Friedemann Miriam
Dokumentation und Bewertung von Vergiftungen, Bundesinstitut für Risikobewertung (BfR), Diedersdorfer Weg 1, 12277, Berlin, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016 Dec;59(12):1556-1565. doi: 10.1007/s00103-016-2456-y.
In November 2012, 23 cases of ciguatera with typical combinations of gastrointestinal and neurological symptoms occurred in Germany after consumption of imported tropical fish (Lutjanus spp.). A questionnaire was used to gather information on the disease course and fish consumption. All patients suffered from pathognomonic cold allodynia. Aside from two severe courses of illness, all other cases showed symptoms of moderate intensity. During a three-year follow-up, seven patients reported prolonged paresthesia for more than one year. Two of them reported further neuropathies over almost three years. This is the first time that long-term persistence of symptoms has been documented in detail. Outbreak cases were allocated to eight clusters in seven German cities. A further cluster was prevented by the successful recall of ciguatoxic fish. Three clusters were confirmed by the detection of ciguatoxin in samples of suspicious and recalled fish. An extrapolation on the basis of ciguatoxic samples revealed twenty prevented cases of ciguatera. Further officially unknown cases should be assumed. During the outbreak investigations, inadvertently falsely labelled fish species and fishing capture areas on import and retail level documents were observed. The ascertainment of cases and the outbreak investigations proved to be difficult due to inconsistent case reports to poisons centers, local health and veterinary authorities. In Germany, many physicians are unaware of the disease pattern of ciguatera and the risks caused by tropical fish. The occurrence of further outbreaks during the following years emphasizes the increasing significance of ciguatera in Germany.
2012年11月，德国有23例食用进口热带鱼（笛鲷属）后出现典型胃肠道和神经症状组合的雪卡毒素中毒病例。通过问卷调查收集疾病病程和鱼类食用情况的信息。所有患者均患有特征性的冷觉异常。除两例病情严重外，其他所有病例症状强度均为中度。在为期三年的随访中，7名患者报告感觉异常持续时间超过一年。其中两人报告近三年出现进一步的神经病变。这是首次详细记录症状的长期持续情况。疫情病例分布在德国七个城市的八个群组中。通过成功召回含雪卡毒素的鱼类，预防了另一个群组。通过在可疑和召回鱼类样本中检测到雪卡毒素，证实了三个群组。根据含雪卡毒素样本进行推断，发现有20例雪卡毒素中毒病例得到预防。应该假定还有其他官方未知的病例。在疫情调查过程中，发现进口和零售层面文件上鱼类物种和捕捞区域标签存在无意的错误标注。由于向毒物中心、地方卫生和兽医当局报告的病例不一致，病例的确定和疫情调查证明很困难。在德国，许多医生不了解雪卡毒素中毒的疾病模式以及热带鱼造成的风险。随后几年进一步疫情的发生凸显了雪卡毒素中毒在德国日益增加的重要性。
