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it is caused by consumption of reef fish contaminated with ciguatoxin, which originates with certain dinoflagellates (algae) associated with coral reef systems and accumulates up the food chain from small herbivorous fish to larger carnivorous fish, such as barracuda and grouper.
G toxicus, which produces ciguatera toxin, tends to proliferate on dead or dying coral reefs
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it is impossible to detect the presence of the toxin in the fish by smell, taste, or appearance
in the US, most outbreaks occur in tropical areas such as Hawaii and Florida, or travellers returning from the Caribbean where some regions have high rates up to 4% of households affected annually!
it is a major problem in Third World countries in the tropics and subtropics (between 35degree north and south latitudes)
it is thought that 50,000 cases occur globally each year