

Eating some bad fish might not seem like the most spectacular way to ruin a tropical vacation, but for a 45-year-old man from England, a bit of tainted seafood was the beginning of a wild ride.

Cold water felt burning hot. Hot things felt icy cold. His tongue felt strange. Drinking alcohol or coffee only increased his suffering.

The patient had ciguatera poisoning – an ailment caused by ciguatoxin, a neurotoxin that is produced by microorganisms and found in a wide variety of tropical fish.

To raise awareness of the bizarre condition, Peter Bain, a researcher at Imperial College in London, described the amusing case in the October issue of Practical Neurology.

He was not the first doctor to witness the strange illness.

In 1774, Captain James Cook, famed explorer of the South Pacific, watched as some of his men experienced the unusual affliction. His surgeon recorded the diverse symptoms, including: a burning sensation in the face, pain in the limbs, and an imaginary feeling of loose teeth.

Bain and his colleagues, Kira Achaibar and Simon Moore, began their report with an excerpt from that historic tale.

Ciguatoxin tends to remain in the flesh long after a meal has been digested. When predatory fish like grouper and red snapper eat smaller fish that feed on algae, they also consume all of the poison that accumulated during the lifetime of their prey.

By the time that the larger fish have been caught, they may have amassed a tremendous dose of the neurotoxin in their livers and fatty tissue. In this case, the next stop for the mysterious chemical was the nervous system of an unsuspecting tourist.

To this day, there is no test or effective treatment for poisoning by the marine toxin. Some doctors may choose to prescribe the drug mannitol, but a randomized trial indicated that it might not work. For the unfortunate traveler, it took ten months to recover from the torturous neurological effects.