Ciguatera fish poisoning
Classification and external resources
Chemical structure of the ciguatoxin-CTX1B
ICD-10	T61.0
ICD-9	988.0
DiseasesDB	31122
MedlinePlus	002851
eMedicine	emerg/100 ped/403

Ciguatera is a foodborne illness caused by eating certain reef fish whose flesh is contaminated with toxins originally produced by dinoflagellates such as Gambierdiscus toxicus which lives in tropical and subtropical waters. These dinoflagellates adhere to coral, algae and seaweed, where they are eaten by herbivorous fish who in turn are eaten by larger carnivorous fish. In this way the toxins move up the food chain and bioaccumulate. Gambierdiscus toxicus is the primary dinoflagellate responsible for the production of a number of similar toxins that cause ciguatera. These toxins include ciguatoxin, maitotoxin, scaritoxin and palytoxin. Predator species near the top of the food chain in tropical and subtropical waters, such as barracudas, snapper, moray eels, parrotfishes, groupers, triggerfishes and amberjacks, are most likely to cause ciguatera poisoning, although many other species cause occasional outbreaks of toxicity. Ciguatoxin is very heat-resistant, so ciguatoxin-laden fish cannot be detoxified by conventional cooking.^[1][2]

Researchers suggest that ciguatera outbreaks caused by cooling climatic conditions propelled the migratory voyages of Polynesians between 1000 and 1400.^[3][4]

Signs and symptoms[link]

Hallmark symptoms of ciguatera in humans include gastrointestinal and neurological effects.^[5][6] Gastrointestinal symptoms include nausea, vomiting, and diarrhea, usually followed by neurological symptoms such as headaches, muscle aches, paresthesia, numbness, ataxia, vertigo, and hallucinations.^[1][6] Severe cases of ciguatera can also result in cold allodynia, which is a burning sensation on contact with cold (commonly incorrectly referred to as reversal of hot/cold temperature sensation).^[5] Doctors are often at a loss to explain these symptoms and ciguatera poisoning is frequently misdiagnosed as multiple sclerosis.^[7]

Dyspareunia and other ciguatera symptoms have developed in otherwise healthy males and females following sexual intercourse with partners suffering ciguatera poisoning, signifying that the toxin may be sexually transmitted.^[8] Diarrhea and facial rashes have been reported in breastfed infants of poisoned mothers, suggesting that ciguatera toxins migrate into breast milk.^[9]

The symptoms can last from weeks to years, and in extreme cases as long as 20 years, often leading to long-term disability.^[10] Most people do recover slowly over time.^[11] Often patients recover, but symptoms then reappear. Such relapses can be triggered by consumption of nuts, seeds, alcohol, fish or fish-containing products, chicken or eggs, or by exposure to fumes such as those of bleach and other chemicals. Exercise is also a possible trigger.^[1] Filipino and Chinese people may possibly be more susceptible.^[1]

Detection methods[link]

Scientific detection[link]

Currently, multiple laboratory methods are available to detect ciguatoxins, including liquid chromatography-mass spectrometry (LCMS), receptor binding assays (RBA), and neuroblastoma assays (N2A). Although testing is possible, in most cases liquid chromatography-mass spectrometry is insufficient to detect clinically relevant concentrations of ciguatoxin in crude extracts of fish.

Folk detection[link]

In Northern Australia, where ciguatera is a common problem, two different folk science methods are widely believed to detect whether fish harbor significant ciguatoxin. The first method is that flies will not land on contaminated fish. The second is that cats display symptoms after eating contaminated fish. A third, less common testing method involves putting a silver coin under the scales of the suspect fish. Only if the coin turns black, is it contaminated. It is not known whether any of these tests produce accurate results.

Folk remedies[link]

Various Caribbean naturopathic and ritualistic treatments originated in Cuba and nearby islands. The most common old-time remedy involves bed rest subsequent to a guanabana juice enema.^{[citation needed]} Other folk treatments range from directly porting and bleeding the gastrointestinal tract to "cleansing" the diseased with a dove during a Santería ritual^{[citation needed]}. In Puerto Rico, natives drink a tea made from mangrove buttons, purportedly high in B Vitamins, to flush the toxic symptoms from the system^{[citation needed]}. The efficacy of these treatments has never been studied or substantiated.

An account of ciguatera poisoning from a linguistics researcher living on Malakula island, Vanuatu, indicates the local treatment: "We had to go with what local people told us: avoid salt and any seafood. Eat sugary foods. And they gave us a tea made from the roots of ferns growing on tree trunks. I don't know if any of that helped, but after a few weeks, the symptoms faded away."^[12]

Treatment[link]

There is no effective treatment or antidote for ciguatera poisoning. The mainstay of treatment is supportive care. There is some evidence that calcium channel blocker type drugs such as Nifedipine and Verapamil are effective in treating some of the symptoms that remain after the initial sickness passes, such as poor circulation and shooting pains through the chest. These symptoms are due to the cramping of arterial walls caused by maitotoxin^{[6][13][14][15]} Ciguatoxin lowers the threshold for opening voltage-gated sodium channels in synapses of the nervous system. Opening a sodium channel causes depolarization, which could sequentially cause paralysis, heart contraction, and changing the senses of hearing and cold. Nifedipine is a calcium channel blocker.^[6] Some medications such as Amitriptyline may reduce some symptoms, such as fatigue and paresthesia,^[16] although benefit does not occur in every case.^[17] Steroids and vitamin supplements support the body's recovery rather than directly reducing toxin effects.

Mannitol was once used for poisoning after one study reported symptom reversal.^[6][18] Followup studies in animals^[19] and case reports in humans^[20] also found benefit from mannitol. However, a randomized, double-blind clinical trial found no difference between mannitol and normal saline,^[21] and based on this result, mannitol is no longer recommended.^[5]

Epidemiology[link]

Due to the limited habitats of ciguatoxin-producing microorganisms, ciguatera is common in only subtropical and tropical waters, particularly the Pacific and Caribbean, and usually is associated with fish caught in tropical reef waters.^[5] Ciguatoxin is found in over 400 species of reef fish. Avoiding consumption of all reef fish (any fish living in warm tropical waters) is the only sure way to avoid exposure.^[2] Imported fish served in restaurants may contain the toxin and to produce illness which often goes unexplained by physicians unfamiliar with the symptoms of a tropical toxin.^[2][22] Ciguatoxin can also occur in farm-raised salmon.^[23] Furthermore, species substitution, labeling a reef fish as a non-reef fish at restaurants and retail, can complicate efforts by consumers to avoid ciguatera.

In 2007, ten people in St. Louis, Missouri developed the disease after eating imported fish.^[24]

In February 2008, the U.S. Food and Drug Administration (FDA) traced several outbreaks to the Flower Garden Banks National Marine Sanctuary in the northern Gulf of Mexico, near the Texas–Louisiana shoreline. The FDA advised seafood processors that ciguatera poisoning was "reasonably likely" to occur from eating several species of fish caught as far as 50 miles (80 km) from the sanctuary.^[25]

In Q1 2012, two restaurants in Lanzarote are thought to have been the source of ciguatera poisoning, leading to new fishing regulations issued 18 April 2012. The first outbreak was reported after eating amberjack in February 2012. The diners suffered with vomiting, diarrhoea and abdominal pain several hours later. The second case was in early April affecting six people who live in Lanzarote and had all eaten amberjack at a local restaurant. ^[26]

History[link]

Ciguatera was first described by one of the surgeon's mates, William Anderson, on the crew of HMS Resolution in 1774. (NY Times incorrectly gives his name as John) ^[27]

See also[link]

• Algal bloom
• Dinoflagellate (see "neurotoxins" and "red tide" under Ecology and fossils and see "phosphate" under Life Cycle)
• Red tide
• Yessotoxin

Footnotes[link]

References[link]

• Ciguatera fish poisoning CDC
• Ciguatera fish poisoning—Florida, 1991. MMWR June 4, 1993;42(21):417-8
• Ciguatera fish poisoning—Texas, 1997. MMWR August 28, 1998;47(33):692-4
• Epidemiologic notes and reports ciguatera fish poisoning—Bahamas, Miami. MMWR July 23, 1982;31(28):391-2
• Epidemiologic notes and reports ciguatera fish poisoning—Vermont. MMWR April 25, 1986;35(16):263-4
• Ciguatera fish poisoning

v t e Plankton About plankton Algal bloom CLAW hypothesis High lipid content microalgae Holoplankton Meroplankton Milky seas effect Paradox of the plankton Planktology Red tide Spring bloom Thin layers More... By size Eukaryotic picoplankton Heterotrophic picoplankton Microphyte (microalgae) Nanophytoplankton Photosynthetic picoplankton Picobiliphyte Picoeukaryote Picoplankton Bacterioplankton Bacteriastrum Aeromonas salmonicida Cyanobacteria Cyanobiont Cyanotoxin Enteric redmouth disease Flavobacterium Flavobacterium columnare Pelagibacter ubique Marine bacteriophage SAR11 clade Streptococcus iniae Phytoplankton Auxospore Axodine Chaetoceros Chaetocerotaceae Coccolithophore Emiliania huxleyi Eustigmatophyte Frustule Heterokont Nannochloropsis Navicula Prasinophyceae Raphidophyte Thalassiosira pseudonana Diatom orders Centrales Pennales (Classes: Coscinodiscophyceae Fragilariophyceae Bacillariophyceae) Flagellates Brevetoxin Choanoflagellates Dinoflagellates Flagellum Pfiesteria piscicida Saxitoxin Velvet (fish disease) Zooxanthella Zooplankton Chaetognatha Ciguatera Ctenophora Gelatinous zooplankton Hunting copepods Ichthyoplankton Jellyfish Marine larvae Crustacean larvae Salmon louse Sea louse Copepod orders Calanoida Cyclopoida Harpacticoida Monstrilloida Poecilostomatoida Siphonostomatoida More... Related topics Aeroplankton Algaculture Algal mat Algal nutrient solutions Artificial seawater Autotrophs Biological pump Diel vertical migration Dimethylsulfoniopropionate f-ratio Fish diseases and parasites Heterotroph Macroalgae Manta trawl Marine mucilage Microbial mat Ocean acidification Primary production Stromatolite Tychoplankton Zoid C-MORE CPR AusCPR MOCNESS SCAR

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Juan Luis Guerra
Juan Luis Guerra during a concert in Boston, Massachusetts.
Background information
Birth name	Juan Luis Guerra Seijas
Born	(1957-06-07) June 7, 1957 (age 55)
Origin	Santo Domingo, Dominican Republic
Genres	Merengue, bachata, salsa, Latin pop
Occupations	Record producer, songwriter, musician, composer, arranger, guitarist
Instruments	Vocals, guitar, piano
Years active	1984–present
Labels	EMI Records
Associated acts	Juanes, Enrique Iglesias, 440
Website	www.juanluisguerra.com

Juan Luis Guerra (born June 7, 1957) is a singer, songwriter and producer from the Dominican Republic who has sold over 30 million records, and won numerous awards including 12 Latin Grammy Awards, two Grammy Awards, and two Latin Billboard Music Awards. He recently won 3 Latin Grammy Awards in 2010, including Album of the Year.

He is one of the most internationally recognized Latin artists of recent decades. His pop style of merengue and bolero and Afro-pop/Latin fusion has garnered him considerable success throughout Latin America. Guerra is sometimes associated with the popular Dominican music called bachata, and while this association is partly true, he actually uses the basics of Bachata rhythm with a more bolero feel to the melodies in some of his songs.^[1] He does not limit himself to one style of music, instead, he incorporates diverse rhythms like merengue, bolero-bachata, balada, salsa, rock and roll, and even gospel as in the song "La Gallera". "Ojalá Que Llueva Café" ("I Wish It Would Rain Coffee") is one of his most critically acclaimed self-written and composed pieces. A remix of "La Llave de Mi Corazón" ("The Key of My Heart") with Taboo from The Black Eyed Peas is also an example of his fusion of genres.

Career[link]

Early life[link]

Born Juan Luis Guerra Seijas in Santo Domingo, Dominican Republic, he is the son of Olga Seijas and Gilberto Guerra, a basketball player. Before he committed to music, Guerra studied philosophy and literature at the Universidad Autónoma de Santo Domingo. He then studied guitar and music theory at El Conservatorio Nacional de Música de Santo Domingo, then decided to go to the United States to attend Berklee College of Music in Boston. He graduated from Berklee in 1982 with a diploma in jazz composition.^[2] After his return to the Dominican Republic, he released his first album, Soplando (1984) with a group of local musicians that subsequently became known as Juan Luis Guerra y 440. The group members were Maridalia Hernández, Roger Zayas-Bazán, and Mariela Mercado. The band's name in Spanish is officially publicized as Cuatro Cuarenta (Four Forty), a shortening of the normally strict reading of number "four hundred forty". The 440 part of the band's name refers to the standard tuning of A440. Reportedly the name for the band came from a practice session where Juan Luis's brother suggested the name because the name would reflect how "in-tune and precise they were".^{[citation needed]} According to Guerra, this first album was based on jazz tunes and concepts he had learned at Berklee, and it "wasn't intended to be a commercial hit." Subsequently, however, he began to write more merengues.^[2]

Two albums followed, Mudanza y Acarreo and Mientras Más Lo Pienso...Tú. The band was nominated to attend the Festival of OTI (Organization of Iberoamerican Television) to represent the Dominican Republic.

Their next album, in 1989, brought them international acclaim. Ojalá Que Llueva Café, a slow melodic number with superfast background tracks, became a number one hit in many Latin American countries, with the hit song of the same name. Subsequently, a video of the song was filmed and Juan Luis Guerra and his 440 band began touring. (The song's fame was revived in 1996 and 2008 with covers by Mexican band Café Tacuba and Spanish singer Rosario Flores.)

1990s[link]

In 1990, they released their next album, Bachata Rosa, which became a major hit and earned Guerra his first Grammy award. The album, having sold more than five million copies at that time, allowed Guerra to keep touring Latin America, USA and Europe. This album contains memorable love songs such as "Burbujas de Amor" (Bubbles of Love), "Bachata Rosa", "Rosalia", "Como Abeja al Panal" (Like a Bee to Honeycomb), "A Pedir Su Mano" (Asking For Her Hand), "Carta de Amor" (Love Letter), and "Estrellitas y Duendes" (Little stars and elves).

Guerra became a controversial figure in 1992 after he released his next album, Areíto (which is a Taíno word for song and dance). It featured the hit single "El costo de la vida", (The Cost of Living), whose video clearly has an anti-capitalist message. Other songs included in this album protest against the poor conditions in many Latin American countries, the celebration of the 'discovery' of the Americas ("1492"), and the double standards of first-world nations. "El costo de la vida" was his first number-one hit in the Hot Latin Tracks. Guerra became the first performer of tropical music to achieve this feat.

In his next album, Fogaraté (1995), he stayed away from recording any protest songs. This album is particularly centered in the more rural and lesser known types of Dominican music, like the Perico Ripiao.

Guerra's 1998 release Ni Es Lo Mismo Ni Es Igual (Neither The Same Nor Equal) garnered much critical acclaim, winning three Latin Grammys in 2000 for Best Merengue Performance, Best Tropical Song, and Best Engineered Album. Its hits include "Mi PC" (My PC), "Palomita Blanca" (Little White Dove), and "El Niágara en Bicicleta" (The Niagara on Bicycle - literal; to ride a bicycle across Niagara Falls, i.e. a difficult task - coloquial "al pasar el Niagara en bicicleta", Cuban).

Juan Luis Guerra in concert in Madrid, Spain, during the Para ti tour. July 2005.

2000s[link]

In 2003, Guerra released his first new album in six years. Entitled "Para Ti" (For you), the album's songs are mostly religious in nature, reflecting Guerra's fervent Christianity. With this album the singer won two awards at the 2005 Billboards, in the categories of Gospel-Pop and Tropical-Merengue, for the hit single Las Avispas (The wasps), the first time ever that one song has won these two categories at the same time. Other hits included "Para Ti" and "Soldado" (Soldier). At the same time, Guerra was honored with the Latino Special Award for the Music Academy of Spain for his contributions to the music of his country and the Caribbean in the last 20 years.

In January 2006, Juan Luis performed at Berklee's 60th anniversary along with other artists such as Paul Simon, Herbie Hancock, Michel Camilo and Chiara Civello. That same year, he recorded with Diego Torres in "Abriendo Caminos" (Opening roads) and with Maná in "Bendita Tu Luz" (Blessed your light).

Notably, Juan Luis Guerra was part of the former highest grossing music tour of all time,(U2's 360 tour is currently the highest grossing music tour of all time) as he was the opening act for The Rolling Stones' A Bigger Bang Tour at their San Juan, Puerto Rico show in February, 2006.

He was also invited by Sting to sing with him at a concert at Altos de Chavón, La Romana in the Dominican Republic in 2006. At the Premio Lo Nuestro awards in 2007, he was given the honorary lifetime achievement award. He also performed the lead single of his new album, "La Llave De Mi Corazón", released in March 2007.

"La llave de mi corazón" reached number one on the Billboard charts for four consecutive weeks, and was the #1 selling album in Colombia while climbing the charts in other countries^{[citation needed]}. Guerra won more than 20 awards with this CD, including 5 Latin Grammy Awards, 6 Premios Casandra awards, 4 billboard Awards, 2 lo nuestro, and one Grammy Award.

On April 6, 2006, Juan Luis Guerra was honored as a BMI Icon at the 13th annual BMI Latin Awards. Named BMI's 1995 Latin Songwriter of the Year, Guerra's songwriting has garnered 14 BMI Latin Awards.^[3]

Juan Luis Guerra was honored at the Latin Grammy Awards in 2007 with 5 awards, sweeping each category he was nominated in: Record of the Year, Album of the Year, Song of the Year, Best Tropical Song & Best Merengue Album. The engineers of the album, Allan Leschhorn, Luis Mansilla, Ronnie Torres, and Adam Ayan were awarded Best Engineered album. One night prior to the Latin Grammy Awards he received the Academy's Person of the Year Award for his contribution to Latin music and for his philanthropy.

On March 10, 2008, Juan Luis was honored with 6 awards in los Premios Casandra, the most important award event in the Dominican Republic. He won for Orchestrator of the year, Outstanding artist abroad, Music album of the year for "La Llave de mi Corazón" and "El Soberano" (The Sovereign), the most important award of the night.

On March 16, 2008 He and other artists participated in the Paz Sin Fronteras concert raised by Juanes, because of the conflict in recent days between Colombia, Venezuela and Ecuador.

On April 11, 2008 Juan Luis Guerra was the Billboard Latin awards big winner, with 7 nominations and 3 awards.

On September 15, 2008 Guerra was named a UNESCO Artist for Peace "in recognition of his efforts for the benefit of children with disabilities and children in need."^[4]

On May 9, 2009, Guerra was awarded an honorary doctorate from his alma mater, Berklee College of Music at its commencement ceremony.

2010 Juan Luis Guerra was featured in Enrique Iglesias' Spanish single, Cuando Me Enamoro, and appeared with Iglesias in the music video. The single has currently spent 17 non-consecutive weeks at #1, the longest tenure at the peak position for both artists. In addition, the single was a self-replacement at #1 for Guerra as it replaced his own single Bachata en Fukuoka from his album A Son de Guerra.

Singing in other languages[link]

Guerra has recorded several songs in English, like "July 19th" on his Fogaraté release (1995), and more recently "Medicine for My Soul" and "Something Good" with Italian singer Chiara Civello. Some of his songs have verses in both English and Spanish such as "Woman del Callao", "Guavaberry", "Señorita" and more recently "La Llave de Mi Corazón". Album Areíto featured two songs, cover-title song "Areíto" and "Naboria daca, mayanimacaná" which are sung in the Arawak language of the extinct Taino natives of Hispaniola. Juan Luis Guerra also recorded the album "Bachata Rosa" in Portuguese. He uses Japanese words in Bachata en Fukuoka (Bachata in Fukuoka), 2010 Latin Grammy winner for Best Tropical Song.

Lyrical style[link]

Being a native Dominican, his music is heavily influenced by native Caribbean rhythms, such as merengue and bachata.

His lyrics are often charged with intentionally simple, heavily metaphorical, erotic, or popular expressions, such as "Burbujas de Amor" (Bubbles Of Love) or "El Niágara en Bicicleta" (Niagara on Bicycle), an idiom for something difficult to do.

Discography[link]

Singles[link]

440 band members[link]

• Roger Zayas
• Maridalia Hernández
• Mariela Mercado
• Marco Hernández (replaced Maridalia Hernández)
• Adalgisa Pantaleón (replaced Mariela Mercado)
• Quico Rizek (replaced Marco Hernández)

Quotation[link]

This section is a candidate to be copied to Wikiquote using the Transwiki process.

We write for our home audience. We play music that appeals to those at home, a music that feels natural and intuitive.^[7]

References[link]

Bibliography[link]

• Manuel, Peter. Caribbean Currents: Caribbean Music from Rumba to Reggae. 

External links[link]

Wikimedia Commons has media related to: Juan Luis Guerra

• Official website in English and Spanish.
• Biography of Juan Luis Guerra With particular focus on his relationship to bachata.
• Juan Luis Guerra at National Geographic World Music
• Juan Luis Guerra Online Scholarship from Berklee College of Music
• Juan Luis Guerra at the Internet Movie Database
• Encarta bio (Archived 2009-10-31)