ABSTRACT
Ciguatoxin is a lipid-soluble, heat-resistant, acid-stable, nonprotein toxin that is produced by a single-celled, free-swimming marine dinoflagellate of the species Gambierdiscus toxicus. Management of chronic ciguatera fish poisoning has been a difficult problem. Tetrodotoxin is a naturally occurring toxin found in a variety of animals; the most notable is the pufferfish. Saxitoxin, neosaxitoxin, and gonyatoxin are heat-resistant, water-soluble neurotoxins found in shellfish contaminated with dinoflagellates. Differential diagnosis includes ciguatera intoxication and paralytic shellfish poisoning. Brevetoxin is a lipid-soluble, heat-stable neurotoxin found in shellfish contaminated by the dinoflagellate Ptychodiscus brevis. Brevetoxin stimulates postganglionic cholinergic nerve fibers and sodium channels and inhibits neuromuscular transmission in skeletal muscle. Most often diagnosed as a fish allergy, scombroid intoxication is becoming a significant form of seafood poisoning. The prevention of reintoxication is an important consideration because a small amount of toxin can cause exacerbation of the disease.
