{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:30:44Z","timestamp":1791401444030,"version":"4.3.3"},"reference-count":31,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2014,10,20]],"date-time":"2014-10-20T00:00:00Z","timestamp":1413763200000},"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>In the present review, the main objective was to describe the epidemiology and clinical features of ciguatera fish poisoning in Hong Kong. From 1989 to 2008, the annual incidence of ciguatera varied between 3.3 and 64.9 (median 10.2) per million people.  The groupers have replaced the snappers as the most important cause of ciguatera.  Pacific-ciguatoxins (CTX) are most commonly present in reef fish samples implicated in ciguatera outbreaks. In affected subjects, the gastrointestinal symptoms often subside within days, whereas the neurological symptoms can persist for weeks or even months. Bradycardia and hypotension, which can be life-threatening, are common. Treatment of ciguatera is primarily supportive and symptomatic. Intravenous mannitol (1 g\/kg) has also been suggested. To prevent ciguatera outbreaks, the public should be educated to avoid eating large coral reef fishes, especially the CTX-rich parts. A Code of Practice on Import and Sale of Live Marine Fish for Human Consumption for Prevention and Control of Ciguatera Fish Poisoning was introduced from 2004 to 2013. The Food Safety Ordinance with a tracing mechanism came into full effect in February 2012. The Government would be able to trace the sources of the fishes more effectively and take prompt action when dealing with  ciguatera incidents.<\/jats:p>","DOI":"10.3390\/toxins6102989","type":"journal-article","created":{"date-parts":[[2014,10,20]],"date-time":"2014-10-20T10:14:47Z","timestamp":1413800087000},"page":"2989-2997","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Epidemiology and Clinical Features of Ciguatera Fish Poisoning in Hong Kong"],"prefix":"10.3390","volume":"6","author":[{"given":"Thomas","family":"Chan","sequence":"first","affiliation":[{"name":"Division of Clinical Pharmacology and Drug and Poisons Information Bureau,  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":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2014,10,20]]},"reference":[{"key":"ref_1","unstructured":"FAO (2004). Marine Biotoxins. FAO Food and Nutrition Paper 80, Food and Agriculture Organization of the United Nations."},{"key":"ref_2","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_3","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_4","doi-asserted-by":"crossref","unstructured":"Botana, L.M. (2014). Seafood and Freshwater Toxins: Pharmacology, Toxicology, and Detection, CRC Press. [3rd ed.].","DOI":"10.1201\/b16662"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1001\/archinte.1992.00400220135023","article-title":"Orthostatic hypotension in ciguatera fish poisoning","volume":"152","author":"Geller","year":"1992","journal-title":"Arch. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.toxicon.2013.10.018","article-title":"Ciguatera caused by consumption of humphead wrasse","volume":"76","author":"Chan","year":"2013","journal-title":"Toxicon"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.3390\/toxins6072041","article-title":"Large outbreaks of ciguatera after consumption of brown marbled grouper","volume":"6","author":"Chan","year":"2014","journal-title":"Toxins"},{"key":"ref_8","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. R. Soc. Trop. Med. Hyg."},{"key":"ref_9","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_10","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1016\/0041-0101(94)90365-4","article-title":"The epidemiology of ciguatera fish poisoning","volume":"32","author":"Glaziou","year":"1994","journal-title":"Toxicon"},{"key":"ref_11","first-page":"12","article-title":"Epidemiology of ciguatera poisoning in Hong Kong","volume":"3","author":"Choi","year":"1994","journal-title":"Public Health Epidemiol. Report"},{"key":"ref_12","first-page":"202","article-title":"The drug and poisons information bureau at the Chinese university of Hong Kong","volume":"45","author":"Chan","year":"1993","journal-title":"J. Hong Kong Med. Assoc."},{"key":"ref_13","first-page":"543","article-title":"Ciguatera poisoning in Hong Kong: A report of two cases","volume":"22","author":"Leung","year":"1992","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1017\/S0950268803008665","article-title":"Peak occurrences of ciguatera fish poisoning precede cholera outbreaks in Hong Kong","volume":"131","author":"Kwan","year":"2003","journal-title":"Epidemiol. Infect."},{"key":"ref_15","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_16","first-page":"49","article-title":"Ciguatera fish poisoning on the rise\u2014A review of cases (January 2004\u2013May 2005)","volume":"13","author":"Au","year":"2005","journal-title":"Communicable Diseases Watch"},{"key":"ref_17","first-page":"3","article-title":"Ciguatera poisoning in Hong Kong","volume":"3","author":"Chan","year":"1999","journal-title":"H.K. Epidemiol. Assoc. Newsl."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/S0895-3988(09)60012-X","article-title":"Features of ciguatera fish poisoning cases in Hong Kong 2004\u20132007","volume":"21","author":"Wong","year":"2008","journal-title":"Biomed. Environ. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1080\/02652030802342505","article-title":"Solid-phase extraction clean-up of ciguatoxin-contaminated coral fish extracts for use in the mouse bioassay","volume":"26","author":"Wong","year":"2009","journal-title":"Food Addit. Contam."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.toxicon.2014.05.006","article-title":"Ciguatera fish poisoning in Hong Kong\u2014A 10-year perspective on the class of ciguatoxins","volume":"86","author":"Wong","year":"2014","journal-title":"Toxicon"},{"key":"ref_21","first-page":"353","article-title":"Incidence and severity of hypotension and bradycardia in ciguatera (abstract)","volume":"52","author":"Chan","year":"2014","journal-title":"Clin. Toxicol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1177\/102490790401100308","article-title":"Ciguatera fish poisoning: A challenge to emergency physicians","volume":"11","author":"Cheng","year":"2004","journal-title":"Hong Kong J. Emerg. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1177\/102490790401100412","article-title":"Ciguatera fish poisoning: A challenge to emergency physicians (letter)","volume":"11","author":"Sia","year":"2004","journal-title":"Hong Kong J. Emerg. Med."},{"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":"Singapore Med. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/S0035-9203(98)90803-3","article-title":"Lengthy persistence of ciguatoxin in the body","volume":"92","author":"Chan","year":"1998","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_26","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_27","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_28","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_29","unstructured":"Centre for Food Safety Food Safety Focus (Hong Kong), 51st issue. Ciguatera fish poisoning, Available online:http:\/\/www.cfs.gov.hk\/english\/multimedia\/multimedia_pub\/files\/FSF51_2010-10-20.pdf."},{"key":"ref_30","unstructured":"Food and Environmental Hygiene Department Code of Practice on the Import and Sale of Live Marine Fish for Human Consumption for Prevention and Control of Ciguatera Fish Poisoning, Available online:http:\/\/www.cfs.gov.hk\/english\/whatsnew\/whatsnew_fsf\/files\/fish_cop_e.pdf."},{"key":"ref_31","unstructured":"Centre for Food Safety Food Safety Ordinance (Chapter 612), Available online:http:\/\/www.cfs.gov.hk\/english\/whatsnew\/whatsnew_fstr\/whatsnew_fstr_Food_Safety_Bill.html."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/6\/10\/2989\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T21:17:11Z","timestamp":1760217431000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/6\/10\/2989"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,10,20]]},"references-count":31,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2014,10]]}},"alternative-id":["toxins6102989"],"URL":"https:\/\/doi.org\/10.3390\/toxins6102989","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,10,20]]}}}