Ciguatera Fish Poisoning

Eating large, tropical, predatory reef fish may put you or your family at risk for ciguatera fishpoisoning. Although fairly uncommon in New York City, most cases of ciguatera fish poisoning have occurred in people who have eaten locally purchased barracuda.

  1. What is ciguatera fish poisoning?
    Ciguatera fish poisoning is a type of food poisoning people get by eating fish, such as barracuda, that contain ciguatoxins.
  2. What are ciguatoxins?
    Ciguatoxins are natural toxins made by algae in warm, tropical or subtropical waters such as the Caribbean.
  3. How do fish get the ciguatoxins?
    The fish that cause ciguatera fish poisoning get the ciguatoxins by eating smaller fish that eat ciguatoxin-producing algae. Ciguatoxin levels can build up in larger fish.
  4. What are the health effects of ciguatera fish poisoning?
    People with ciguatera fish poisoning usually have a mix of symptoms, including:
    • Nausea, vomiting, diarrhea, and stomach pain or cramps. These symptoms usually occur within 24 hours of eating the fish and can last for a few days.
    • Numbness; tingling of the mouth, hands or feet; dizziness, difficulty walking; itchiness; weakness; reversal of hot and cold sensation (cold items feel hot and hot items feel cold), or becoming sensitive to temperature changes. These symptoms may occur after nausea, vomiting, diarrhea and stomach pain symptoms and can last for a few weeks, months, or even years.
    • Cardiovascular problems such as hypotension and a slow heart rate. Cardiovascular symptoms may last 2 to 5 days.
    • Other symptoms can include headache, muscle aches, joint pain, a feeling of loose teeth, and a metallic taste in the mouth.
  5. Is there a medical test to diagnose ciguatera fish poisoning?
    There is no readily available test for ciguatera fish poisoning. The diagnosis of ciguatera fish poisoning is based on symptoms and a recent history of eating fish that may have ciguatoxins.
  6. How is ciguatera fish poisoning treated?
    There is no specific treatment for ciguatera poisoning but your doctor may be able to treat your symptoms.
  7. How can I avoid getting ciguatera fish poisoning?
    Always ask what kind of fish you are buying. You can avoid getting ciguatera fish poisoning by not eating big barracuda, grouper, or other large tropical, predatory reef fish. In general, eating smaller fish decreases the risk of ciguatera fish poisoning. Small barracuda and other small reef fish generally have less ciguatoxins than bigger barracuda and bigger reef fish. Even a small amount of a large fish can make you sick.
  8. Which fish may contain ciguatoxins?
    Most of the cases of ciguatera poisoning in New York City are in people who ate barracuda. In general, the bigger the fish, the more ciguatoxin it contains. The highest levels of ciguatoxin are usually found in large, tropical, predatory ‘reef fish’ like:
    • Barracuda
    • Grouper
    • Amberjack
    • Snapper
    • Mackerel

    Not all fish of a certain type or from a certain place will contain ciguatoxins. For pictures of these and other fish visit:
  9. Where did the fish associated with the New York City ciguatera fish poisoning come from?
    The barracuda responsible for many New York City cases was shipped to New York from Florida. Florida has the largest number of ciguatera fish poisoning cases in the United States.
  10. Does cooking or freezing the fish destroy ciguatoxins?
    Cooking or freezing the fish does NOT destroy ciguatoxins.
  11. Is there a way to tell if a fish has ciguatoxins?
    Fish with ciguatoxins do not look sick. Ciguatoxins do not hurt the fish. Fish with ciguatoxins do not look, smell or taste differently from fish without ciguatoxins.
  12. Where can I get more information?
    • If you think you may have ciguatera poisoning or for more information, call the New York City Poison Control Center at 1-800-222-1222 or 212-POISONS. Poison specialists are available 24 hours a day, with translation services in more than 150 languages.
    • To report a case of ciguatera fish poisoning to the New York City Department of Health and Mental Hygiene, call 311.
    • For more information and pictures of barracuda or other fish, visit the United States Food and Drug Administration’s (FDA) website at and type ‘regulatory fish encyclopedia’ into the search box or click here.