Tue, Apr 03, 2007 - Page 16 News List

The revenge of the fishes

Despite their gastronomic cache, eating reef fish may cost you more than you are prepared to pay


Should global warming and pollution worsen and boost ciguatera poisonings, as most experts predict, health officials will face a daunting challenge.

Currently, there is no reliable way to detect whether a fish has ciguatera. The molecule is extremely complex and differs markedly from region to region.

There also is no antidote.

Furthermore, doctors are often ill-equipped to diagnose ciguatera, which has a range of symptoms and is sometimes misdiagnosed as chronic fatigue syndrome or other maladies.

Those challenges faced Edgar Portigo at Doctors General Hospital in Iloilo, about 430km southeast of Manila, when the Roa family and others arrived. The emergency room was filling with patients yelping in pain, vomiting, or, in the case of Dabby Roa, so paralyzed that he had to be carried in by a security guard.

"Normally, you have one or two emergency cases. Here we had 30 plus all at once,'' from ages 4 to 65, Portigo said.

At first, Portigo surmised the patients had heavy metal poisoning. But when he learned of the common thread — the barracuda dinners — he sent a sample of the fish to Manila for testing. It came back positive for ciguatera.

Portigo gave his patients intravenous drips and a diuretic to relieve their suffering. Most like Roa were released from the hospital in a week, he said, and fully recovered.

"Although this is quite rare, it can happen anytime,'' said Portigo, noting this was the first ciguatera outbreak in the city.

A relatively quick recovery is the norm, but some have lingering symptoms.

Dennis McGillicuddy, a 65-year-old retired cable television company owner from Sarasota, Florida, fell sick a few hours after eating a mutton snapper he caught off the coast of Bermuda in 2000.

Within hours, his vomiting and diarrhea were so severe that he became delirious and was "reduced to crawling," he recalled.

The digestive symptoms lasted two weeks. After that, McGillicuddy became so sensitive to temperature extremes that it was hard to take a shower. Numbness in his extremities lasted for almost a year.

"I've never had anything like this," said McGillicuddy, who still occasionally feels tingling in his left arm. "You feel terrible all over your body."

The US Food and Drug Administration and others who monitor ciguatera say they are hampered by the lack of a reliable test. Bans on certain fish or "hot spots" can help, but they often are impractical.

"It's very hard to manage," said professor Richard Lewis, of the University of Queensland in Australia, who has studied ciguatera. "Unless you don't eat the fish, you have a risk of getting ciguatera."

Poorer countries often lack even rudimentary measures to protect consumers. Those precautions that do exist are undermined by government corruption or lack of enforcement.

Hong Kong has refused to enact mandatory measures to prevent ciguatera despite increased outbreaks. It argues that educating consumers and traders is the answer, rejecting calls to crack down on traders or ban fish from suspect areas.

"Given the fact we eat so much seafood in Hong Kong, this should be one of the priorities in protecting the population," Sadovy said. "I just hope we don't have to wait for someone to die before something is done."

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