{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:45:13Z","timestamp":1792802713165,"version":"4.5.0"},"reference-count":106,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2008,8,21]],"date-time":"2008-08-21T00:00:00Z","timestamp":1219276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Marine Drugs"],"abstract":"<jats:p>Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world, and it causes substantial physical and functional impact. It produces a myriad of gastrointestinal, neurologic and\/or cardiovascular symptoms which last days to weeks, or even months. Although there are reports of symptom amelioration with some interventions (e.g. IV mannitol), the appropriate treatment for CFP remains unclear to many physicians. We review the literature on the treatments for CFP, including randomized controlled studies and anecdotal reports. The article is intended to clarify treatment options, and provide information about management and prevention of CFP, for emergency room physicians, poison control information providers, other health care providers, and patients.<\/jats:p>","DOI":"10.3390\/md6030456","type":"journal-article","created":{"date-parts":[[2008,12,1]],"date-time":"2008-12-01T09:42:49Z","timestamp":1228124569000},"page":"456-479","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":248,"title":["Ciguatera Fish Poisoning: Treatment, Prevention and Management"],"prefix":"10.3390","volume":"6","author":[{"given":"Melissa","family":"Friedman","sequence":"first","affiliation":[{"name":"Mount Sinai Medical Center, Miami Beach, Florida 33140, USA"},{"name":"NSF NIEHS Oceans and Human Health Center, Rosenstiel School of Marine and Atmospheric Sciences, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lora","family":"Fleming","sequence":"additional","affiliation":[{"name":"NSF NIEHS Oceans and Human Health Center, Rosenstiel School of Marine and Atmospheric Sciences, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedes","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Carlos Albizu University, Miami, FL 33172, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Bienfang","sequence":"additional","affiliation":[{"name":"University of Hawaii, Honolulu, HI 96822, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Schrank","sequence":"additional","affiliation":[{"name":"University of Miami Department of Medicine\/Jackson Memorial Medical Center, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Dickey","sequence":"additional","affiliation":[{"name":"Food and Drug Administration, Division of Seafood Science and Technology, Center for Food Safety and Nutrition, Dauphin Island, AL 36528, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Yasmine","family":"Bottein","sequence":"additional","affiliation":[{"name":"NOAA-National Ocean Service, Center for Coastal Environmental Health and Biomolecular Research, Charleston, SC 29412, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine","family":"Backer","sequence":"additional","affiliation":[{"name":"National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram","family":"Ayyar","sequence":"additional","affiliation":[{"name":"University of Miami Department of Neurology, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Weisman","sequence":"additional","affiliation":[{"name":"Florida Poison Information Center, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Watkins","sequence":"additional","affiliation":[{"name":"Aquatic Toxins Program, Division of Environmental Health, Florida Department of Health, Tallahassee, FL 32399, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray","family":"Granade","sequence":"additional","affiliation":[{"name":"Food and Drug Administration, Division of Seafood Science and Technology, Center for Food Safety and Nutrition, Dauphin Island, AL 36528, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Reich","sequence":"additional","affiliation":[{"name":"Aquatic Toxins Program, Division of Environmental Health, Florida Department of Health, Tallahassee, FL 32399, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2008,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1136\/jnnp.70.1.4","article-title":"Neurology of ciguatera","volume":"70","author":"Pearn","year":"2001","journal-title":"J Neurol Neurosurg & Psych"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1136\/pgmj.75.889.678","article-title":"Ciguatera fish poisoning","volume":"75","author":"Crump","year":"1999","journal-title":"Postgrad Med J"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/15563659309000371","article-title":"Ciguatera","volume":"31","author":"Swift","year":"1993","journal-title":"J Toxicol - Clin Toxicol"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"584","DOI":"10.5694\/j.1326-5377.1986.tb139504.x","article-title":"Ciguatera in Australia. Occurrence, clinical features, pathophysiology and management","volume":"145","author":"Gillespie","year":"1986","journal-title":"Med J Austr"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/S0168-1605(00)00382-2","article-title":"Ciguatera: recent advances but the risk remains","volume":"61","author":"Lehane","year":"2000","journal-title":"Int J Food Microbiol"},{"key":"ref_6","first-page":"1","article-title":"ciguatera fish poisoning","volume":"1","author":"Fleming","year":"1997","journal-title":"Shoreman\u2019s Travel Medicine Monthly"},{"key":"ref_7","unstructured":"deWolff, FA (1995). Marine toxins, Elsevier Press."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/S0041-0101(00)00161-6","article-title":"The changing face of ciguatera","volume":"39","author":"Lewis","year":"2001","journal-title":"Toxicon"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1001\/jama.1980.03310030030021","article-title":"Ciguatera fish poisoning in Miami","volume":"244","author":"Lawrence","year":"1980","journal-title":"J Am Med Assoc"},{"key":"ref_10","unstructured":"McKee, D, Fleming, LE, Tamer, R, Weisman, R, and Blythe, DG (2001). Physician diagnosis and reporting of ciguatera fish poisoning in an endemic area. Harmful Algal Blooms, 451\u2013453."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1177\/003335490612100605","article-title":"Outbreak bias in illness reporting and case confirmation in ciguatera fish poisoning Surveillance in South Florida","volume":"121","author":"Begier","year":"2006","journal-title":"Pub Health Rep"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"88","DOI":"10.3390\/md403082","article-title":"Ciguatoxins: cyclic polyether modulators of voltage-gated ion channel function","volume":"4","author":"Nicholson","year":"2006","journal-title":"Mar Drugs"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"37","DOI":"10.3390\/md403037","article-title":"Marine toxins targeting ion channels","volume":"4","author":"Arias","year":"2006","journal-title":"Mar Drugs"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/0022-510X(91)90022-Y","article-title":"Electrophysiological studies on ciguatera poisoning in man (Part II)","volume":"101","author":"Cameron","year":"1991","journal-title":"J Neurol Sci"},{"key":"ref_15","first-page":"25","article-title":"Clinical aspects of ciguatera (fish poisoning) in French Polynesia","volume":"28","author":"Bagnis","year":"1968","journal-title":"Hawaii Med J"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.4269\/ajtmh.1979.28.1067","article-title":"Clinical observations on 3,009 cases of ciguatera (fish poisoning) in the South Pacific","volume":"28","author":"Bagnis","year":"1979","journal-title":"Am J Trop Med Hyg"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1146\/annurev.me.33.020182.000525","article-title":"Ciguatera fish poisoning","volume":"33","author":"Withers","year":"1982","journal-title":"Ann Rev Med"},{"key":"ref_18","unstructured":"Yasumoto, T, Raj, U, and Bagnis, R (1984). Symposium on Seafood Toxins from Tropical Regions, Tohoku University Japan."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Steidinger, K, and Baden, DG (1985). Toxic marine dinoflagellates, Academic Press.","DOI":"10.1016\/B978-0-12-656520-1.50011-0"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"423","DOI":"10.3109\/15563658708992645","article-title":"Treatment of ciguatera fish poisoning with amitriptyline and nifedipine","volume":"25","author":"Calvert","year":"1987","journal-title":"J Toxicol - Clin Toxicol"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/j.toxicon.2007.06.005","article-title":"Brevetoxins, like ciguatoxins, are potent ichthyotoxic neurotoxins that accumulate in fish","volume":"50","author":"Naar","year":"2007","journal-title":"Toxicon"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1038\/nature435755a","article-title":"Red tide and marine mammal mortalities","volume":"435","author":"Flewelling","year":"2005","journal-title":"Nature"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.acn.2007.03.003","article-title":"Neuropsychological study of ciguatera fish poisoning: A longitudinal case-control study","volume":"22","author":"Friedman","year":"2007","journal-title":"Arch Clin Neuropsychol"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.hal.2003.08.006","article-title":"A pilot study of the cognitive and psychological correlates of chronic ciguatera poisoning","volume":"3","author":"Arena","year":"2004","journal-title":"Harmful Algae"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/0041-0101(95)00164-6","article-title":"Ciguatera in Reunion Island (SW Indian Ocean): epidemiology and clinical patterns","volume":"34","author":"Quod","year":"1996","journal-title":"Toxicon"},{"key":"ref_26","unstructured":"Gopalakrishnakone, P, and Tan, CK (1987). Progress in venom and toxin research, National University of Singapore."},{"key":"ref_27","first-page":"11","article-title":"Ciguatera management","volume":"7","author":"Lewis","year":"2000","journal-title":"SPC Live Reef Fish Information Bulletin"},{"key":"ref_28","unstructured":"Falconer, I (1993). Algal toxins in seafood and drinking water, Academic Press."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"842","DOI":"10.4269\/ajtmh.2007.77.842","article-title":"Prevalence of chronic symptoms of ciguatera disease in French Polynesian adults","volume":"77","author":"Chinain","year":"2007","journal-title":"Am J Trop Med Hyg"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/0041-0101(89)90121-9","article-title":"Variations in symptomatology of ciguatera poisoning","volume":"27","author":"Kodama","year":"1989","journal-title":"Toxicon"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1191\/096032701682692928","article-title":"Chronicity of neurological features in ciguatera fish poisoning","volume":"20","author":"Chan","year":"2001","journal-title":"Hum Exp Toxicol"},{"key":"ref_32","first-page":"425","article-title":"Clinical experience with i.v. Mannitol in the treatment of ciguatera","volume":"85","author":"Blythe","year":"1992","journal-title":"Bull Soc Pathol Exotique"},{"key":"ref_33","first-page":"33","article-title":"Reversal of Pacific ciguatoxin-1B effects on myelinated axons by agents used in ciguatera treatment","volume":"24","author":"Benoit","year":"2000","journal-title":"Cybium"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/0035-9203(93)90428-S","article-title":"Life-threatening bradycardia and hypotension in a patient with ciguatera fish poisoning","volume":"87","author":"Chan","year":"1993","journal-title":"Trans Roy Soc Trop Med Hyg"},{"key":"ref_35","unstructured":"Ruff, RL, and Lewis, J (1994). Clinical aspects of ciguatera: an overview. Memoirs of the Queensland Museum, 609\u2013619."},{"key":"ref_36","first-page":"419","article-title":"Study of factors that influence the clinical response to ciguatera fish poisoning","volume":"85","author":"Glaziou","year":"1992","journal-title":"Bull Soc Pathol Exotique"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1097\/00063110-200112000-00009","article-title":"Ciguatera poisoning: a global issue with common management problems","volume":"8","author":"Ting","year":"2001","journal-title":"Europ J Emerg Med"},{"key":"ref_38","first-page":"89","article-title":"[Neurologic complications of ciguatera]","volume":"70","author":"Bagnis","year":"1977","journal-title":"Bull Soc Pathol Exotique"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.toxicon.2005.03.014","article-title":"Biomonitoring of ciguatoxin exposure in mice using blood collection cards","volume":"46","author":"Wang","year":"2005","journal-title":"Toxicon"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.toxicon.2006.10.002","article-title":"Optimization of ciguatoxin extraction method from blood for Pacific ciguatoxin (P-CTX-1)","volume":"49","author":"Wang","year":"2007","journal-title":"Toxicon"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.neuro.2007.05.013","article-title":"Transcriptional profiling of whole blood and serum protein analysis of mice exposed to the neurotoxin Pacific Ciguatoxin-1","volume":"28","author":"Ryan","year":"2007","journal-title":"NeuroToxicol"},{"key":"ref_42","unstructured":"Stinn, JF, de Sylva, DP, Fleming, LE, and Hack, E (,  2000). San Diego, CA."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1002\/(SICI)1522-7189(199907\/08)7:4<157::AID-NT52>3.0.CO;2-#","article-title":"Monitoring brevetoxins during a Gymnodinium breve red tide: comparison of sodium channel specific cytotoxicity assay and mouse bioassay for determination of neurotoxic shellfish toxins in shellfish extracts","volume":"7","author":"Dickey","year":"1999","journal-title":"Nat Toxins"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1093\/jaoac\/78.2.521","article-title":"Detection of sodium channel toxins: directed cytotoxicity assays of purified ciguatoxins, brevetoxins, saxitoxins, and seafood extracts","volume":"78","author":"Manger","year":"1995","journal-title":"J AOAC Int"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Botana, LM (2008). Seafood and Freshwater Toxins: Pharmacology, Physiology, and Detection, Taylor and Francis (CRC Press). [2].","DOI":"10.1201\/9781420007541"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0041-0101(98)00169-X","article-title":"Ciguatoxins and brevetoxins, neurotoxic polyether compounds active on sodium channels","volume":"37","author":"Dechraoui","year":"1999","journal-title":"Toxicon"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.toxicon.2005.04.006","article-title":"Use of two detection methods for discriminating ciguatoxins from brevetoxins: application to Great Barracuda from Florida","volume":"46","author":"Tiedeken","year":"2005","journal-title":"Toxicon"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.toxicon.2003.09.004","article-title":"Identification of slow and fast-acting toxins in highly ciguatoxic barracuda (Sphyraene barracuda) by HPLC\/MS and radiolabelled ligand binding","volume":"42","author":"Pottier","year":"2003","journal-title":"Toxicon"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/S0041-0101(02)00146-0","article-title":"Multiple ciguatoxins present in Indian Ocean reef fish","volume":"40","author":"Hamilton","year":"2002","journal-title":"Toxicon"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/0014-5793(87)80252-1","article-title":"Ciguatoxin and brevetoxins share a common receptor site on the neuronal voltage-dependent Na+ channel","volume":"219","author":"Lombet","year":"1987","journal-title":"FEBS Lett"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.toxicon.2007.05.007","article-title":"Ciguatera risk assessment in two toxic sites of French Polynesia using the receptor-binding assay","volume":"50","author":"Darius","year":"2007","journal-title":"Toxicon"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1021\/ac980598h","article-title":"HPLC\/tandem electrospray mass spectrometry for the determination of Sub-ppb levels of Pacific and Caribbean ciguatoxins in crude extracts of fish","volume":"71","author":"Lewis","year":"1999","journal-title":"Anal Chem"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/S0041-0101(01)00259-8","article-title":"Isolation and characterisation of Indian Ocean ciguatoxin","volume":"40","author":"Hamilton","year":"2002","journal-title":"Toxicon"},{"key":"ref_54","unstructured":"Hallegraeff, GM, Anderson, DM, and Cembella, AD (2004). Manual on harmful marine microalgae, UNESCO. IOC Manuals and Guides No. 33."},{"key":"ref_55","first-page":"1","article-title":"Simplified solid-phase membrane immunobead assay (MIA) with monoclonal anti-ciguatoxin antibody (MAb-CTX) for detection of ciguatoxin and related polyether toxins","volume":"7","author":"Hokama","year":"1998","journal-title":"J Nat Tox"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.toxicon.2005.06.023","article-title":"Study of an outbreak of ciguatera fish poisoning in Hong Kong","volume":"46","author":"Wong","year":"2005","journal-title":"Toxicon"},{"key":"ref_57","first-page":"481","article-title":"Evaluation of a solid-phase immunobead assay for detection of ciguatera-related biotoxins in Caribbean finfish","volume":"34","author":"Dickey","year":"1994","journal-title":"Memoirs of the Queensland Museum"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1904","DOI":"10.1126\/science.1065757","article-title":"Total synthesis of ciguatoxin CTX3C","volume":"294","author":"Hirama","year":"2001","journal-title":"Science"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"4380","DOI":"10.1021\/ja00167a040","article-title":"Structures and configurations of ciguatoxin from the moray eel Gymnothorax javanicus and its likely precursor from the dinoflagellate Gambierdiscus toxicus","volume":"112","author":"Murata","year":"1990","journal-title":"J Am Chem Soc"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"8929","DOI":"10.1021\/ja00206a032","article-title":"Structures of ciguatoxin and its congener","volume":"111","author":"Murata","year":"1989","journal-title":"J Am Chem Soc"},{"key":"ref_61","first-page":"6827","article-title":"Improvements in the Sensitivity of Inverse-Detected Heteronuclear Correlation Spectra Using Micro Inverse Probes and Micro Cells: HMQC and HMBC Spectra of Caribbean Ciguatoxin -- Preliminary Structural Inferences","volume":"36","author":"Crouch","year":"1995","journal-title":"Tetrahedron Lett"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/S0041-0101(96)00191-2","article-title":"Isolation and characterisation of Caribbean ciguatoxins from the horse-eye jack (Caranx latus)","volume":"35","author":"Vernoux","year":"1997","journal-title":"Toxicon"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/0041-0101(91)90209-A","article-title":"Purification and characterization of ciguatoxins from moray eel (Lycodontis javanicus, Muraenidae)","volume":"29","author":"Lewis","year":"1991","journal-title":"Toxicon"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1212\/WNL.58.6.873","article-title":"Ciguatera fish poisoning: a double-blind randomized trial of mannitol therapy","volume":"58","author":"Schnorf","year":"2002","journal-title":"Neurology"},{"key":"ref_65","first-page":"67","article-title":"[Evaluation of the efficacy of mannitol in the treatment of ciguatera in French Polynesia]","volume":"52","author":"Bagnis","year":"1992","journal-title":"Med Tropicale"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Hui, YH, Kitts, D, and Stanfield, PS (2001). Foodborne Disease Handbook, Marcel Dekker.","DOI":"10.1201\/9781482289954"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2740","DOI":"10.1001\/jama.1988.03720180066035","article-title":"Successful treatment of ciguatera fish poisoning with intravenous mannitol","volume":"259","author":"Palafox","year":"1988","journal-title":"J Am Med Assoc"},{"key":"ref_68","unstructured":"Blythe, DG, Fleming, LE, Ayyar, RA, de Sylva, DP, Baden, DG, and Shrank, K (1994). Mannitol Therapy for acute and chronic ciguatera fish poisoning. Memoirs of the Queensland Museum, 34."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.neuropharm.2005.04.024","article-title":"Neuroprotectant effects of iso-osmolar d-mannitol to prevent Pacific ciguatoxin-1 induced alterations in neuronal excitability: A comparison with other osmotic agents and free radical scavengers","volume":"49","author":"Davies","year":"2005","journal-title":"Neuropharmacol"},{"key":"ref_70","unstructured":"Williamson, JA, Fenner, PJ, Burnett, JW, and Rifkin, JF (1996). Ciguatera (fish poisoning), University of New South Wales Press."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"77","DOI":"10.5694\/j.1326-5377.1989.tb101165.x","article-title":"Ciguatera and mannitol: experience with a new treatment regimen","volume":"151","author":"Pearn","year":"1989","journal-title":"Medical Journal of Australia"},{"key":"ref_72","unstructured":"Botana, LM (2007). Marine neurotoxins as a starting point to drugs, Taylor and Francis (CRC Press)."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"567","DOI":"10.5694\/j.1326-5377.1992.tb137364.x","article-title":"Symptomatic improvement of chronic fatigue with fluoxetine in ciguatera fish poisoning","volume":"157","author":"Berlin","year":"1992","journal-title":"Med J Austr"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1001\/archinte.1992.00400220075013","article-title":"Travel and ciguatera fish poisoning","volume":"152","author":"Lange","year":"1992","journal-title":"Arch Int Med"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1056\/NEJM198607033150115","article-title":"Symptomatic improvement with amitriptyline in ciguatera fish poisoning","volume":"315","author":"Davis","year":"1986","journal-title":"New Engl J Med"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1056\/NEJM200103013440919","article-title":"Treatment of ciguatera poisoning with gabapentin","volume":"344","author":"Perez","year":"2001","journal-title":"New Engl J Med"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/0378-8741(92)90017-L","article-title":"Traditional remedies used in the western Pacific for the treatment of ciguatera poisoning","volume":"36","author":"Bourdy","year":"1992","journal-title":"J Ethnopharmacol"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1001\/jama.1990.03450160042019","article-title":"Mother\u2019s milk turns toxic following fish feast","volume":"264","author":"Blythe","year":"1990","journal-title":"J Am Med Assoc"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"193","DOI":"10.3109\/15563658909038583","article-title":"Can ciguatera be a sexually transmitted disease?","volume":"27","author":"Lange","year":"1989","journal-title":"J Toxicol - Clin Toxicol"},{"key":"ref_80","first-page":"177","article-title":"Ciguatera toxicity","volume":"35","author":"Lange","year":"1987","journal-title":"Am Fam Phys"},{"key":"ref_81","unstructured":"Lewis, R, Jones, A, and Vernoux, J (,  1999). Noumea, New Caledonia."},{"key":"ref_82","unstructured":"Ebesu, J (1998). Isolation and Characterization of Novel Ciguateric Compounds from Acanthurus Triostegus (Manini), University of Hawaii. Ph.D. Thesis."},{"key":"ref_83","first-page":"631","article-title":"Ciguatera in the French West Indies","volume":"34","author":"Vernoux","year":"1993","journal-title":"Memoires of the Queensland Museum"},{"key":"ref_84","unstructured":"Reguera, B, Blanco, J, Fernandez, ML, and Wyatt, T (1998). Sea surface temperature, benthic dinoflagellate toxicity and toxin transmission in the ciguatera food web, Xunta de Galicia and IOC."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.hal.2006.08.008","article-title":"Petroleum production platforms as sites for the expansion of ciguatera in the northwestern Gulf of Mexico","volume":"6","author":"Villareal","year":"2007","journal-title":"Harmful Algae"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1577\/1548-8659(1988)117<0374:CTAAPF>2.3.CO;2","article-title":"Ciguatera toxins adversely affect piscivorous fishes","volume":"117","author":"Davin","year":"1988","journal-title":"Trans Am Fish Soc"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1577\/1548-8659(1986)115<908:EOCTOT>2.0.CO;2","article-title":"Effects of ciguatera toxins on the bluehead","volume":"115","author":"Davin","year":"1986","journal-title":"Trans Am Fish Soc"},{"key":"ref_88","unstructured":"B Reguera, JB, Fernandez, ML, and Wyatt, T (1998). Harmful Algae, Xunta de Galicia and Intergovernmental Oceanographic Commission of UNESCO."},{"key":"ref_89","unstructured":"Kirkpatrick, B, Fleming, LE, Stephan, W, Backer, L, Reich, A, Dalpra, D, Weisman, R, and Van De Bogart, G (, January Nov). Cape Town, South Africa."},{"key":"ref_90","unstructured":"Fleming, LE, Jerez, E, Stephan, W, Cassedy, A, Bean, JA, Reich, A, Kirkpatrick, B, Backer, L, Nierenberg, K, Watkins, S, and Weisman, R (2007). Florida poison information center, University of Miami; Florida Department of Health; CDC; Childrens Hospital Cincinnati; Mote Marine Laboratory."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.marpolbul.2006.08.012","article-title":"Oceans and human health: Emerging public health risks in the marine environment","volume":"53","author":"Fleming","year":"2006","journal-title":"Mar Poll Bull"},{"key":"ref_92","unstructured":"Walsh, PJ, Smith, SL, Fleming, LE, Solo Gabriele, H, and Gerwick, WH Oceans and Human Health: Risks and Remedies from the Sea, Elsevier Science Publishers. in press."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"208","DOI":"10.3390\/md504208","article-title":"Evaluation of Harmful Algal Bloom Outreach Activities","volume":"5","author":"Fleming","year":"2007","journal-title":"Mar Drugs"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.toxicon.2006.05.014","article-title":"Production of monoclonal antibodies for sandwich immunoassay detection of ciguatoxin 51-hydroxyCTX3C","volume":"48","author":"Tsumuraya","year":"2006","journal-title":"Toxicon"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1289\/ehp.7498","article-title":"Effects of inhaled brevetoxins in allergic airways: toxin-allergen interactions and pharmacologic intervention","volume":"113","author":"Abraham","year":"2005","journal-title":"Environ Health Perspect"},{"key":"ref_96","first-page":"326","article-title":"The epidemiology of ciguatera fish poisoning in Hawaii, 1975\u20131981","volume":"42","author":"Anderson","year":"1983","journal-title":"Hawaii Med J"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1001\/archinte.1982.00340190046008","article-title":"Clinical features of ciguatera fish poisoning: a study of the disease in the US Virgin Islands","volume":"142","author":"Morris","year":"1982","journal-title":"Arch Int Med"},{"key":"ref_98","first-page":"315","article-title":"[Epidemiology of Ciguatera in the Iles Saintes (Guadeloupe)]","volume":"32","author":"Czernichow","year":"1984","journal-title":"Rev Epidemiol Sante Pub"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/0277-9536(86)90255-8","article-title":"Disease and development: ciguatera fish poisoning","volume":"23","author":"Lewis","year":"1986","journal-title":"Soc Sci Med"},{"key":"ref_100","unstructured":"Luber, G, Azziz-Baumgartner, E, Latka, R, Monteihl, C, Conklin, L, and Backer, L Surveillance for ciguatera fish poisoning in Culebra, Puerto Rico. (in press)."},{"key":"ref_101","first-page":"84","article-title":"Ciguatera fish poisoning in the United States Virgin Islands: preliminary studies","volume":"6","author":"McMillan","year":"1980","journal-title":"J Coll Virgin Is"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"177","DOI":"10.3109\/15563658408992553","article-title":"An analysis of poison control center reports of ciguatera toxicity in Puerto Rico for one year","volume":"22","author":"Holt","year":"1984","journal-title":"J Toxicol - Clin Toxicol"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1093\/infdis\/158.5.1128","article-title":"A large common-source outbreak of ciguatera fish poisoning","volume":"158","author":"Frennette","year":"1988","journal-title":"J Infect Dis"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"336","DOI":"10.7326\/0003-4819-98-3-336","article-title":"Ciguatera fish poisoning: a major common-source outbreak in the U.S. Virgin Islands","volume":"98","author":"Engleberg","year":"1983","journal-title":"Ann Int Med"},{"key":"ref_105","unstructured":"Escalona de Motta, G, and De la Noceda, GG (,  1985). Tahiti (French Polynesia)."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.4269\/ajtmh.2007.77.1170","article-title":"Neurologic signs of ciguatera disease: evidence of their persistence","volume":"77","author":"Beuter","year":"2007","journal-title":"Am J Trop Med Hyg"}],"container-title":["Marine Drugs"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-3397\/6\/3\/456\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T13:28:01Z","timestamp":1770816481000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-3397\/6\/3\/456"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,8,21]]},"references-count":106,"aliases":["10.3390\/md20080022"],"journal-issue":{"issue":"3","published-online":{"date-parts":[[2008,9]]}},"alternative-id":["md6030456"],"URL":"https:\/\/doi.org\/10.3390\/md6030456","relation":{},"ISSN":["1660-3397"],"issn-type":[{"value":"1660-3397","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,8,21]]}}}