Serious neurological manifestations of ciguatera: is the delay unusually long?

Ciguatera poisoning is the commonest fish food poisoning encountered in tropical islands, especially in the Pacific.1 The disease is usually benign, with gastrointestinal and cutaneous manifestations which resolve spontaneously within a few hours. However, serious forms of this fish poisoning, with cardiovascular and neurological disorders, have been described.1-3 The ciguatoxins involved in ciguatera disturbances are competitive inhibitors of the brevetoxins and have a common binding site on neuronal voltage dependent sodium channels.4 Even if their action remains partially understood a prolonged axonal sodium channel activation, by contrast with other fish toxins (tetrodotoxin for instance), is now described as the main mechanism by most authors.4 We present the results of the retrospective analysis of ciguatera cases admitted to Gaston Bourret hospital (Noumea, …