ABSTRACT
Ciguatera is an illness most often presenting as an acute multisystem, multisymptom syndrome acquired rapidly following consumption of piscivorous, reef-dwelling fish. A longstanding tenet regarding causation of acute ciguatera is the toxicological opinion that confirmation of exposure demands identification of ciguatoxin in fish flesh. Acute ciguatera is not likely to be seen inland, certainly not in most medical school clinics, although it is worthy of maybe 5 minutes of discussion in a medical school lecture on sodium channel toxins. If the acute, explosive onset of a gastrointestinal and neurologic illness might arouse suspicion of acute ciguatera, the treating physician must examine other possible explanations as part of differential diagnosis, including a viral syndrome or heat exposure. The chapter reports acute ciguatera acquired following consumption of shellfish. It notes possible risk of longer-term illness from acute ciguatera and does not address the observance of increased neurologic injury with repeated bouts of acute illness.
