Ciguatera fish poisoning--Texas, 1998, and South Carolina, 2004.

Ciguatera fish poisoning is characterized by gastrointestinal symptoms such as nausea, vomiting, and diarrhea and neurologic symptoms such as weakness, tingling, and pruritus (itching). The condition is caused by eating fish containing toxins produced by the dinoflagellate Gambierdiscus toxicus, a one-celled plantlike organism that grows on algae in tropical waters worldwide. Because these toxins are lipid soluble, they accumulate through the food chain as carnivorous fish consume contaminated herbivorous reef fish; toxin concentrations are highest in large, predatory fish such as barracuda, grouper, amberjack, snapper, and shark. Because fish caught in ciguatera-endemic areas are shipped nationwide, ciguatera fish poisoning can occur anywhere in the United States. This report describes ciguatera fish poisoning in four persons (two in 1998, two in 2004) who ate fish caught by recreational fishers in waters outside of ciguatera-endemic areas (e.g., the Caribbean Sea and the Atlantic and Gulf Coast waters off southern Florida). These cases underscore the need for physicians, regardless of whether they are in a ciguatera-endemic area, to consider ciguatera in patients who have gastrointestinal or neurologic symptoms after eating large, predatory fish.