pain, trouble breathing, seizure, confusion, or abnormal skin color, call either [medicinenet.com]

  Austin was in bad shape, unable to maintain consciousness and suffering from seizures. They were taken to a public hospital where the staff was unable to ascertain any information from them due to their conditions. [islander.org]

• Giddiness

  The toxin can also cause hallucinations or "giddiness," Friedman says, if the fish came from the Pacific or Indian Oceans. Although ciguatera is new to most people, poisonings are fairly common in tropical and subtropical regions, Friedman says. [npr.org]

Because of the rapid onset of symptoms seen in the mentioned types of fish poisoning, a prompt diagnosis can be life-saving. A proper patient history is the single most important step in the workup. Data regarding recent consumption of fish, the development of similar symptoms in friends or other persons who ate the same food (or have been in the same restaurant) can be crucial for a presumptive diagnosis of intoxication [1] [5] [7]. The physical examination is an important component of the workup, during which the severity of complaints and their progression should be defined, mainly in order to consider the optimal therapeutic approach. Despite the scarce availability of commercial tests for specific toxins found in fish, recent introduction of novel biochemical tests might be useful for detecting the concentration of ciguatera toxin, histamine, tetrodotoxin, and saxitoxin in respective fish species; this confirming the presumed source [1] [2] [3] [5] [6]. An assessment of histamine concentration in blood or its metabolites in urine might also be a useful diagnostic tool [6].

Treatment with mannitol fails to correct these effects. [ncbi.nlm.nih.gov]

The prognosis is good and complete recovery is to be expected. However, relapses can occur, especially on re-exposure to the toxin. [ncbi.nlm.nih.gov]

Prognosis The prognosis for PSP is quite good, especially if the patient has passed the initial 12 hours of illness without needing breathing support. Most deaths occur during this period if breathing help is not available. [medical-dictionary.thefreedictionary.com]

During 2009-2015, 85 outbreaks of confirmed histamine fish poisoning involving 250 illnesses were reported to the CDC, with one hospitalizaiton and no deaths. [14] Prognosis Patients with histamine fish toxicity have a good prognosis. [emedicine.medscape.com]

Other postulated second agents are cadaverine or putrescine. [9, 10] Etiology The fish species most commonly implicated in histamine toxicity are scombroid dark-meat fish (eg, tuna, mackerel, skipjack, bonito, marlin) and nonscombroid species, such as [emedicine.medscape.com]

In this review, we discuss the epidemiology, pathophysiology, evaluation, and treatment of scombroid disease. [ncbi.nlm.nih.gov]

In this review, we discuss the epidemiology, pathophysiology, evaluation, and treatment of scombroid disease. [ncbi.nlm.nih.gov]

This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs), diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future [mdpi.com]

To prevent ciguatera outbreaks, the public should be educated to avoid eating large coral reef fishes, especially the CTX-rich parts. [ncbi.nlm.nih.gov]

Prevention Fish should be chilled and properly refrigerated as soon as possible after being caught to prevent histamine formation. [sahealth.sa.gov.au]

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2. Hurley W, Wolterstorff C, MacDonald R, Schultz D. Paralytic Shellfish Poisoning: A Case Series. West J Emerg Med. 2014;15(4):378-381.
3. Centers for Disease Control and Prevention (CDC). Paralytic shellfish poisoning - Southeast Alaska, May-June 2011. MMWR Morb Mortal Wkly Rep. 2011;60(45):1554–1556.
4. Lago J, Rodríguez LP, Blanco L, Vieites JM, Cabado AG. Tetrodotoxin, an Extremely Potent Marine Neurotoxin: Distribution, Toxicity, Origin and Therapeutical Uses. Long P, ed. Mar Drugs. 2015;13(10):6384-6406.
5. Centers for Disease Control and Prevention (CDC). Tetrodotoxin poisoning associated with eating puffer fish transported from Japan--California, 1996. MMWR Morb Mortal Wkly Rep. 1996;45(19):389-391.
6. Stratta P, Badino G. Scombroid poisoning. CMAJ. 2012;184(6):674.
7. Feldman KA, Werner SB, Cronan S, et al. A large outbreak of scombroid fish poisoning associated with eating escolar fish (Lepidocybium flavobrunneum). Epidemiol Infect. 2005;133(1):29-33.