It's the most common form of fish-related food poisoning in the world, and according to a new study published online in the American Journal of Tropical Medicine and Hygiene, it just became even more common in the state of Florida.
It's called ciguatera, and it's caused by a tiny micro-algae that grows on reefs in warmer waters including the Atlantic, Caribbean, Indian and Pacific oceans.
Affected fish include popular sport fish like grouper, amberjack, barracuda, but according to the Florida Department of Health, 400 known fish species, like snapper, tuna, eel, sea bass, hogfish, and mackerel have been classified as potential ciguatoxin carriers.
Based on a survey of thousands of recreational saltwater anglers across the state, researchers at the University of Florida's Emerging Pathogens Institute and the Florida Department of Health believe the annual incidence of ciguatera poisoning is about 5.6 cases per 100,000 people. Previous estimates were at only .2 cases per 100,000.
In Monroe County, where the Florida Keys are located, the numbers rise to 84 per 100,000, and illness in Miami-Dade, was at 28 per 100,000.
The symptoms of ciguatera poisoning can begin within hours of eating the contaminated fish. They can include severe nausea and vomiting, joint and muscle pain and neurological symptoms like tingling in the hands or feet, and a reversal of hot/cold sensations.
Cooking and freezing does not destroy the toxin and there is no way to determine if the fish is contaminated because there is no distinct smell or discoloration.
If you develop the symptoms, it's important to call the poison information center and see a physician quickly, because a medication, mannitol, must be administered within the first 24 hours. They also ask that you save a portion of the fish meal, if possible, for analysis.
These researchers do not believe that ciguatera poisoning is on the rise; rather, they believe it is likely under-reported because not all cases were seen by physicians or it may not have been distinguished from other types of food poisoning.
Because this was a survey of fishermen, there is also the chance that some of these self-identified cases were caused by something else.
While the vast majority of cases are transmitted by eating contaminated fish, there has been a report of a mother-child transmission while breastfeeding.