European Journal Of Emergency Medicine, 2001, 8, 295300

Abstract

to intravenous mannitol. This is in contrast to a fifth patient who developed symptoms suggestive of ciguatoxicity in the same week as the index cases but actually had staphylococcal endocarditis with bacteraemia. In addition to a lack of response to mannitol, clinical and laboratory indices of sepsis were present in this patient. Apart from ciguatera, acute gastroenteritis followed by neurological symptoms may be due to paralytic or neurotoxic shellfish poisoning, scombroid and pufferfish toxicity, botulism, enterovirus 71, toxidromes and bacteraemia. Clinical aspects of ciguatera toxicity, its pathophysiology, diagnostic difficulties and epidemiology are discussed. # 2001 Lippincott Williams & Wilkins. Keywords: ciguatera poisoning; toxinological; food-borne illness; public health; common source outbreak INTRODUCTION Ciguatera poisoning, a fish-borne toxinological syndrome comprising a mixture of gastrointestinal, neurocutaneous and constitutional symptoms, is encounte