Ting, J Y, Brown, A F · European journal of emergency medicine : official journal of the European Society for Emergency Medicine · 2001 · DOI
Ciguatera poisoning is a food-borne illness caused by eating contaminated tropical fish that causes stomach problems, nerve symptoms, and fatigue that can last months or years. This study describes four tourists who recovered well after receiving a specific treatment (intravenous mannitol), but highlights that the condition is often misdiagnosed as chronic fatigue syndrome or other illnesses, delaying proper treatment.
ME/CFS patients are at risk of misdiagnosis because ciguatera poisoning can present with constitutional symptoms (fatigue, malaise) that mimic chronic fatigue syndrome. Understanding ciguatera as a treatable toxinological syndrome is important for clinicians evaluating ME/CFS patients with specific exposure histories, particularly those who have traveled to or consumed fish from endemic tropical regions.
This study does not prove that ciguatera causes ME/CFS or that most ME/CFS cases are due to ciguatera poisoning. The case series is too small and observational to establish causation; it only demonstrates that ciguatera can be mistaken for chronic fatigue syndrome when symptoms overlap. The study provides no prevalence data on how often this misdiagnosis occurs.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Ting, J Y & Brown, A F (2001). Ciguatera poisoning: a global issue with common management problems.. European journal of emergency medicine : official journal of the European Society for Emergency Medicine. https://doi.org/10.1097/00063110-200112000-00009
BibTeX
@article{mecfsatlas-ting-2001-ciguatera-poisoning,
author = {Ting, J Y and Brown, A F},
title = {Ciguatera poisoning: a global issue with common management problems.},
journal = {European journal of emergency medicine : official journal of the European Society for Emergency Medicine},
year = {2001},
doi = {10.1097/00063110-200112000-00009},
note = {PubMed: 11785597},
url = {https://www.mecfsatlas.com/evidence/ting-2001-ciguatera-poisoning},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/ting-2001-ciguatera-poisoning
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