Ciguatera toxicity.

Ciguatera poisoning is the most common foodborne illness caused by a chemical toxin in the United States and is endemic in the Caribbean and Indo-Pacific. Ciguatoxin, produced by a marine dinoflagellate that attaches to algae, is passed up the food chain to large fish and, finally, to humans. The toxin has anticholinesterase activity. The clinical picture is characterized by a variety of gastrointestinal, neurologic and cardiovascular symptoms, usually self-limited. Amitriptyline is reported to be beneficial.