Ciguatera poisoning is most commonly associated with which source and symptom cluster?

• A. Found in eel and large reef fish; reversal of hot and cold temperatures, paresthesias and GI upset
• B. Found in shellfish; wheezing and dermatitis
• C. Found in dairy products; fever and rash
• D. Found in fresh water fish; constipation and bradycardia

Answer: (A)

Ciguatera poisoning comes from ciguatoxin produced by dinoflagellates that bioaccumulate in large reef fish and eel. The key feature is a neurologic–GI symptom cluster: sensory changes like paresthesias and a notable reversal of hot and cold temperatures, along with gastrointestinal upset such as nausea or vomiting. Cooking does not destroy the toxin, so the risk persists with these fish.

This is best matched by the description of eel and large reef fish causing hot-cold reversal, paresthesias, and GI upset. The other options don’t fit with ciguatera: shellfish-related symptoms like wheezing and dermatitis point to allergic or histamine-mediated reactions; dairy-related fever and rash aren’t typical; freshwater fish with constipation and bradycardia does not describe ciguatera.