Ciguatera toxin is created in tropical reef-dwelling fish that ingest toxins from algal blooms produced by the dinoflagellate Gambierdiscus toxicus. The main toxin appears to be ciguatoxin, although maitotoxin has also been implicated. Ciguatera can present initially with gastrointestinal or neurological symptoms, such as paresthesia of the extremities and around the mouth. Although the fatality rate is low, neurologic effects can last for weeks. Mothers suspected of having ciguatera poisoning should not breastfeed until they have recovered.