Amanda Austrin, pictured in Tauranga Hospital, still vomits
every day - 18 months after her holiday. Photo / Alan
As soon as she took a bite of the fish caught and
prepared for her by some Fijian locals, Amanda Austrin knew
something was wrong.
The coral trout, cooked on a white sand beach in banana
leaves over an open fire, was a kind gesture by a couple of
villagers on the Coral Coast after an unsuccessful fishing
jaunt with her friends that day.
But it tasted bitter and the 41-year-old environmental
scientist spat it out, noticing some of its gut smeared over
the white flesh.
A few hours later her face, body and limbs began to tingle
and go numb.
She remembers shivering in her hotel bed wrapped in the
winter clothes she had worn for the trip from Whakatane to
Auckland to catch her flight to the island but never thought
she'd need as the mercury outside topped 30C.
Vomiting uncontrollably and suffering from diarrhoea, she
felt as if she was dying.
She returned home a couple of days later when a GP thought
she had little more than traveller's diarrhoea and told her
to drink fluids and keep her food intake up.
Within days she was in hospital, even more nauseous and with
more intense bursts of pain with hot and cold temperature
reversals that made touching metal objects feel like they
were burning cold.
"I had a hot cup of coffee given to me that felt cold but it
was burning my hand," she said.
"It was burning my mouth but it felt cold and picking up
stainless steel knives felt cold and was excruciating."
Baffled doctors scoured the internet to try to work out what
they were dealing with.
It took them a week to diagnose Ms Austrin with ciguatera
The toxin, which is produced by tiny organisms in tropical
and subtropical waters around the Pacific Islands and
northern parts of eastern Australia, sticks to coral reefs,
seaweed and algae and is eaten by small herbivorous fish.
Larger reef fish such as barracuda, snapper and tuna then eat
these fish, which in turn are caught and eaten by humans.
There is no known antidote for the poison, which usually
causes headaches, vomiting, dizziness and fatigue but in
extreme cases can cause neurological problems and even death.
Ms Austrin has spent more than 30 weeks of the past 18 months
since her Fijian visit in July 2011 in and out of Whakatane
and Tauranga hospitals and is about to undergo further
treatment at Waikato Hospital.
Before the poisoning, she rode horses competitively, competed
in triathlons, game fished and was a search and rescue
volunteer. Now she cannot walk far without wanting to
She has learned the toxin can be sexually transmitted. Its
effect on her pancreas means she has also become
insulin-dependent and has developed type one diabetes.
Her employer, Norske Skog, gave her a year's worth of paid
leave but they let her go when doctors could not give a clear
answer how long she could be away from work.
"They can't give a timeframe - the toxin can stay in your
body for up to 20 years.
"It stores itself in your adipose tissue ... so with me there
are triggers like extreme exercise, dehydration and extreme
weight loss which is happening with me and that's why I'm so
bad all the time."
Other triggers include any fish, nuts, alcohol, chocolate,
caffeine and foods full of the mood-improving chemical
Unable to eat or drink fluids, she has lost 20kg from her
slight frame and spends several hours of every day hooked up
to a total parenteral nutrition feeding system.
"My life has come to a complete halt," she said.
National Poisons Centre poison officer Robin Slaughter said
reports of travellers returning from tropical holidays with
ciguatera poisoning were not unknown.
He said a 2010 article in the New Zealand Medical Journal
warned doctors about an "increasing number of inquiries"
regarding patients contracting the marine poison.
Mr Slaughter said doctors could only treat the symptoms as
they arose but these were generally short-term.
"It can be sort of uncomfortable but most people do come
right. It's not very often where it is that serious - for it
to last months or years is kind of weird."
The ESR's Foodborne Disease in NZ 2011 report showed just two
cases of ciguatera fish poisoning last year, but cases can go
unreported. Other than warning people not to eat fish while
on holiday, Ms Austrin thinks the Ministry of Foreign Affairs
and Trade should include warnings about ciguatera poisoning
on its website.
She said her case should also serve to alert doctors when
travellers returned from the Pacific Islands or Australia
with similar symptoms. "Every doctor I had had to Google it
to find out how to do treatment because I was the first case
they had come across."
She still plans to wed her fiance on their Whakatane farm
next month and refuses to let her illness keep her down.
- James Ihaka, New Zealand Herald