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Peripheral neuropathy caused by ciguatoxin

Last edited: 4/10/2026

Overview

Ciguatera poisoning is caused by the consumption of certain tropical and subtropical reef fish contaminated with ciguatoxins 1. While gastrointestinal and neurological symptoms are common, cardiotoxicity is an underrecognized manifestation 1.

Diagnosis

  • Neurologic symptoms are common 1.
  • Cardiotoxicity may present with hypotension (75.0%) and bradycardia (67.6%) 1.
  • Electrocardiogram abnormalities can include sinus bradycardia (35.9%) and atrioventricular blocks (15.4%) 1.

    • Management

  • Symptomatic treatments are utilized 1.
  • Atropine, dopamine, and epinephrine are commonly used 1.
  • Intensive care unit admission is infrequently required (4.1%) 1.

    • Key Recommendations

  • Recognize cardiotoxicity as a potential manifestation of ciguatera poisoning, characterized by hypotension and bradycardia 1. (Evidence: Moderate)
  • Consider symptomatic treatment with agents such as atropine, dopamine, and epinephrine for cardiotoxic effects 1. (Evidence: Weak)

    • References

    1 Morihara C, Yinadsawaphan T, Capirig CJ, Fujiuchi B, Hirao Y, Hu J et al.. Clinicoepidemiological Profile of Ciguatera Cardiotoxicity: A Systematic Review. The American journal of tropical medicine and hygiene 2024. link 2 Rougerie F, Bagnis R. Bursts of ciguatera and endo-upwelling process on coral reef. Bulletin de la Societe de pathologie exotique (1990) 1992. link

    Original source

    1. [1]
      Clinicoepidemiological Profile of Ciguatera Cardiotoxicity: A Systematic Review. — Morihara C, Yinadsawaphan T, Capirig CJ, Fujiuchi B, Hirao Y, Hu J et al. The American journal of tropical medicine and hygiene (2024)
    2. [2]
      Bursts of ciguatera and endo-upwelling process on coral reef. — Rougerie F, Bagnis R Bulletin de la Societe de pathologie exotique (1990) (1992)
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