Ciguatera por consumo de pescados: diagnóstico diferencial de alergia alimentar e alerta emergente para regiões costeiras brasileiras
Ciguatera from fish consumption: a differential diagnosis of food allergy and an emerging alert for Brazilian coastal regions
Bruno Emanuel Carvalho Oliveira
Resumo
A ciguatera é uma intoxicação alimentar causada pela ingestão de peixes recifais contaminados por ciguatoxinas, potentes toxinas lipofílicas produzidas por dinoflagelados dos gêneros Gambierdiscus e Fukuyoa. Essas toxinas se bioacumulam ao longo da cadeia trófica, atingindo maiores concentrações em peixes carnívoros de grande porte. A ciguatoxina é termoestável, incolor, insípida, não degradada por congelamento ou digestão humana, o que inviabiliza sua inativação por métodos culinários. Sua estrutura favorece a ligação a canais de sódio voltagemdependentes, promovendo despolarização sustentada das membranas celulares e explicando os sintomas gastrointestinais e neurológicos observados. A doença é endêmica em regiões tropicais do Pacífico Sul e Caribe, mas tem emergido em novas áreas, como o Brasil. Entre 2022 e 2025, cerca de 190 casos suspeitos foram registrados em Fernando de Noronha, além de relatos em Natal (RN). Clinicamente, manifesta-se com sintomas gastrointestinais agudos seguidos de parestesias, alodinia ao frio, inversão térmica e fadiga persistente. Casos graves podem evoluir com bradicardia, hipotensão e distúrbios cardíacos. O diagnóstico é essencialmente clínico, baseado na ingestão recente de peixe recifal e sinais neurológicos característicos. Não há antídoto específico, e o tratamento é sintomático. Diante da semelhança com quadros alérgicos relacionados à ingestão de alimentos, especialmente nas manifestações agudas, a ciguatera deve ser considerada no diagnóstico diferencial dessas condições, sobretudo em populações que habitam ou frequentam regiões costeiras. Seu reconhecimento como problema emergente é crucial para a vigilância epidemiológica, o diagnóstico precoce e o manejo clínico adequado.
Palavras-chave
Abstract
Ciguatera is a foodborne intoxication caused by the ingestion of reef fish contaminated with ciguatoxins, potent lipophilic toxins produced by dinoflagellates of the genera Gambierdiscus and Fukuyoa. These toxins bioaccumulate along the food chain, reaching higher concentrations in large carnivorous fish. Ciguatoxins are thermostable, colorless, and tasteless, and are not degraded by freezing or human digestion, rendering them resistant to inactivation by cooking. Their structure favors binding to voltage-gated sodium channels, leading to sustained depolarization of cell membranes and explaining the gastrointestinal and neurological symptoms observed. Although endemic in tropical regions of the South Pacific and the Caribbean, ciguatera has emerged in new areas such as Brazil. Between 2022 and 2025, approximately 190 suspected cases were reported in Fernando de Noronha, in addition to cases described in Natal, Rio Grande do Norte, northeastern Brazil. Clinically, it presents with acute gastrointestinal symptoms followed by paresthesias, cold allodynia, temperature reversal, and persistent fatigue. Severe cases may progress to bradycardia, hypotension, and cardiac rhythm disturbances. Diagnosis is essentially clinical, based on recent consumption of reef fish and characteristic neurological signs. There is no specific antidote, and treatment is symptomatic. Given its similarity to food-related allergic reactions, particularly during the acute phase, ciguatera should be considered in the differential diagnosis of such conditions, especially in individuals living in or visiting coastal regions. Recognition of ciguatera as an emerging issue is crucial for epidemiological surveillance, early diagnosis, and appropriate clinical management.
Keywords
References
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Submitted date:
05/10/2025
Accepted date:
06/11/2025
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