{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T01:19:36Z","timestamp":1781227176065,"version":"3.54.1"},"reference-count":80,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2018,2,28]],"date-time":"2018-02-28T00:00:00Z","timestamp":1519776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Ciguatera fish poisoning (CFP) is the most prevalent non-bacterial food-borne form of poisoning in French Polynesia, which results from the consumption of coral reef fish naturally contaminated with ciguatoxins produced by dinoflagellates in the genus Gambierdiscus. Since the early 2000s, this French territory has also witnessed the emergence of atypical forms of ciguatera, known as ciguatera shellfish poisoning (CSP), associated with the consumption of marine invertebrates. In June 2014, nine tourists simultaneously developed a major and persistent poisoning syndrome following the consumption of the gastropod Tectus niloticus collected in Anaho, a secluded bay of Nuku Hiva Island (Marquesas Archipelago, French Polynesia). The unusual nature and severity of this event prompted a multidisciplinary investigation in order to characterize the etiology and document the short\/long-term health consequences of this mass-poisoning event. This paper presents the results of clinical investigations based on hospital medical records, medical follow-up conducted six and 20 months post-poisoning, including a case description. This study is the first to describe the medical signature of T. niloticus poisoning in French Polynesia and contributed to alerting local authorities about the potential health hazards associated with the consumption of this gastropod, which is highly prized by local communities in Pacific island countries and territories.<\/jats:p>","DOI":"10.3390\/toxins10030102","type":"journal-article","created":{"date-parts":[[2018,2,28]],"date-time":"2018-02-28T12:54:12Z","timestamp":1519822452000},"page":"102","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Tectus niloticus (Tegulidae, Gastropod) as a Novel Vector of Ciguatera Poisoning: Clinical Characterization and Follow-Up of a Mass Poisoning Event in Nuku Hiva Island (French Polynesia)"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5858-1731","authenticated-orcid":false,"given":"Cl\u00e9mence","family":"Gatti","sequence":"first","affiliation":[{"name":"Laboratory of Toxic Microalgae, Institut Louis Malard\u00e9 (ILM)\u2014UMR 241-EIO, P.O. box 30, 98713 Papeete, Tahiti, French Polynesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Lonati","sequence":"additional","affiliation":[{"name":"Poison Control Centre and National Toxicology Information Centre\u2014Toxicology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Maugeri Hospital and University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1184-7034","authenticated-orcid":false,"given":"H\u00e9l\u00e8ne","family":"Darius","sequence":"additional","affiliation":[{"name":"Laboratory of Toxic Microalgae, Institut Louis Malard\u00e9 (ILM)\u2014UMR 241-EIO, P.O. box 30, 98713 Papeete, Tahiti, French Polynesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arturo","family":"Zancan","sequence":"additional","affiliation":[{"name":"Subacute Care Unit, Istituti Clinici Scientifici Maugeri, IRCCS Maugeri Hospital, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7503-4633","authenticated-orcid":false,"given":"M\u00e9lanie","family":"Rou\u00e9","sequence":"additional","affiliation":[{"name":"Institut de Recherche pour le D\u00e9veloppement (IRD)\u2014UMR 241-EIO, P.O. box 529, 98713 Papeete, Tahiti, French Polynesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azzurra","family":"Schicchi","sequence":"additional","affiliation":[{"name":"Poison Control Centre and National Toxicology Information Centre\u2014Toxicology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Maugeri Hospital and University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Locatelli","sequence":"additional","affiliation":[{"name":"Poison Control Centre and National Toxicology Information Centre\u2014Toxicology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Maugeri Hospital and University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireille","family":"Chinain","sequence":"additional","affiliation":[{"name":"Laboratory of Toxic Microalgae, Institut Louis Malard\u00e9 (ILM)\u2014UMR 241-EIO, P.O. box 30, 98713 Papeete, Tahiti, French Polynesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Skinner, M.P., Brewer, T.D., Johnstone, R., Fleming, L.E., and Lewis, R.J. (2011). Ciguatera fish poisoning in the pacific islands (1998 to 2008). PLoS Negl. Trop. Dis., 5.","DOI":"10.1371\/journal.pntd.0001416"},{"key":"ref_2","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_3","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/j.toxicon.2007.11.025","article-title":"Severe seafood poisoning in French Polynesia: A retrospective analysis of 129 medical files","volume":"51","author":"Gatti","year":"2008","journal-title":"Toxicon"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.4269\/ajtmh.1979.28.1067","article-title":"Clinical observations on 3009 cases of ciguatera (fish poisoning) in the south pacific","volume":"28","author":"Bagnis","year":"1979","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.toxicon.2010.02.026","article-title":"Ciguatera fish poisoning and sea surface temperatures in the Caribbean Sea and the West Indies","volume":"56","author":"Tester","year":"2010","journal-title":"Toxicon"},{"key":"ref_6","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_7","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.toxicon.2010.07.021","article-title":"Ciguatera fish poisoning on the west africa coast: An emerging risk in the canary islands (Spain)","volume":"56","author":"Boada","year":"2010","journal-title":"Toxicon"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3466","DOI":"10.3390\/md13063466","article-title":"Ciguatera fish poisoning in East Asia and Southeast Asia","volume":"13","author":"Chan","year":"2015","journal-title":"Mar. Drugs"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Nishimura, T., Sato, S., Tawong, W., Sakanari, H., Uehara, K., Shah, M.M., Suda, S., Yasumoto, T., Taira, Y., and Yamaguchi, H. (2013). Genetic diversity and distribution of the ciguatera-causing dinoflagellate Gambierdiscus spp. (dinophyceae) in coastal areas of Japan. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0060882"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1080\/15563650701502865","article-title":"Ciguatoxin-like substances in edible fish on the eastern Mediterranean","volume":"45","author":"Bentur","year":"2007","journal-title":"Clin. Toxicol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"6032","DOI":"10.1021\/ac100516q","article-title":"First toxin profile of ciguateric fish in Madeira Arquipelago (Europe)","volume":"82","author":"Otero","year":"2010","journal-title":"Anal. Chem."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"139","DOI":"10.2310\/7060.2001.24387","article-title":"Ciguatera fish poisoning: An emerging syndrome in Italian travelers","volume":"8","author":"Bavastrelli","year":"2001","journal-title":"J. Travel Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1080\/08998280.2009.11928495","article-title":"Ciguatera poisoning: An unwelcome vacation experience","volume":"22","author":"Winter","year":"2009","journal-title":"Proc. Bayl. Univ. Med. Cent."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.toxicon.2014.10.016","article-title":"Ciguatera fish poisoning: A first epidemic in Germany highlights an increasing risk for European countries","volume":"91","author":"Mattei","year":"2014","journal-title":"Toxicon"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/0306-4522(95)00506-4","article-title":"Nodal swelling produced by ciguatoxin-induced selective activation of sodium channels in myelinated nerve fibers","volume":"71","author":"Benoit","year":"1996","journal-title":"Neuroscience"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/S0304-3940(98)00575-8","article-title":"Ciguatoxin (CTX-1) modulates single tetrodotoxin-sensitive sodium channels in rat parasympathetic neurones","volume":"252","author":"Hogg","year":"1998","journal-title":"Neurosci. Lett."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"42810","DOI":"10.1038\/srep42810","article-title":"Multiple sodium channel isoforms mediate the pathological effects of pacific ciguatoxin-1","volume":"7","author":"Inserra","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1038\/sj.bjp.0704980","article-title":"Pacific ciguatoxin-1b effect over Na+ and K+ currents, inositol 1,4,5-triphosphate content and intracellular Ca2+ signals in cultured rat myotubes","volume":"137","author":"Hidalgo","year":"2002","journal-title":"Br. J. Pharmacol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/j.toxicon.2009.05.039","article-title":"Pacific ciguatoxin 1b-induced modulation of inflammatory mediators in a murine macrophage cell line","volume":"56","author":"Matsui","year":"2010","journal-title":"Toxicon"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8353","DOI":"10.1016\/S0021-9258(17)39735-1","article-title":"Ciguatoxin is a novel type of Na+ channel toxin","volume":"259","author":"Bidard","year":"1984","journal-title":"J. Biol. Chem."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1007\/s12017-013-8220-7","article-title":"Neurotoxicity and reactive astrogliosis in the anterior cingulate cortex in acute ciguatera poisoning","volume":"15","author":"Zhang","year":"2013","journal-title":"Neuromol. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/S0196-0644(87)80750-3","article-title":"A theoretical discourse on the pharmacology of toxic marine ingestions","volume":"16","author":"Sims","year":"1987","journal-title":"Ann. Emerg. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Friedman, M.A., Fernandez, M., Backer, L.C., Dickey, R.W., Bernstein, J., Schrank, K., Kibler, S., Stephan, W., Gribble, M.O., and Bienfang, P. (2017). An updated review of ciguatera fish poisoning: Clinical, epidemiological, environmental, and public health management. Mar. Drugs, 15.","DOI":"10.3390\/md15030072"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e120","DOI":"10.11622\/smedj.2013095","article-title":"Severe bradycardia and prolonged hypotension in ciguatera","volume":"54","author":"Chan","year":"2013","journal-title":"Singap. Med. J."},{"key":"ref_25","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. Psychiatry"},{"key":"ref_26","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."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"571","DOI":"10.3109\/15563659309025762","article-title":"The basis of the paradoxical disturbance of temperature perception in ciguatera poisoning","volume":"31","author":"Cameron","year":"1993","journal-title":"J. Toxicol. Clin. Toxicol."},{"key":"ref_28","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_29","doi-asserted-by":"crossref","first-page":"3795","DOI":"10.1038\/emboj.2012.207","article-title":"Ciguatoxins activate specific cold pain pathways to elicit burning pain from cooling","volume":"31","author":"Vetter","year":"2012","journal-title":"EMBO J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"704","DOI":"10.4269\/ajtmh.15-0686","article-title":"Characteristic features and contributory factors in fatal ciguatera fish poisoning--implications for prevention and public education","volume":"94","author":"Chan","year":"2016","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e89","DOI":"10.1097\/PHM.0000000000000606","article-title":"Intractable seizures and rehabilitation in ciguatera poisoning","volume":"96","author":"Derian","year":"2017","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_32","first-page":"75","article-title":"[ciguatera and acute polyradiculoneuritis. Description of two cases in French Polynesia: Immunoallergic hypothesis?]","volume":"69","author":"Oehler","year":"2009","journal-title":"Med. Trop."},{"key":"ref_33","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_34","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1300\/J092v02n02_03","article-title":"Chronic ciguatera: One organic cause of the chronic fatigue syndrome","volume":"2","author":"Pearn","year":"1996","journal-title":"J. Chronic Fatigue Syndr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.toxicon.2009.10.015","article-title":"Prevalence, symptoms and chronicity of ciguatera in New Caledonia: Results from an adult population survey conducted in Noumea during 2005","volume":"56","author":"Baumann","year":"2010","journal-title":"Toxicon"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"309","DOI":"10.5694\/j.1326-5377.1997.tb122320.x","article-title":"Chronic fatigue syndrome: Chronic ciguatera poisoning as a differential diagnosis","volume":"166","author":"Pearn","year":"1997","journal-title":"Med. J. Aust."},{"key":"ref_37","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. Exot."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/0041-0101(93)90130-B","article-title":"Study of factors that influence the clinical response to ciguatera fish poisoning","volume":"31","author":"Glaziou","year":"1993","journal-title":"Toxicon"},{"key":"ref_39","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_40","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/j.hal.2008.04.005","article-title":"Are cyanobacteria involved in ciguatera fish poisoning-like outbreaks in New Caledonia?","volume":"7","author":"Laurent","year":"2008","journal-title":"Harmful Algae"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/j.1529-8817.2012.01118.x","article-title":"Molecular characterization of the diversity and potential toxicity of cyanobacterial mats in two tropical lagoons in the south pacific ocean","volume":"48","author":"Villeneuve","year":"2012","journal-title":"J. Phycol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.hal.2016.05.007","article-title":"Evidence of the bioaccumulation of ciguatoxins in giant clams (Tridacna maxima) exposed to Gambierdiscus spp. Cells","volume":"57","author":"Darius","year":"2016","journal-title":"Harmful Algae"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1080\/19440049.2012.755644","article-title":"Evaluation of seafood toxicity in the Australes Archipelago (French Polynesia) using the neuroblastoma cell-based assay","volume":"30","author":"Pawlowiez","year":"2013","journal-title":"Food Addit. Contam. Part A Chem. Anal. Control Expo. Risk Assess."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3740","DOI":"10.3390\/toxins7093740","article-title":"First report of ciguatoxins in two starfish species: Ophidiaster ophidianus and Marthasterias glacialis","volume":"7","author":"Silva","year":"2015","journal-title":"Toxins"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"14070","DOI":"10.1021\/es403175d","article-title":"Pacific ciguatoxins in food web components of coral reef systems in the republic of Kiribati","volume":"47","author":"Mak","year":"2013","journal-title":"Environ. Sci. Technol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/1810-522X-52-44","article-title":"Effects of grazing by herbivorous gastropod (Trochus niloticus) on the survivorship of cultured coral spat","volume":"52","author":"Villanueva","year":"2013","journal-title":"Zool. Stud."},{"key":"ref_47","first-page":"9","article-title":"Pacific islands trochus introductions 1927\u20131998","volume":"9","author":"Gillett","year":"2002","journal-title":"SPC Trochus Inf. Bull."},{"key":"ref_48","unstructured":"Bour, W. (1992). Un Mollusque Nacrier du Pacifique. Biologie, \u00c9cologie et Gestion Rationnelle d\u2019un Mollusque Nacrier du Pacifique: Le Troca (Trochus niloticus L.) de Nouvelle Cal\u00e9donie, Institut Francais de Recherche Scientifique pour le D\u00e9veloppement en Coop\u00e9ration. Editions de l\u2019ORSTOM, Collection Etudes et Th\u00e8ses."},{"key":"ref_49","unstructured":"French Polynesia (1988). D\u00e9lib\u00e9ration relative \u00e0 la protection de certaines esp\u00e8ces animales marines et d\u2019eau douce du patrimoine naturel polyn\u00e9sien, Journal Officiel de la Polyn\u00e9sie Fran\u00e7aise."},{"key":"ref_50","first-page":"65","article-title":"[Neurological features after consumption of a variety of neo-caledonian shellfish]","volume":"156","author":"Angibaud","year":"2000","journal-title":"Rev. Neurol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Darius, H.T., Roue, M., Sibat, M., Viallon, J., Gatti, C.M.I., Vandersea, M.W., Tester, P.A., Litaker, R.W., Amzil, Z., and Hess, P. (2018). Tectus niloticus (Tegulidae, Gastropod) as a novel vector of ciguatera poisoning: Detection of pacific ciguatoxins in toxic samples from Nuku Hiva Island (French Polynesia). Toxins, 10.","DOI":"10.3390\/toxins10010002"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1002\/ptr.3396","article-title":"A review of traditional remedies of ciguatera fish poisoning in the pacific","volume":"25","author":"Matsui","year":"2011","journal-title":"Phytother. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1056\/NEJMoa1013297","article-title":"HLA-A*3101 and carbamazepine-induced hypersensitivity reactions in Europeans","volume":"364","author":"McCormack","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_54","first-page":"93","article-title":"Endoscopic evaluation of gastro-esophageal reflux disease","volume":"72","author":"Armstrong","year":"1999","journal-title":"Yale J. Biol. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.taap.2004.08.020","article-title":"Block of voltage-gated potassium channels by pacific ciguatoxin-1 contributes to increased neuronal excitability in rat sensory neurons","volume":"204","author":"Gunning","year":"2005","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.neuropharm.2014.06.001","article-title":"Involvement of both sodium influx and potassium efflux in ciguatoxin-induced nodal swelling of frog myelinated axons","volume":"85","author":"Mattei","year":"2014","journal-title":"Neuropharmacology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.tox.2011.02.005","article-title":"Toxicokinetics of the ciguatoxin P-CTX-1 in rats after intraperitoneal or oral administration","volume":"284","author":"Bottein","year":"2011","journal-title":"Toxicology"},{"key":"ref_58","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_59","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.tox.2007.12.013","article-title":"Repeat exposure to ciguatoxin leads to enhanced and sustained thermoregulatory, pain threshold and motor activity responses in mice: Relationship to blood ciguatoxin concentrations","volume":"246","author":"Rezvani","year":"2008","journal-title":"Toxicology"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1001\/archneur.1991.00530200116031","article-title":"Polymyositis after ciguatera toxin exposure","volume":"48","author":"Stommel","year":"1991","journal-title":"Arch. Neurol."},{"key":"ref_61","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_62","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.ntt.2010.05.007","article-title":"Defining the neurotoxin derived illness chronic ciguatera using markers of chronic systemic inflammatory disturbances: A case\/control study","volume":"32","author":"Shoemaker","year":"2010","journal-title":"Neurotoxicol. Teratol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.hal.2016.03.009","article-title":"Gene expression patterns in peripheral blood leukocytes in patients with recurrent ciguatera fish poisoning: Preliminary studies","volume":"57","author":"Lopez","year":"2016","journal-title":"Harmful Algae"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Ryan, J.C., Wu, Q., and Shoemaker, R.C. (2015). Transcriptomic signatures in whole blood of patients who acquire a chronic inflammatory response syndrome (CIRS) following an exposure to the marine toxin ciguatoxin. BMC Med. Genom., 8.","DOI":"10.1186\/s12920-015-0089-x"},{"key":"ref_65","first-page":"469","article-title":"Ciguatoxin-induced chronic disease unmasks people carrying hla epitopes peculiar to celiac disease and rheumatoid arthritis","volume":"55","author":"Schicchi","year":"2017","journal-title":"Clin. Toxicol."},{"key":"ref_66","first-page":"395","article-title":"Clinical findings and genomic biomarkers in three cases of chronic ciguatera poisoning","volume":"52","author":"Lonati","year":"2014","journal-title":"Clin. Toxicol."},{"key":"ref_67","unstructured":"(2014, February 06). Ciguatera-Online. Available online: www.ciguatera-online.com."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1071\/SP10001","article-title":"Ciguatera fish poisoning and other seafood intoxication syndromes: A revisit and a review of the existing treatments employed in ciguatera fish poisoning","volume":"28","author":"Matsui","year":"2010","journal-title":"S. Pac. J. Nat. Appl. Sci."},{"key":"ref_69","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. Aust."},{"key":"ref_70","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":"JAMA"},{"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":"Med. J. Aust."},{"key":"ref_72","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. Trop."},{"key":"ref_73","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":"Neuropharmacology"},{"key":"ref_74","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_75","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1080\/15563650.2017.1327664","article-title":"Is mannitol the treatment of choice for patients with ciguatera fish poisoning?","volume":"55","author":"Mullins","year":"2017","journal-title":"Clin. Toxicol."},{"key":"ref_76","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":"N. Engl. J. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"588","DOI":"10.3109\/15563650.2015.1052499","article-title":"Pregabalin to treat ciguatera fish poisoning","volume":"53","author":"Brett","year":"2015","journal-title":"Clin. Toxicol."},{"key":"ref_78","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":"N. Engl. J. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jep.2012.05.045","article-title":"Protective effect of Heliotropium foertherianum (Boraginaceae) folk remedy and its active compound, rosmarinic acid, against a pacific ciguatoxin","volume":"143","author":"Rossi","year":"2012","journal-title":"J. Ethnopharmacol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"431","DOI":"10.3390\/md6030431","article-title":"Neurotoxic shellfish poisoning","volume":"6","author":"Watkins","year":"2008","journal-title":"Mar. Drugs"}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/10\/3\/102\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T14:56:51Z","timestamp":1760194611000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/10\/3\/102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,28]]},"references-count":80,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2018,3]]}},"alternative-id":["toxins10030102"],"URL":"https:\/\/doi.org\/10.3390\/toxins10030102","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,28]]}}}