Sir.—Ciguatera fish poisoning is a serious public health and economic problem concentrated in the Caribbean and Indo-Pacific areas. Ciguatera poisoning is a clinical syndrome that follows ingestion of fish containing ciguatoxin. Ciguatoxin is a biotoxin produced by a dinoflagellate, Gambierdiscus toxicus, and concentrated in the food chain of predator reef fish.1 Symptoms consist primarily of distinctive neurologic and gastrointestinal manifestations. Historically, treatment has been supportive. Recently, while reviewing our work in the Marshall Islands, we reported successful treatment of a series of adult patients using an intravenous infusion of mannitol.2 We here describe successful treatment with mannitol infusion of a young child affected by ciguatera poisoning.
Report of a Patient.—A 23-month-old, 9.2-kg Marshallese girl presented in the late evening to the emergency department of Majuro Hospital, Majuro, Marshall Islands, with a chief complaint of persistent crying, severe irritability of 5 hours duration, and inability to sleep.