The mechanism of Ciguatera poisoning is
eating the flesh of fish that harbor the toxin. It does not occur from a spine puncture. Ciguatera toxin comes from dinoflagellates that are ingested by the fish; the dinoflagellate toxin builds up in the tissue. Ciguatera poisoning is more likely from predatory fish that consume other fish. The poison is concentrated as it moves up the food chain. Given this discussion, more information can be found at
https://www.fishlaboratory.com/fish/blue-tang/
When a puncture wound, or any wound occurs, the initial first aid should be cleaning with soap and water.
If the wound stings, or has symptoms beyond those expected from the actual trauma, then one should assume there is a toxin involved. In general, toxins from fish are heat labile (sensitive) and the first aid should be soaking the injured area in hot water. (Don't burn the tissue!) In general, toxins from cnidarians (corals, anemones, jellyfish) are sensitive to pH. First aid should be treating with vinegar (mild acid). One could also use ammonia (basic) however ammonia is toxic whereas vinegar is not.
The most common serious complication to a wound from the aquarium would a bacterial infection. If it occurs, this would develop over a few days. If an injured area gets red, hot, swollen, tender, or has drainage, then an infection should be suspected. If it warrants a trip to the doctor, be sure to inform your physician that the infection started from exposure to your aquarium. Typically, for skin infections we treat with antibiotics designed for Gram + bacteria. However, the marine environment harbors a lot of Gram negative bacteria. Your physician may wish to use a broader spectrum antibiotic, which covers Gram negative bacteria as well.
