Ciguatera fish poisoning (CFT) seems to be increasing in its global spread. It is a collection of symptoms which occur after people eat fish with ciguatoxin. The toxin is made by dionflagellates in shallow coastal regions such as reefs and atolls. The toxin goes up the food chain from herbivorous to carnivorous reef fish such as barracuda and grouper. It is tasteless and odourless and not destroyed by cooking or freezing the fish. Within minutes to 12 hours of eating contaminated fish people may get nausea, vomiting and diarrhoea followed over the next 48 hours by neurologic symptoms such as burning or tingling sensations in the hands, feet and possibly mouth; itch; sore muscles or joints; dizziness, fatigue, anxiety and the reversal of heat and cold sensation. It has occurred in the Pacific and Caribbean for many years but is now being seen in previously unreported areas such as the western Gulf of Mexico, eastern Mediterranean, Crete, Brazil, Hong Kong, Thailand, and West Africa (eastern Atlantic.) You can reduce your risk of getting ciguatera poisoning by checking with locals about its presence and not eating large amounts of reef fish particularly the brain or organs which are more likely to have the toxin.