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].

• Chills

  Severe cases of ciguatera poisoning may result in tearing of the eyes, chills, skin rash, itching, shortness of breath, drooling, and paralysis. Death due to heart or respiratory failure occurs in rare cases. [medicinenet.com]

  Severe cases of ciguatera poisoning may result in shortness of breath, salivation, tearing, chills, rashes, itching, and paralysis. Bradycardia, coma and hypotension can occur. Death due to poisoning is rare (less then 0.5 %). [emedicinehealth.com]

  It was bought from the Fishermen's Co-op the following day and kept hygienic and chilled throughout. "Each staff member ate about 100g of meat," the owner said yesterday. "There's absolutely no negligence. [northernstar.com.au]

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

• Falling

  Delicious as these might sound, however, even the most adventurous stomachs have been known to fall to foreign foods. [travelinsurancedirect.com.au]

  For most patients, the symptoms will go away as the mercury level falls, but in serious cases, health might improve but not necessarily return to normal. [consumerreports.org]

  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]

  There is no real need to ask how you will know if you have ciguatera poisoning – because like falling in love…boy you will know. Even a mild dose of ciguatera poisoning will leave you feeling distinctly unwell. [crewtoo.com]

  They include: Abdominal cramps Diarrhea (severe and watery) Nausea and vomiting Shortly after these symptoms develop, you will start to have strange sensations, which may include: A feeling that your teeth are loose and about to fall out Confusing hot [medlineplus.gov]

• Difficulty Walking

  For example, a man ate grouper at a Manhattan restaurant and went from swimming two miles a day to having difficulty walking that lasted for months. But these aren’t just rare anecdotes. [nutritionfacts.org]

  Numbness; tingling of the mouth, hands or feet; dizziness, difficulty walking; itchiness; weakness; reversal of hot and cold sensation (cold items feel hot and hot items feel cold), or becoming sensitive to temperature changes. [www1.nyc.gov]

  Symptoms may include: Numbness of lips and tongue Numbness of face and extremities Sensations of lightness or floating Headache Nausea and vomiting Abdominal pain Diarrhea Slurred speech Difficulty walking Extensive muscle weakness Convulsions Respiratory [hopkinsmedicine.org]

• Unconsciousness

  Marlin and Karen Goncalves’ boyfriend experienced violent hallucinations, and Austin and his mom were unconscious by the time the ambulance arrived to the timeshare. [islander.org]

• 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]

• 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]

• Hypotension

  RESULTS: Volume depletion was excluded as a cause for hypotension. Our patient showed low plasma catecholamine levels and marked pressor hypersensitivity to norepinephrine infusion. Hypotension and bradycardia were reversed by atropine infusion. [ncbi.nlm.nih.gov]

  We report two patients with persistent bradycardia and hypotension after eating mackerel fish. [heartviews.org]

• Irregular Heart Rhythm

  Irregular heart rhythms and low blood pressure may also be experienced. Ciguatera poisoning symptoms typically resolve within several days, but may last up to 4 weeks. The symptoms of ciguatera poisoning may resemble other medical conditions. [hopkinsmedicine.org]

• Flushing

  Typical symptoms like flushing, urticaria, and palpitations mimic those of allergy so histamine fish poisoning can easily be misdiagnosed. Diagnosis is often clinical and the mainstay of treatment is antihistamines. [ncbi.nlm.nih.gov]

  HFP is a common self limiting condition sharing features with that of allergy, such as flushing, urticaria, and palpitations. [emj.bmj.com]

  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

  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]

• Muscle Weakness

  Abdominal symptoms, pruritus, and muscle weakness with a history of consuming a fish-meal were diagnostic indicators of 'ciguatera fish poisoning.' All cases were industrial ship crewmembers. [ncbi.nlm.nih.gov]

  Nausea, vomiting, and abdominal cramps then develop, followed by muscle weakness. Untreated respiratory paralysis may be fatal; for survivors, recovery is usually complete. Drugs Mentioned In This Article Drug Name Select Trade OSMITROL, RESECTISOL [merckmanuals.com]

  Ciguatera fish poisoning causes nausea, vomiting, diarrhea, muscle weakness, joint aches, headache, dizziness, and low blood pressure. A characteristic symptom is "hot-cold reversal"; hot items feel cold and cold items feel hot. [poison.org]

  Symptoms may include: Numbness of lips and tongue Numbness of face and extremities Sensations of lightness or floating Headache Nausea and vomiting Abdominal pain Diarrhea Slurred speech Difficulty walking Extensive muscle weakness Convulsions Respiratory [hopkinsmedicine.org]

• Tingling

  BACKGROUND: Ciguatera-fish poisoning (or ciguatera) is a common but underdiagnosed food-borne illness related to fish consumption that is characterized by nausea, vomiting and neurologic symptoms such as tingling in the fingers or toes. [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]

• 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]

• Ataxia

  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]

  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 [symptoma.com]

  1997 Symptom Number of cases n = 30 % Gastrointestinal Diarrhoea 20 67 Abdominal Pain 14 47 Nausea 9 30 Vomiting 5 17 Neurological Paraesthesia of hands 26 87 Paraesthesia of feet 23 77 Hot/cold temperature reversal 19 63 Circumoral paraesthesia 17 57 Ataxia [health.gov.au]

• Convulsions

  The clinical features were generally dominated by convulsions and coma, with various focal neurological signs. [ncbi.nlm.nih.gov]

  Diaphoresis, excessive salivation, dysphagia, convulsions, hypotension, bradycardia, and fixed dilated pupils are other notable symptoms of pufferfish poisoning. [symptoma.com]

  Dizziness and tingling about the lips and tongue may soon be followed by muscular incoordination, convulsions, and respiratory paralysis. More than 60 percent of the cases are fatal within a few hours. [britannica.com]

  Symptoms may include: Numbness of lips and tongue Numbness of face and extremities Sensations of lightness or floating Headache Nausea and vomiting Abdominal pain Diarrhea Slurred speech Difficulty walking Extensive muscle weakness Convulsions Respiratory [hopkinsmedicine.org]

• Tremor

  Other neurotoxin videos include Preventing Parkinson’s Disease With Diet and Essential Tremor and Diet. In health, Michael Greger, M.D. [nutritionfacts.org]

  Food and Drug Administration says that too much mercury can cause: anxiety depression irritability memory problems numbness pathologic shyness tremors More often, mercury poisoning builds up over time. [healthline.com]

  Number of cases n = 30 % Gastrointestinal Diarrhoea 20 67 Abdominal Pain 14 47 Nausea 9 30 Vomiting 5 17 Neurological Paraesthesia of hands 26 87 Paraesthesia of feet 23 77 Hot/cold temperature reversal 19 63 Circumoral paraesthesia 17 57 Ataxia 11 37 Tremors [health.gov.au]

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]

1. Friedman MA, Fleming LE, Fernandez M, et al. Ciguatera Fish Poisoning: Treatment, Prevention and Management. Mar Drugs. 2008;6(3):456-479.
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.