Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs), diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future directions, and recommendations for clinicians and patients. It updates and expands upon the previous review of CFP published by Friedman et al. (2008) and addresses new insights and relevant emerging global themes such as climate and environmental change, international market issues, and socioeconomic impacts of CFP. It also provides a proposed universal case definition for CFP designed to account for the variability in symptom presentation across different geographic regions. Information that is important but unchanged since the previous review has been reiterated. This article is intended for a broad audience, including resource and fishery managers, commercial and recreational fishers, public health officials, medical professionals, and other interested parties.

Climate change-related ocean warming and reduction in Arctic sea ice extent, duration and thickness increase the risk of toxic blooms of the dinoflagellate Alexandrium catenella in the Alaskan Arctic. This algal species produces neurotoxins that impact marine wildlife health and cause the human illness known as paralytic shellfish poisoning (PSP). This study reports Paralytic Shellfish Toxin (PST) concentrations quantified in Arctic food web samples that include phytoplankton, zooplankton, benthic clams, benthic worms, and pelagic fish collected throughout summer 2019 during anomalously warm ocean conditions. PSTs (saxitoxin equivalents, STX eq.) were detected in all trophic levels with concentrations above the seafood safety regulatory limit (80 μg STX eq. 100 g^-1) in benthic clams collected offshore on the continental shelf in the Beaufort, Chukchi, and Bering Seas. Most notably, toxic benthic clams (Macoma calcarea) were found north of Saint Lawrence Island where Pacific walruses (Odobenus rosmarus) are known to forage for a variety of benthic species, including Macoma. Additionally, fecal samples collected from 13 walruses harvested for subsistence purposes near Saint Lawrence Island during March to May 2019, all contained detectable levels of STX, with fecal samples from two animals (78 and 72 μg STX eq. 100 g^-1) near the seafood safety regulatory limit. In contrast, 64% of fecal samples from zooplankton-feeding bowhead whales (n = 9) harvested between March and September 2019 in coastal waters of the Beaufort Sea near Utqiaġvik (formerly Barrow) and Kaktovik were toxin-positive, and those levels were significantly lower than in walruses (max bowhead 8.5 μg STX eq. 100 g^-1). This was consistent with the lower concentrations of PSTs found in regional zooplankton prey. Maximum ecologically-relevant daily toxin doses to walruses feeding on clams and bowhead whales feeding on zooplankton were estimated to be 21.5 and 0.7 μg STX eq. kg body weight^-1 day^-1, respectively, suggesting that walruses had higher PST exposures than bowhead whales. Average and maximum STX doses in walruses were in the range reported previously to cause illness and/or death in humans and humpback whales, while bowhead whale doses were well below those levels. These findings raise concerns regarding potential increases in PST/STX exposure risks and health impacts to Arctic marine mammals as ocean warming and sea ice reduction continue.

Clams are efficient vectors of potent algal neurotoxins, a suite of saxitoxin (STX) congeners collectively called paralytic shellfish toxins (PSTs), to higher trophic levels. The Alaskan Arctic is a region facing an expanding threat from PSTs due to ocean warming, yet little is known about PSTs in clams from this region. Quantifying total toxicity in bivalves requires analytical techniques, such as high-performance liquid chromatography (HPLC). Enzyme-linked immunosorbent assays (ELISAs) are an efficient but only semi-quantitative method for measuring clam toxicity. PSTs (STX eq.) were measured in split clam samples (n = 16) from the Alaskan Arctic using ELISA and HPLC methods to develop a preliminary linear model for conservatively estimating total toxicity in clams from ELISA toxin values (R²_adj = 0.95, p < 0.001). Profiles of PST congeners and total toxicity using HPLC were also assessed in additional clams (n = 36 additional, n = 52 total). Clams contained mostly potent PST congeners, and over half of the clams had PST concentrations above the seafood regulatory limit. These data will help assess the exposure risks of PSTs in Arctic marine food webs, as harmful algal bloom activity is predicted to increase as the Arctic continues to warm.

Butter clams (Saxidomus gigantea) are a staple in the subsistence diets of Alaskan Native communities and are also harvested recreationally. This filter–feeding species can accumulate saxitoxins (STXs), potent neurotoxins produced by late spring and summer blooms of the microalga Alexandrium catenella. The consumption of tainted clams can cause paralytic shellfish poisoning (PSP). Traditional beliefs and early reports on the efficacy of removing clam siphons have created the impression that cleaning butter clams by removing certain tissues makes them safe to eat. However, the toxin distribution within clams can vary over time, making the practice of cleaning butter clams unreliable. This study tested the effectiveness of the cleaning methods practiced by harvesters on Kodiak Island, Alaska. Specifically, butter clams were cleaned by removing different tissues to produce samples of “edible” tissues that were tested for STX content. The results were compared to historical data from a study conducted in Southeast Alaska from 1948 to 1949. Using these data, the risk for an average–sized man and woman consuming 200 g of edible tissue was calculated. The results showed that for clams containing >200 µg STX–equivalents 100 g edible tissue⁻¹, no cleaning method reduced the concentration of STXs in the remaining tissue below the regulatory limit. Meals containing >900 µg STX–equivalents 100 g edible tissue⁻¹ posed a substantial risk of moderate or severe symptoms. No cleaning method assured that untested butter clams are safe to eat.