ID Case Conference January 9, 2008. Carlos M. Perez, MD, FACP Associate Professor of Medicine Pontificia Universidad Catolica de Chile. Case 1 & 2.
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Carlos M. Perez, MD, FACP
Associate Professor of Medicine
Pontificia Universidad Catolica de Chile
How they got it?
Because they ate Dusky grouper (“Mero”)
Initial treatment of ciguatera is supportive. Multiple uncontrolled trials have found that intravenous mannitol, given at a dose of 1 g/kg, reduces neurologic symptoms when given within the first 48 hours.
See Abstract for Palafox, NA, Jain, LG, Pinano, AZ, et al. Successful treatment of ciguatera fish poisoning with intravenous mannitol. JAMA 1988; 259;2740
Amitriptyline and fluoxetine have been reported to benefit ciguatera patients suffering from chronic fatigue, insomnia, and depression. Gabapentin was reported to improve polyneuropathic symptoms in two patients, but it is an expensive therapy.
See Blythe, DG, Hack E, Washington, G. The medical management of seafood poisoning. Foodborne Disease Handbook: Seafood and Environmental Toxins (vol. 4)