Ciguatera fish poisoning is caused by

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Ciguatera poisoning happens when people eat reef fish that have the toxin ciguatoxin in them. These toxins are produced by certain dinoflagellates on tropical reefs and accumulate up the food chain in larger predatory reef fish like barracuda, grouper, and snapper. Ciguatoxins are heat-stable and affect nerve and muscle function by altering the gating of voltage-gated sodium channels, leading to a mix of gastrointestinal symptoms (nausea, vomiting, diarrhea) and neurological symptoms (tingling, dizziness, and sometimes a reversal of hot and cold sensations). The toxin can persist in fish flesh, so proper cooking doesn’t eliminate the risk. The other options refer to different toxins from other sources: tetrodotoxin from pufferfish causes distinct nerve-blockade effects, saxitoxin from shellfish causes paralytic symptoms, and microcystin from algae causes liver toxicity in freshwater systems.