Vergiftung durch Tropenfisch: Ciguatera-Epidemie in Deutschland

Zusammenfassung

Ciguatera ist eine Vergiftung, die durch den Verzehr von mit Ciguatoxinen belasteten tropischen Fischen verursacht wird. Ciguatoxine sind lipophile Polyether, die von benthischen Dinoflagellaten produziert werden und sich über die marine Nahrungskette anreichern. In Europa kommt Ciguatera hauptsächlich bei Reiserückkehrern aus tropischen und subtropischen Endemiegebieten des Pazifiks und der Karibik vor. Im Jahr 2012 gab es in Deutschland jedoch eine kurze Serie von Fällen aufgrund von Import und Verkauf von kontaminierten Fischprodukten, die aus Fanggebieten des Indischen Ozeans stammten. Die Symptome waren in diesen Fällen zwar typisch für Ciguatera: Übelkeit, Erbrechen und Durchfall sowie die typischen neurologischen Symptome wie intensiver Pruritus, Parästhesien, Hypothermie, verändertes Temperaturempfinden und diffuse Schmerzen. Dennoch wurde die richtige Diagnose in allen Fällen verzögert gestellt, weil erstbehandelnden Ärzten die Vergiftung unbekannt war. Angesichts zunehmender globaler Mobilität, internationalen Handels und der wachsenden Ausbreitung benthnischer Dinoflagellaten in bisher nicht-endemische Gebiete muss Ciguatera als mögliche Diagnose in Betracht gezogen werden, wenn Magen-Darm- und neurologische Symptome im Zusammenhang mit Fischverzehr auftreten.

Abstract

Ciguatera is a seafood-borne illness caused by consumption of tropical fish contaminated with ciguatoxins, lipophilic polyethers that are produced in benthic dinoflagellates and accumulate through the marine food chain. Ciguatera cases in Europe usually occur in travellers returning from tropical and subtropical regions of the Pacific and Carribean, where ciguatera is endemic. In 2012, several cases of ciguatera occurred in Germany due to sale of contaminated fish products originating from the Indian Ocean. Although the symptomatology in these cases were typical of ciguatera, with patients reporting gastrointestinal discomfort including nausea, vomiting and diarrhea as well as neurological effects including widespread intense pruritus, paresthesias, hypothermia or altered temperature sensation and diffuse pain, correct diagnosis was delayed in all cases due to lack of awareness of the treating medical practitioners. In light of increasing global mobility, trade, and occurrence of ciguatoxic fish in previously non-endemic areas, ciguatera should be considered as a possible diagnosis if gastrointestinal and neurological symptoms occur shortly after consumption of fish.

Schlüsselwörter

Fischvergiftung - Kaltallodynie - Ciguatoxine - Natriumkanäle

Key Words

seafood intoxication - cold allodynia - ciguatoxins - sodium channels

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