What is a noticeable neurological symptom of ciguatera fish poisoning?

Reversal of hot and cold sensations is a distinctive neurological symptom associated with ciguatera fish poisoning. This phenomenon, known as "temperature graduation," occurs when the affected individual experiences a misperception of temperature; for instance, they may feel cold objects as hot and vice versa. This sensory disruption is a result of neurotoxin effects from the toxins found in certain reef fish that have consumed specific marine microorganisms.

The other symptoms mentioned, such as dizziness, severe headaches, and lethargy, while they can occur with various types of poisoning or illness, are not unique to ciguatera. The reversal of hot and cold sensations, however, is a hallmark indication that differentiates ciguatera from other types of fish poisoning, making it a critical symptom for identification and diagnosis of the condition. Understanding this specific symptom is essential for effective public health monitoring and response to ciguatera poisoning cases.