{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T00:29:42Z","timestamp":1725496182369},"reference-count":28,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Patients with ciguatera poisoning commonly present with gastrointestinal and neurologic symptoms, but its cardiotoxicity has been largely unrecognized. This systematic review is the first to summarize the evidence regarding clinical characteristics of cardiotoxicity from ciguatera poisoning to provide the illness script and pertinent knowledge for clinicians. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including \u201cciguatera\u201d and \u201ccardiotoxicity\u201d from their inception to January 2024. We included 20 articles, including 148 cases, in this systematic review. Among the included cases, the median age was 54\u2009years with male predominance (62.2%). Based on the WHO designation, 68.5% were reported from the Western Pacific Region. Common symptoms included hypotension (75.0%) and bradycardia (67.6%), and chest pain or syncope were less commonly reported (2.7% and 1.4%, respectively). Sinus bradycardia was the most common electrocardiogram abnormality (35.9%), followed by atrioventricular blocks (15.4%). Symptomatic treatments such as atropine, dopamine, and epinephrine were commonly used, and only 4.1% required intensive care unit admission. None expired due to cardiotoxicity from ciguatera. This review summarizes the current evidence and the characteristics of cardiotoxicity from ciguatera. Although ciguatera cardiotoxicity is currently underrecognized, increased awareness of the condition in clinicians is crucial because the clinical outcomes of the patients could be benign as long as it is identified and intervened early.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0207","type":"journal-article","created":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T13:37:00Z","timestamp":1720532220000},"page":"671-675","source":"Crossref","is-referenced-by-count":0,"title":["Clinicoepidemiological Profile of Ciguatera Cardiotoxicity: A Systematic Review"],"prefix":"10.4269","volume":"111","author":[{"given":"Clarke","family":"Morihara","sequence":"first","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thanaboon","family":"Yinadsawaphan","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian John","family":"Capirig","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley","family":"Fujiuchi","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Hirao","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reed McCardell","family":"Malone","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jadon","family":"Neuendorf","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sable","family":"Neuendorf","sequence":"additional","affiliation":[{"name":"Medical Education, California University of Science and Medicine, Colton, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sorawit","family":"Ongsupankul","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazushige","family":"Shiraishi","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Benavente","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshito","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, Hawaii;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Toxins (Basel)","first-page":"535","article-title":"Clinical characteristics of ciguatera poisoning in Martinique, French West Indies\u2014A case series","volume":"14","author":"R\u00e9si\u00e8re","year":"2022"},{"key":"b2","series-title":"Toxicon","first-page":"656","article-title":"Ciguatera incidence and fish toxicity in Okinawa, Japan","volume":"56","author":"Oshiro","year":"2010"},{"key":"b3","series-title":"Mar Drugs","first-page":"456","article-title":"Ciguatera fish poisoning: Treatment, prevention and management","volume":"6","author":"Friedman","year":"2008"},{"key":"b4","series-title":"Eur J Neurosci","first-page":"242","article-title":"Ciguatoxin-induced oscillations in membrane potential and action potential firing in rat parasympathetic neurons","volume":"16","author":"Hogg","year":"2002"},{"key":"b5","series-title":"BMJ Case Rep","first-page":"e229354","article-title":"Junctional bradycardia caused by ciguatera intoxication","volume":"12","author":"Raman","year":"2019"},{"key":"b6","series-title":"BMJ","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021"},{"key":"b7","series-title":"N Z Med J","first-page":"113","article-title":"Ciguatera fish poisoning","volume":"129","author":"Armstrong","year":"2016"},{"key":"b8","series-title":"Rev Hyg Med Soc","first-page":"619","article-title":"Fish poisoning in French Polynesia. Clinical and epidemiological study","volume":"15","author":"Bagnis","year":"1967"},{"key":"b9","series-title":"Toxicon","first-page":"662","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"},{"key":"b10","series-title":"Toxicon","first-page":"255","article-title":"Ciguatera caused by consumption of humphead wrasse","volume":"76","author":"Chan","year":"2013"},{"key":"b11","series-title":"Trans R Soc Trop Med Hyg","first-page":"71","article-title":"Life-threatening bradycardia and hypotension in a patient with ciguatera fish poisoning","volume":"87","author":"Chan","year":"1993"},{"key":"b12","series-title":"Hong Kong J Emerg Med","first-page":"173","article-title":"Ciguatera fish poisoning: A challenge to emergency physicians","volume":"11","author":"Cheng","year":"2004"},{"key":"b13","series-title":"Toxins 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