Intensive Care Unit, Martinique University Hospital, 97261 Fort-de-France, Martinique, France.
Intensive Care Unit, Cayenne General Hospital, 97300 Cayenne, French Guiana, France.
Toxins (Basel). 2022 Aug 3;14(8):535. doi: 10.3390/toxins14080535.
Ciguatera poisoning (CP) is one of the most common causes worldwide of marine poisoning associated with fish consumption from tropical areas. Its incidence is underreported. CP cases seem to increase with grouped cases reported during summer. Exposure to ciguatoxins, toxins responsible for CP with sodium-channel agonistic, voltage-gated potassium channel blocking, cholinergic, and adrenergic activities, may result in a large spectrum of manifestations. We aimed to describe the clinical characteristics, management, and outcome of CP in Martinique, French West Indies. We conducted an observational retrospective single-center study during six years (October 2012 to September 2018) including all CP patients managed by the prehospital medical services, admitted to the university hospital emergency department, or declared to the regional health agency. A total of 149 CP patients (81 females/63 males; median age, 46 years (interquartile range, 34-61)) were included. Acute features consisted in general (91%; mainly, myalgia pruritus, and asthenia), gastrointestinal (90%; mainly diarrhea, abdominal pain, and nausea), neurological (72%; mainly, paresthesia, dysgeusia, and impairment of hot/cold feeling), and cardiovascular manifestations (22%; bradycardia, hypotension, and heart conduction disorders). Management was supportive. No patient died but symptoms persisted in 40% of the 77 patients with follow-up at day 15. CP was mainly attributed to the ingestion of trevallies (59%), snappers (13%), and king mackerels (8%) with collective contaminations (71%). Unusual fish (tuna, salmon, and spider conchs) were suspected in rare cases. Ingestion of trevallies was associated with significantly higher persistent symptoms (odds ratio, 3.00; 95% confidence interval, (1.20-8.00); = 0.03). CP incidence was 0.67 cases per 10,000 patient-years in Martinique over the study period. To conclude, CP represents an increasing public health issue in Martinique, as is the case in other Caribbean islands. Patients present usual but possibly life-threatening features. Outcome is excellent despite frequently prolonged manifestations.
雪卡毒素中毒（CP）是全球最常见的与热带地区鱼类消费相关的海洋中毒原因之一。其发病率被低估。CP 病例似乎随着夏季报告的群组病例而增加。接触雪卡毒素会导致 CP，雪卡毒素具有钠通道激动剂、电压门控钾通道阻断剂、胆碱能和肾上腺素能活性。它可能导致一系列广泛的表现。我们旨在描述法属西印度群岛马提尼克岛的 CP 的临床特征、管理和结果。我们进行了一项为期六年的观察性回顾性单中心研究（2012 年 10 月至 2018 年 9 月），包括由院前医疗服务、大学医院急诊部收治或向地区卫生局报告的所有 CP 患者。共纳入 149 例 CP 患者（81 例女性/63 例男性；中位年龄 46 岁[四分位距 34-61 岁]）。急性特征主要包括全身（91%；主要为肌痛、瘙痒和乏力）、胃肠道（90%；主要为腹泻、腹痛和恶心）、神经（72%；主要为感觉异常、味觉障碍和冷热感觉障碍）和心血管表现（22%；心动过缓、低血压和心脏传导障碍）。管理是支持性的。没有患者死亡，但在 77 例有随访的患者中，有 40%的患者在第 15 天仍有症状。CP 主要归因于食用鲷鱼（59%）、鲷鱼（13%）和鲭鱼（8%），伴有集体污染（71%）。在罕见情况下，怀疑食用了不常见的鱼类（金枪鱼、三文鱼和蜘蛛螺）。鲷鱼的摄入与持续性症状显著相关（优势比，3.00；95%置信区间，（1.20-8.00）； = 0.03）。在研究期间，马提尼克岛的 CP 发病率为每 10000 患者年 0.67 例。总之，CP 在马提尼克岛是一个日益严重的公共卫生问题，在其他加勒比岛屿也是如此。患者出现常见但可能危及生命的特征。尽管经常出现持续时间延长的表现，但预后良好。
