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This illness is caused by eating contaminated tropical reef fish such as barracuda, grouper, sea bass, snapper, mullet, and a number of other fish that live in equatorial waters. The toxin that causes it becomes progressively concentrated as it moves up the food chain from small fish to large fish that eat them, and reach particularly high concentrations in large predatory tropical reef fish.
What is ciguatera poisoning?
Ciguatoxins that cause ciguatera poisoning are actually produced by microscopic sea plants called dinoflagellates.
Symptoms occur within a few minutes to 30 hours after eating contaminated fish, and occasionally it may take up to 6 hours. Common nonspecific symptoms include nausea, vomiting, diarrhea, cramps, excessive sweating, headache, and muscle aches. The sensation of burning or "pins-and-needles," weakness, itching, and dizziness can occur. Patients may experience reversal of temperature sensation in their mouth (hot surfaces feeling cold and cold, hot), unusual taste sensations, nightmares, or hallucinations. Ciguatera poisoning is rarely fatal. Symptoms usually clear in 1 to 4 weeks.