Original Article

Association of Cardiac Disease and Alcohol Use with the Development of Severe Ciguatera

Authors: Elizabeth G. Radke, PhD, Lynn M. Grattan, PhD, John Glenn Morris MD, MPH&TM

Abstract

Objectives: Ciguatera is a foodborne illness that causes severe gastrointestinal and neurologic symptoms, but the risk factors for illness are not well established.

Methods: In St Thomas, US Virgin Islands, we performed a case-control study for ciguatera, enrolling 47 patients primarily through the emergency department and 141 age- and sex-matched controls identified through an island-wide survey. We used conditional logistic regression to assess health-related risk factors for ciguatera, including comorbidities and alcohol and tobacco use.

Results: Cases were more likely than controls to report alcohol consumption at least weekly (odds ratio 5.7, 95% confidence interval 2.7–24.8). Cases also more frequently had a history of heart disease (odds ratio 6.3, 95% confidence interval 1.2–32.7). Previous ciguatera episodes, lower levels of education, and frequent fish consumption also were associated with illness.

Conclusions: This study provides preliminary evidence that preexisting health status influences an individual’s risk of developing severe ciguatera. There may be a benefit to educating high-risk individuals about preventing ciguatera.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Bagnis R, Chanteau S, Chungue E, et al. Origins of ciguatera fish poisoning: a new dinoflagellate, Gambierdiscus-toxicus Adachi and Fukuyo, definitively involved as a causal agent. Toxicon. 1980; 18: 199–208.
 
2. Lewis RJ, Ruff TA. Ciguatera: ecological, clinical, and socioeconomic perspectives. Crit Rev Environ Sci Technol. 1993; 23: 137–156.
 
3. Radke EG, Grattan LM, Cook RL, et al. Ciguatera incidence in the US Virgin Islands has not increased over a 30-year time period despite rising seawater temperatures. Am J Trop Med Hyg. 2013; 88: 908–913.
 
4. Bagnis R, Kuberski T, Laugier S. Clinical observations on 3,009 cases of ciguatera (fish poisoning) in the South Pacific. Am J Trop Med Hyg. 1979; 28: 1067–1073.
 
5. Glaziou P, Martin PM. Study of factors that influence the clinical response to ciguatera fish poisoning. Toxicon. 1993; 31: 1151–1154.
 
6. Morris JG Jr, Lewin P, Smith CW, et al. Ciguatera fish poisoning epidemiology of the disease on St. Thomas, U.S. Virgin Islands. Am J Trop Med Hyg. 1982; 31: 574–578.
 
7. Chateau-Degat ML, Huin-Blondey MO, Chinain M, et al. Prevalence of chronic symptoms of ciguatera disease in French Polynesian adults. Am J Trop Med Hyg. 2007; 77: 842–846.
 
8. Katz AR, Terrell-Perica S, Sasaki DM. Ciguatera on Kauai: investigation of factors associated with severity of illness. Am J Trop Med Hyg. 1993; 49: 448–454.
 
9. Friedman MA, Fleming LE, Fernandez M, et al. Ciguatera fish poisoning: treatment, prevention and management. Mar Drugs. 2008; 6: 456–479.
 
10. Engleberg NC, Morris JG Jr, Lewis J, et al. Ciguatera fish poisoning: a major common-source outbreak in the U.S. Virgin Islands. Ann Intern Med. 1983; 98: 336–337.
 
11. Gillespie NC, Lewis RJ, Pearn JH, et al. Ciguatera in Australia. Occurrence, clinical features, pathophysiology and management. Med J Aust. 1986; 145: 584–590.
 
12. Lewis RJ. Ciguatera: Australian perspectives on a global problem. Toxicon. 2006; 48: 799–809.
 
13. Barton ED, Tanner P, Turchen SG, et al. Ciguatera fish poisoning. A southern California epidemic. West J Med. 1995; 163: 31–35.