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contaminated fish = painful intercourse?!?! WTF!?!?

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contaminated fish = painful intercourse?!?! WTF!?!?

Old 04-03-2009, 06:06 AM
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Default contaminated fish = painful intercourse?!?! WTF!?!?

The Admiral is an infectious disease practitioner and often gets these alerts through a professional
association...thought this one was particularly interesting and relevant to the gang here...the underline
and bold font is my emphasis...



CIGUATERA TOXIN, 2007 - USA: (NORTH CAROLINA), UNUSUAL SYMPTOMS
************************************************** *************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 27 Mar 2009
Source: MMWR 2009;58:283-285
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5811a3.htm>


Cluster of Ciguatera Fish Poisoning - North Carolina, 2007
----------------------------------------------------------
Ciguatera fish poisoning (CFP) is a distinctive type of foodborne
disease that results from eating predatory ocean fish contaminated
with ciguatoxins. As many as 50 000 cases are reported worldwide
annually, and the condition is endemic in tropical and subtropical
regions of the Pacific basin, Indian Ocean, and Caribbean. In the
USA, 5-70 cases per 10 000 persons are estimated to occur yearly in
ciguatera-endemic states and territories (1). CFP can cause
gastrointestinal symptoms (nausea, vomiting, abdominal cramps, or
diarrhea) within a few hours of eating contaminated fish. Neurologic
symptoms, with or without gastrointestinal disturbance, can include
fatigue, muscle pain, itching, tingling, and (most
characteristically) reversal of hot and cold sensation. This report
describes a cluster of 9 cases of CFP that occurred in North Carolina
in June 2007. Among the 9 patients, 6 experienced reversal of hot and
cold sensations, 5 had neurologic symptoms only, and overall symptoms
persisted for more than 6 months in 3 patients. Among 7 patients who
were sexually active, 6 patients also complained of painful
intercourse. This report highlights the potential risks of eating
contaminated ocean fish. Local and state health departments can train
emergency and urgent care physicians in the recognition of CFP and
make them aware that symptoms can persist for months to years.

On 28 Jun 2007, a woman and her husband (the index couple), both aged
31 years, were treated at a hospital emergency department for illness
that developed within 24 hours after eating amberjack fish purchased
from a local fish market and cooked at their home. Diagnoses of CFP
were based on symptoms of mild diarrhea 4-12 hours after eating fish,
followed by reversal of hot and cold sensation, abnormal skin
sensations, and other neurologic symptoms within 24 hours. Both
patients improved after treatment with intravenous mannitol, a
long-standing treatment for CFP neurologic symptoms.

Upon notification, investigators from the Food and Drug Protection
Division of the North Carolina Department of Agriculture and Consumer
Services contacted the fish market that sold the amberjack filets and
discovered that 7 of 8 persons at a local dinner party also had
become ill after eating amberjack from the same shipment. The person
who did not become ill was a young child who did not eat any fish.

For the subsequent investigation, a case was defined as illness with
gastrointestinal or neurologic symptoms within 72 hours of eating
amberjack purchased at the fish market in June 2007. The 9 patients
whose illnesses met the case definition included 3 males and 6
females, aged 31-44 years (median: 37 years). Patients became ill
4-48 hours (median: 12 hours) after eating the fish. Abnormal skin
sensations, joint pains, or weakness, shakiness, or fatigue affected
7 patients (Table [for table, see original URL - Mod.LL]). For 3
persons, symptoms reappeared or worsened after alcohol consumption. 6
of 7 sexually active patients (2 males and 4 females) also reported
painful intercourse as a symptom. Both males described painful
ejaculation with intercourse. One male stated that ejaculation was
painful during the course of one week; the duration of the 2nd male's
genitourinary symptoms was not reported. All 4 females described
having a burning sensation during intercourse and 15 minutes to 3
hours after intercourse. 2 females reported that burning sensations
associated with intercourse continued for 1 month. Severity of
illness could not be related to the amount of amberjack consumed nor
to the incubation period.

Symptoms (i.e., abnormal skin sensations, itching, fatigue, or
altered heat-cold sensation) lasted at least one month in all 9
patients, but cleared within 6 months in 6 of the patients. Abnormal
skin sensations persisted for 6-12 months in one patient; one year
after onset of their CFP illnesses, 2 of the 9 patients were still
experiencing occasional symptoms of abnormal skin sensations, and one
of those was easily fatigued.

Samples of cooked amberjack were sent to the Food and Drug
Administration (FDA) Gulf Coast Seafood Laboratory in Dauphin Island,
Alabama, for ciguatoxin analysis. Acetone extracts of fish tissue
were analyzed for ciguatera-related toxins using the sodium
channel-specific mouse neuroblastoma assay with Caribbean
ciguatoxin-1 (C-CTX-1) as a standard (2). A level of 0.6 ng C-CTX-1
equivalents per gram (0.6 ppb) of fish flesh was found in both fish
samples, and C-CTX-1 was confirmed by liquid chromatography/mass spectrometry.

The 1st female patient had become symptomatic within 24 hours of
eating the fish. She proactively collected, stored frozen, and
submitted 4 breast milk samples for testing at the FDA laboratory
because she was breastfeeding her infant and, upon researching CFP on
the Internet and speaking with a Florida physician who had treated
cases of CFP, had learned that breast milk might be a transmission
vehicle. Against medical advice, she continued to breastfeed, but her
infant, aged 8 months, exhibited no observable adverse effects. She
collected a breast milk samples previous to eating the amberjack and
the other samples at one, 2, and 5 days after eating the fish. No
activity of C-CTX-1 was reported by the FDA laboratory in any of the
breast milk samples.

Traceback of the fish responsible for this cluster of CFP cases
revealed that the fish was shipped to the local fish market via a
seafood distributor in Atlanta, Georgia. The amberjack had been
caught off the Islamorada Hump in the Florida Keys.

[Byline: Langley R, Shehee M, MacCormack N, et al.]

Editorial Note:
---------------
Ciguatoxins are lipid-soluble cyclic polyether compounds and are the
most potent sodium channel toxins known (3). Carnivorous tropical and
semitropical fish, such as barracuda, amberjack, red snapper, and
grouper, become contaminated with ciguatoxins by feeding on
plant-eating fish that have ingested _Gambierdiscus toxicus_ or
another member of the _Gambierdiscus_ genus, a group of large
dinoflagellates commonly found in coral reef waters (4).
Gambiertoxins from _Gambierdiscus spp._ are converted into more
potent lipid-soluble ciguatoxins. Spoilage of fish that have been
caught is not a factor in toxin development, and cooking does not
deactivate the toxin. Humans who eat contaminated predatory fish are
exposed to variable concentrations of ciguatoxin, depending on the
fish size, age, and part consumed (toxins concentrate more in the
viscera, especially liver, spleen, gonads, and roe). The attack rate
can be as high as 80 to 90 percent in persons who eat affected fish,
depending on the amount of toxin in the fish.

This cluster was unusual because 6 of the 7 sexually active patients
reported onset of painful intercourse beginning in the 1st few days
after onset of illness. Sexual transmission of ciguatoxin has been
documented (5), and painful intercourse has been reported (6);
however, painful intercourse is not commonly described as a
consequence of CFP. Because all of the patients ate fish and
developed other symptoms of CFP hours and days before experiencing
painful intercourse, transmission through sexual intercourse was not
considered likely in this cluster.

CFP has been associated almost exclusively with eating fish caught in
tropical or semitropical waters, but increased global marketing of
these species has increased the possibility that persons in temperate
zones might become ill with CFP (4). Moreover, warming seawaters
might expand the ranges of ciguatoxin-contaminated fish (8). In the
USA, such fish have been found as far north as the coastal waters of
North Carolina. Despite underreporting, CFP now is considered one of
the most common illnesses related to fish consumption in the United States (9).
Old 04-03-2009, 07:11 AM
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Originally Posted by happyjack92 View Post
The Admiral is an infectious disease practitioner and often gets these alerts through a professional
association...thought this one was particularly interesting and relevant to the gang here...the underline
and bold font is my emphasis...
I've seen people suffer from this disease and its devastating. It can cause a slow and painful death. I know a fish biologist who believes this disease has been in NC waters for many years now. Fortunately, it is pretty rare.
Old 04-03-2009, 07:22 AM
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Nothing new, coral reef fish will have it mostly barracuda from eating sick reef fish. Not normaly found along the Atlantic coast of the US.

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