2. * Ciguatera * Scombroid * Shellfish Poisoning

3. * Food borne illness caused by dinoflagellates * Gambierdiscus toxicus * The toxin produced is ciguatoxin * Ciguatoxin is orderless, tasteless and very heat stable

4. Ciguatera Bioamplification

5. * Barracudas * Moray eels * Snapper * Groupers * Amberjacks * Triggerfish * Parrotfish

6. * Symptoms usually develop 1–3 hours after eating contaminated fish * They can include nausea, vomiting, diarrhea, and stomach pain * Some people may have neurologic symptoms, such as a tingling sensation, tooth pain or feeling as if the teeth are loose, itching, a metallic taste in the mouth, and blurred vision * Hot-cold reversal

7. * Mannitol used in past – no good evidence of benefit * Symptomatic Rx, IV fluids * Long term sequelae

8. * Food Borne illness caused by high levels of histamine * Caused by fish that have naturally high levels of the amino acid histidine – scombridae family * Bacteria convert histidine to histamine when the fish is not correctly stored * Histamine is heat stable and not destroyed by cooking

9. * Tuna * Mackerel * Mahimahi * Sardines, anchovies, herring * Bluefish * Amberjack * Marlin

10. * Symptoms usually develop within a few minutes to an hour after eating fish * Resemble an allergic reaction, such as flushing of the face, headache, heart palpitations, itching, blurred vision, cramps, and diarrhea * Symptoms can be treated with antihistamines Even without treatment, people usually get better within 12 hours

11. * Contaminated fish may taste peppery, sharp, metallic, or bitter, but it may also look and taste normal. Fish should be iced, refrigerated, or frozen immediately after it is caught.

12. * Brevetoxins

13. * Several forms of shellfish poisoning may occur after ingesting filter-feeding bivalve mollusks (such as mussels, oysters, clams, scallops, and cockles) that contain potent brevetoxins. * Culprit is dinoflagellate blooms called harmful algal blooms (HABs). One example of a HAB is the Florida red tide caused by Karenia brevis.

14. * Neurotoxic * Paralytic * Amnestic

15. * Similar to Ciguatera * Nausea/vomiting/diarrhea * Numbness or tingling in mouth * Headache, dizziness * Hot and cold temperature reversal

16. * 30 minutes after ingestion * Numbness & tingling in mouth * Arms and legs may become temporarily paralyzed

17. * Nausea, vomiting diarrhea * Short-term memory loss

18. * Most recover within 48 hrs * No long-term sequelae reported * IV fluids, sedatives, pain management

19. Ciguatera Scombroid Shellfish Poisoning