An updated review of ciguatera fish poisoning: Clinical, epidemiological, environmental, and public health management

Melissa A. Friedman, Mercedes Fernandez, Lorraine C. Backer, Robert W. Dickey, Jeffrey Bernstein, Kathleen Schrank, Steven Kibler, Wendy Stephan, Matthew O. Gribble, Paul Bienfang, Robert E. Bowen, Stacey Degrasse, Harold A.Flores Quintana, Christopher R. Loeffler, Richard Weisman, Donna Blythe, Elisa Berdalet, Ram Ayyar, Danielle Clarkson-Townsend, Karen SwajianRonald Benner, Tom Brewer, Lora E Fleming

Research output: Contribution to journalReview articlepeer-review

151 Scopus citations


Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs), diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future directions, and recommendations for clinicians and patients. It updates and expands upon the previous review of CFP published by Friedman et al. (2008) and addresses new insights and relevant emerging global themes such as climate and environmental change, international market issues, and socioeconomic impacts of CFP. It also provides a proposed universal case definition for CFP designed to account for the variability in symptom presentation across different geographic regions. Information that is important but unchanged since the previous review has been reiterated. This article is intended for a broad audience, including resource and fishery managers, commercial and recreational fishers, public health officials, medical professionals, and other interested parties.

Original languageEnglish (US)
Article number72
JournalMarine Drugs
Issue number3
StatePublished - Mar 2017


  • Algae
  • Ciguatera fish poisoning
  • Ciguatoxin
  • Climate change
  • Diagnosis
  • Environmental change
  • Food poisoning
  • Gambierdiscus
  • Harmful algal bloom
  • Human health
  • Natural toxins
  • Neurology
  • Neuropsychology
  • Neurotoxin
  • Seafood poisoning
  • Treatment

ASJC Scopus subject areas

  • Drug Discovery


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