Unlucky Fiji Divers Poisoned by Dinner

My wife, 13-year-old daughter and I arrived on the Fijian island of Kadavu on June 3, where we were met by Australian resort owners, Bob and Rena Foster. We had selected the resort in part because of a good Chapbook review. Dinner the first night offered a choice of fish or Indian curry. My daughter and I had the curry, and my wife, Jenny, ordered the fish. The meals were well presented.

Jenny woke up in the night and her hands were itchy, she had diarrhea, and her legs felt “heavy” and ached. She had an “odd” sensation in her feet when walking on the cold bathroom tiles. In the morning her palms “burned” when washing her hands in cold water, and water tasted metallic and carbonated.

While her symptoms might have something in common with DCS, she had not yet been diving. Bob Foster speculated that it might be ciguatera, or “fish poisoning,” saying he himself had the poisoning and recognized some symptoms.

That afternoon I read the marine toxin reference book in the resort library. I was struck by the variability of the symptoms, which may present from 4 to 30 hours following ingestion of the affected fish. They included low blood pressure, lowered heart rate; muscle aches; and abnormal sensation of the skin, such as numbness, tingling or burning. Reversal of hot and cold sensation is classic. The toxin is not detectable in raw fish. Freezing and cooking do not inactivate it. Local knowledge of which fish to avoid is the best method to avoid ciguatera.

That day a Fijian dive instructor began having similar symptoms, and other staff were also affected. At dinner Sunday, an American diver collapsed and broke out in a cold sweat. She had a slow and thready pulse and shallow respiration and her hands tingled. She was taken by boat to the local hospital. That night an Australian diver, who had claimed he had a cast-iron stomach, developed diarrhea, muscle aches, sweating and itchiness and spent most of the next day in bed.

Everyone who had eaten the fish on Saturday night had ciguatera. Localised severe itching that didn’t respond to topical creams was the main ongoing symptom. Calamine lotion offered by an affected dive staff member helped just a little. The resort offered their visitors nothing.

Bob said they are careful where they buy their fish and avoid large reef fish, especially pelagics, that may carry ciguatera. However, Rena told me that they did not know from where the suspect fish had come. Bob said there was no treatment, and he had done the right thing by taking the American to the hospital. While he said there was nothing more he could do, I learned that antihistamines can reduce the symptoms. There is some evidence that early treatment with intravenous Mannitol — a diuretic — may also reduce the severity and arrest the progression of symptoms. However, ingesting more fish or seafood, alcohol, nuts and oil can increase the severity of ciguatera symptoms, advice we did not get.

More than a month after the first symptoms, Jenny’s problems continue; mainly mild itching and tingling of the hands and feet, sensitivity to cold, and fatigue. By email, she learned that two other travellers are suffering ongoing effects. Symptoms are reported to last for months and sometimes years.

Because ciguatera had occurred in the area — and Bob himself had had it and therefore recognised Jenny’s symptoms — one would think that the resort certainly should have had more information on hand, as well as basic meds such as antihistamine. And we travellers certainly should have applied more pressure to get medical assistance.

– Warren Foreman, Adelaide, South Australia

PS: By telephone, we discussed this outbreak with Bob Foster, owner of Dive Kadavu. He says that the ciguatera poisoning came from fish served at the resort, specifically a Spanish mackerel. Foster maintains that the disease is common among locals, who generally wait it out without treatment. He told us that because he is not a doctor, all he could offer his guests was a ride to the local hospital. Dr. Foreman, a veterinarian, said his wife had no such offer .