{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:05:06Z","timestamp":1761609906519,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2014,7,11]],"date-time":"2014-07-11T00:00:00Z","timestamp":1405036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Brown marbled grouper (Epinephelus fuscoguttatus) is an apex predator from coral reefs of the Indo-Pacific region. All five published case series of ciguatera after consumption of brown marbled grouper were reviewed to characterize the types, severity and chronicity of ciguatera symptoms associated with its consumption. Three of these case series were from large outbreaks affecting over 100\u2013200 subjects who had eaten this  reef fish served at banquets. Affected subjects generally developed a combination of gastrointestinal, neurological and, less commonly, cardiovascular symptoms. Gastrointestinal symptoms occurred early and generally subsided in 1\u20132 days. Some neurological symptoms (e.g., paresthesia of four limbs) could last for weeks or months. Sinus bradycardia and hypotension occurred early, but could be severe and prolonged, necessitating the timely use of intravenous fluids, atropine and dopamine. Other cardiovascular and neurological features included atrial ectopics, ventricular ectopics, dyspnea, chest tightness, PR interval &gt;0.2 s, ST segment changes, polymyositis and coma. Concomitant alcohol consumption was associated with a much higher risk of developing bradycardia, hypotension and altered skin sensation. The public should realize that consumption of the high-risk fish (especially the ciguatoxin-rich parts and together with alcohol use) and repeated ciguatoxin exposures will result in more severe and chronic illness.<\/jats:p>","DOI":"10.3390\/toxins6072041","type":"journal-article","created":{"date-parts":[[2014,7,11]],"date-time":"2014-07-11T10:48:29Z","timestamp":1405075709000},"page":"2041-2049","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Large Outbreaks of Ciguatera after Consumption of  Brown Marbled Grouper"],"prefix":"10.3390","volume":"6","author":[{"given":"Thomas","family":"Chan","sequence":"first","affiliation":[{"name":"Division of Clinical Pharmacology, Department of Medicine and Therapeutics,  Faculty of Medicine, the Chinese University of Hong Kong, Prince of Wales Hospital,  Shatin, New Territories, Hong Kong, China"},{"name":"Centre for Food and Drug Safety, Faculty of Medicine,  the Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2014,7,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/j.toxicon.2006.07.019","article-title":"Ciguatera: Australian perspectives on a global problem","volume":"48","author":"Lewis","year":"2006","journal-title":"Toxicon"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.toxicon.2009.09.008","article-title":"Ciguatera: A public health perspective","volume":"56","author":"Dickey","year":"2010","journal-title":"Toxicon"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.toxicon.2010.05.017","article-title":"Global distribution of ciguatera causing dinoflagellates in the genus Gambierdiscus","volume":"56","author":"Litaker","year":"2010","journal-title":"Toxicon"},{"key":"ref_4","unstructured":"FAO (2004). 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