8/8/2015 DiseaseListing,MarineToxins,GeneralInformation|CDCBacterial,MycoticDiseaseshttp://www.cdc.gov/ncidod/dbmd/diseaseinfo/marinetoxins_g.htm 1/4Home AboutCDC PressRoom Funding AZIndex Centers,Institute&Offices Training&Employment ContactUsCDCenEspaolSearch: ProgramsEnglishandSpanish(800)CDCINFO(800)2324636TTY:(888)2326348FAX:(770)4884760InternationalTravelPhone:18873948747ContactCDCINFOHome>DiseaseListing>MarineToxinsMarineToxinsDiseaseListing|GeneralInformation|TechnicalInformation|AdditionalInformationFrequentlyAskedQuestionsWhataremarinetoxins?Whatsortofdiseasesdomarinetoxinscause?Howcanthesediseasesbediagnosed?Howcanthesediseasesbetreated?Aretherelongtermconsequencestothesediseases?Howcommonarethesediseases?WhatcanIdotopreventpoisoningbymarinetoxins?Whatisthegovernmentdoingaboutthesediseases?Whatelsecanbedonetopreventthesediseases?HowcanIlearnmoreaboutthisandotherpublichealthproblems?Whataremarinetoxins?Marinetoxinsarenaturallyoccurringchemicalsthatcancontaminatecertainseafood.Theseafoodcontaminatedwiththesechemicalsfrequentlylooks,smells,andtastesnormal.Whenhumanseatsuchseafood,diseasecanresult.Whatsortofdiseasesdomarinetoxinscause?ThemostcommondiseasescausedbymarinetoxinsinUnitedStatesinorderofincidencearescombrotoxicfishpoisoning,ciguaterapoisoning,paralyticshellfishpoisoning,neurotoxicshellfishpoisoningandamnesicshellfishpoisoning.Scombrotoxicfishpoisoningalsoknownasscombroidorhistaminefishpoisoning,iscausedbybacterialspoilageofcertainfinfishsuchastuna,mackerel,bonito,and,rarely,otherfish.Asbacteriabreakdownfishproteins,byproductssuchashistamineandothersubstancesthatblockhistaminebreakdownbuildupinfish.Eatingspoiledfishthathavehighlevelsofthesehistaminescancauseinhumandisease.Symptomsbeginwithin2minutesto2hoursaftereatingthefish.Themostcommonsymptomsarerash,diarrhea,flushing,sweating,headache,andvomiting.Burningorswellingofthemouth,abdominalpain,orametallictastemayalsooccur.Themajorityofpatientshavemildsymptomsthatresolvewithinafewhours.Treatmentisgenerallyunnecessary,butantihistaminesorepinephrinemaybeneededincertaininstances.Symptomsmaybemoresevereinpatientstakingcertainmedicationsthatslowthebreakdownofhistaminebytheirliver,suchasisoniazideanddoxycycline.Ciguaterapoisoningorciguateraiscausedbyeatingcontaminatedtropicalreeffish.Ciguatoxinsthatcauseciguaterapoisoningareactuallyproducedbymicroscopicseaplantscalleddinoflagellates.Thesetoxinsbecomeprogressivelyconcentratedastheymoveupthefoodchainfromsmallfishtolargefishthateatthem,andreachparticularlyhighconcentrationsinlargepredatorytropicalreeffish.Barracudaarecommonlyassociatedwithciguatoxinpoisoning,buteatinggrouper,seabass,snapper,mullet,andanumberofotherfishthatliveinoceansbetweenlatitude35Nand35Shascausedthedisease.ThesefisharetypicallycaughtbysportfishermenonreefsinHawaii,GuamandotherSouthPacificislands,theVirginIslands,andPuertoRico.Ciguatoxinusuallycausessymptomswithinafewminutesto30hoursaftereatingcontaminatedfish,andoccasionallyitmaytakeupto68/8/2015 DiseaseListing,MarineToxins,GeneralInformation|CDCBacterial,MycoticDiseaseshttp://www.cdc.gov/ncidod/dbmd/diseaseinfo/marinetoxins_g.htm 2/4hours.Commonnonspecificsymptomsincludenausea,vomiting,diarrhea,cramps,excessivesweating,headache,andmuscleaches.Thesensationofburningor"pinsandneedles,"weakness,itching,anddizzinesscanoccur.Patientsmayexperiencereversaloftemperaturesensationintheirmouth(hotsurfacesfeelingcoldandcold,hot),unusualtastesensations,nightmares,orhallucinations.Ciguaterapoisoningisrarelyfatal.Symptomsusuallyclearin1to4weeks.Paralyticshellfishpoisoningiscausedbyadifferentdinoflagellatewithadifferenttoxin,thanthatcausingciguaterapoisoning.Thesedinoflagellateshavearedbrowncolor,andcangrowtosuchnumbersthattheycauseredstreakstoappearintheoceancalled"redtides."ThistoxinisknowntoconcentratewithincertainshellfishthattypicallyliveinthecoldercoastalwatersofthePacificstatesandNewEngland,thoughthesyndromehasbeenreportedinCentralAmerica.Shellfishthathavecausedthisdiseaseincludemussels,cockles,clams,scallops,oysters,crabs,andlobsters.Symptomsbeginanywherefrom15minutesto10hoursaftereatingthecontaminatedshellfish,althoughusuallywithin2hours.Symptomsaregenerallymild,andbeginwithnumbnessortinglingoftheface,arms,andlegs.Thisisfollowedbyheadache,dizziness,nausea,andmuscularincoordination.Patientssometimesdescribeafloatingsensation.Incasesofseverepoisoning,muscleparalysisandrespiratoryfailureoccur,andinthesecasesdeathmayoccurin2to25hours.Neurotoxicshellfishpoisoningiscausedbyathirdtypeofdinoflagellatewithanothertoxinthatoccasionallyaccumulatesinoysters,clams,andmusselsfromtheGulfofMexicoandtheAtlanticcoastofthesouthernstates.Symptomsbegin1to3hoursaftereatingthecontaminatedshellfishandincludenumbness,tinglinginthemouth,armsandlegs,incoordination,andgastrointestinalupset.Asinciguaterapoisoning,somepatientsreporttemperaturereversal.Deathisrare.Recoverynormallyoccursin2to3days.Amnesicshellfishpoisoningisararesyndromecausedbyatoxinmadebyamicroscopic,redbrown,saltwaterplant,ordiatomcalledNitzchiapungens.Thetoxinproducedbythesediatomsisconcentratedinshellfishsuchasmusselsandcausesdiseasewhenthecontaminatedshellfishareeaten.Patientsfirstexperiencegastrointestinaldistresswithin24hoursaftereatingthecontaminatedshellfish.Otherreportedsymptomshaveincludeddizziness,headache,disorientation,andpermanentshorttermmemoryloss.Inseverepoisoning,seizures,focalweaknessorparalysis,anddeathmayoccur.BacktoTopHowcanthesediseasesbediagnosed?Diagnosisofmarinetoxinpoisoningisgenerallybasedonsymptomsandahistoryofrecentlyeatingaparticularkindofseafood.Laboratorytestingforthespecifictoxininpatientsamplesisgenerallynotnecessarybecausethisrequiresspecialtechniquesandequipmentavailableinonlyspecializedlaboratories.Ifsuspect,leftoverfishorshellfishareavailable,theycanbetestedforthepresenceofthetoxinmoreeasily.Identificationofthespecifictoxinisnotusuallynecessaryfortreatingpatientsbecausethereisnospecifictreatment.Howcanthesediseasesbetreated?Otherthansupportivecaretherearefewspecifictreatmentsforciguaterapoisoning,paralyticshellfishpoisoning,neurotoxicshellfishpoisoning,oramnesicshellfishpoisoning.Antihistaminesandepinephrine,however,maysometimesbeusefulintreatingthesymptomsofscombrotoxicfishpoisoning.Intravenousmannitolhasbeensuggestedforthetreatmentofsevereciguaterapoisoning.BacktoTopAretherelongtermconsequencestothesediseases?Ciguaterapoisoninghasresultedinsomeneurologicproblemspersistingforweeks,andinrarecases,evenyears.Symptomshavesometimesreturnedaftereatingcontaminatedfishasecondtime.Amnesicshellfishpoisoninghasresultedinlongtermproblemswithshorttermmemory.Longtermconsequenceshavenotbeenassociatedwithparalyticshellfishpoisoning,neurotoxicshellfishpoisoning,andscombrotoxicfishpoisoning.Howcommonarethesediseases?Everyyear,approximately30casesofpoisoningbymarinetoxinsarereportedintheUnitedStates.Becausehealthcareprovidersarenotrequiredtoreporttheseillnessesandbecausemanymildercasesarenotdiagnosedorreported,theactual8/8/2015 DiseaseListing,MarineToxins,GeneralInformation|CDCBacterial,MycoticDiseaseshttp://www.cdc.gov/ncidod/dbmd/diseaseinfo/marinetoxins_g.htm 3/4numberofpoisoningsmaybemuchgreater.Toxicseafoodpoisoningsaremorecommoninthesummerthanwinterbecausedinoflagelatesgrowwellinwarmerseasons.Itisestimatedfromcaseswithavailabledatathatonepersondiesevery4yearsfromtoxicseafoodpoisonings.BacktoTopWhatcanIdotopreventpoisoningbymarinetoxins?Generalguidelinesforsafeseafoodconsumption:1. Althoughanypersoneatingfishorshellfishcontainingtoxinordiseasecausingbacteriamaybecomeill,personswithweakenedimmunesystemsorliverproblemsshouldnoteatrawseafoodbecauseoftheirhigherriskofVibrioinfection(seeVibrioFAQhttp://www.cdc.gov/ncidod/DFBMD/diseaseinfo/vibriovulnificus_g.htm).2. Keepseafoodoniceorrefrigeratedatlessthan38Fahrenheittopreventspoilage.Specificadviseforavoidingmarinetoxinpoisoning:1. Keepfreshtuna,mackerel,grouper,andmahimahirefrigeratedtopreventdevelopmentofhistamine.Don'tbelievethatcookingspoiledortoxicseafoodwillkeepyousafe.Thesetoxinsarenotdestroyedbycooking.2. Donoteatbarracuda,especially,thosefromtheCaribbean.3. Checkwithlocalhealthofficialsbeforecollectingshellfish,andlookforHealthDepartmentadvisoriesaboutalgalblooms,dinoflagellategrowthor"redtide"conditionsthatmaybepostedatfishingsupplystores.4. Donoteatfinfishorshellfishsoldasbait.Baitproductsdonotneedtomeetthesamefoodsafetyregulationsasseafoodforhumanconsumption.BacktoTopWhatisthegovernmentdoingaboutthesediseases?Somehealthdepartmentstestshellfishharvestedwithintheirjurisdictiontomonitorthelevelofdinoflagellatetoxinsandassestheriskforcontamination.Basedontheresultsofsuchtesting,recreationalandcommercialseafoodharvestingmaybeprohibitedlocallyduringperiodsofrisk.Stateandfederalregulatoryagenciesmonitorreportedcasesofmarinetoxinpoisoning,andhealthdepartmentsinvestigatepossibleoutbreaksanddevisecontrolmeasures.TheCentersforDiseaseControlandPrevention(CDC)providessupporttoinvestigatorsasneeded.Whatelsecanbedonetopreventthesediseases?Itisimportanttonotifypublichealthdepartmentsaboutevenonepersonwithmarinetoxinpoisoning.Publichealthdepartmentscantheninvestigatetodetermineifarestaurant,oysterbed,orfishingareahasaproblem.Thispreventsotherillnesses.Inanyfoodpoisoningoccurrence,consumersshouldnotefoodseatenandfreezeanyuneatenportionsincasetheyneedtobetested.AcommercialtesthasbeendevelopedinHawaiitoallowpersonstotestsportcaughtfishforciguatoxins.BacktoTopHowcanIlearnmoreaboutthisandotherpublichealthproblems?Youcandiscussanymedicalconcernsyoumayhavewithyourdoctororotherhealthcareprovider.Yourlocalcity,county,orstatehealthdepartmentcanprovidemoreinformationaboutthisandotherpublichealthproblemsthatareoccurringinyourarea.GeneralinformationaboutthepublichealthofthenationispublishedeveryweekintheMorbidityandMortalityWeeklyReport,byCDCinAtlanta,GA(http://www.cdc.gov/mmwr/).Epidemiologistsinyourlocalandstatehealthdepartmentsaretrackinganumberofimportantpublichealthproblems,investigatingspecialproblemsthatarise,andhelpingtopreventthemfromoccurringinthefirstplace,andfromspreadingiftheydooccur.BacktoTopDate:October12,2005Contentsource:NationalCenterforImmunizationandRespiratoryDiseases:DivisionofBacterialDiseasesHome|PoliciesandRegulations|Disclaimer|eGovernment|FOIA|ContactUs8/8/2015 DiseaseListing,MarineToxins,GeneralInformation|CDCBacterial,MycoticDiseaseshttp://www.cdc.gov/ncidod/dbmd/diseaseinfo/marinetoxins_g.htm 4/4DepartmentofHealthandHumanServicesCentersforDiseaseControlandPrevention,1600CliftonRd,Atlanta,GA30333,U.S.AEnglishandSpanish:(800)CDCINFO/(800)2324636TTY:(888)2326348/FAX:(770)4884760