The Department of Health Surveillance in Natal, Brazil has issued an alert following the identification of 13 suspected cases of ciguatera poisoning linked to the consumption of contaminated fish. Authorities advise the public to avoid eating species such as arabaiana and dourado, which are under investigation.

Ciguatera poisoning is a non-contagious foodborne illness from consuming fish harboring ciguatoxins. Improper preparation of fish containing ciguatoxins is the main source of toxin ingestion. Most people exhibit symptoms in a dose-dependent relationship with the amount of toxin consumed.

Symptoms: Ciguatera poisoning can cause gastrointestinal, neurologic, neuropsychiatric, and cardiovascular symptoms. The first symptoms usually develop within 3–6 hours after eating contaminated fish but can be delayed up to 30 hours. Typically, there is a gastrointestinal illness with diarrhea, nausea, vomiting, and abdominal pain, accompanied by or closely followed by a wide range of neurological and neuropsychiatric signs. These include paresthesia, weakness, pain in the teeth or a sensation that the teeth are loose, a burning or metallic taste in the mouth, impaired memory, depression, chronic fatigue, generalized itching, sweating, and blurred vision. Cold allodynia (abnormal sensation when touching cold water or objects) and temperature reversal (cold items feel hot; hot items feel cold) are pathognomonic but not always present. Neurologic features usually last a few days to several weeks but can persist for months or even years. Cardiovascular signs and symptoms include bradycardia, heart block, or hypotension.