Cigua Toxin Poisoning



Most Common Associated Fish Species in US

Fish Inspection and Toxin Stability





  • Mechanism: increases permeability of sodium channels, resulting in norepinephrine and acetlycholine release


  • Stool culture: negative

Clinical Manifestations

General Comments

  • Severity of illness is related to repeated exposures to toxin

Cardiovascular Manifestations

  • Hypotension (see Hypotension, [[Hypotension]]): systolic BP <80 occurs in only 2% of cases
  • Sinus Bradycardia (see Sinus Bradycardia, [[Sinus Bradycardia]]): HR <60 occurs in only 14% of cases

Gastroenterologic Manifestations (78% of cases)

  • General Comments
    • Onset: gastrointestinal symptoms begin min-24 hrs after ingestion
    • Duration: gastrointestinal symptoms last for 1-2 days
  • Hypersalivation (see Hypersalivation, [[Hypersalivation]])
  • Nausea/Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]]): 35-38% of cases
  • Abdominal Cramps (see Abdominal Pain, [[Abdominal Pain]]): 47-52% of cases
  • Watery Diarrhea (see Diarrhea, [[Diarrhea]]): 64-70% of cases

Neurologic Manifestations

  • Cranial Nerve Dysfunction
  • Reversal of Sensation of Hot and Cold (76-88%)
  • Parasthesias, Dysesthesias of Circumoral Region and Extremities: 66-89% of cases and 71-89% of cases, respectively
    • Exacerbated by ethanol consumption
  • Generalized/Localized Pruritus: 45-76% of cases
    • Exacerbated by ethanol consumption
  • Headache
  • Weakness
  • Dizziness
  • Looseness or pain in teeth: 25-37% of cases
  • Ataxia: 38-54% of cases
  • Vertigo: 42-45% of cases

Other Manifestations

  • Xerostomia
  • Myalgias/Arthralgias
  • Chills
  • Flushing: although fever is unusual
  • Dysuria (see Dysuria, [[Dysuria]]): 20% of cases
    • Exacerbated by sexual intercourse
  • Diaphoresis


  • Supportive: most cases are self-limited
  • Atropine: may be required for bradycardia
  • Mannitol infusion (1 g/kg IV over 30-45 min.): unclear mechanism of action, but best benefit is seen in first 24 hours after onset of symptoms
    • no controlled trials
  • Amitriptyline (25 mg BID): use-ful for long-term symptoms
    • May modulate sodium channels
  • Other: tocainide/ mexilitene/ nifedipine have been used with variable success
  • Prevention: avoid ingestion of fish from areas with “red tide” of plankton


  • Prognosis: case-fatality rate is 0.1%
  • Median duration of illness is 2-3 weeks (may last months-years)
  • Chronicity is predicted by more severe symptoms, long latency period, and longer duration of peak symptoms


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