Ciguatera fish poisoning is a foodborne illness caused by the ingestion of reef fish contaminated with toxins (ciguatoxin) from Gambierdiscus toxicus. It commonly occurs in tropical and subtropical coastal areas, but it can occur in temperate areas due to imported reef fish and, rarely, contamination of nontropical fish.

Ciguatoxin is a lipid-soluble, highly resistant (heat stable and acid resistant) neurotoxin.

The disease typically presents within a few hours of consumption. Patients initially develop gastrointestinal symptoms such as diarrhea, nausea, vomiting, and abdominal cramping, and neurological symptoms such as paresthesias, pruritus without rash, tooth pain, myalgia, or altered temperature perception. Patients may also present with decreased heart rate or hypotension, sometimes requiring emergency medical services.

In patients with ciguatoxin ingestions in the United States between 1998-2008, approximately 10% required hospitalization with an approximately 0.15% mortality (1 death in 705 exposures).

Ciguatoxin accounts for about 3% of single-etiology foodborne disease outbreaks annually in the United States. The majority of ciguatoxin outbreaks originate from an individual's home as opposed to other foodborne outbreaks that originate from the food service industry. Compared to foodborne outbreaks involving leafy greens, ciguatoxin outbreaks typically affect a smaller number of individuals.