Clinical and laboratory evidence of Haff disease – case series from an outbreak in Salvador, Brazil, December 2016 to April 2017

Abstract

We describe a series of 15 Haff disease cases from an outbreak in Salvador, Brazil, starting early December 2016. Eleven cases were grouped in four family clusters of two to four individuals, four were isolated cases. All but one patient consumed cooked fish; 11 within 24h before symptoms onset. Cases consumed ‘Olho de Boi’ (Seriola spp.) and ’Badejo’ (Mycteroperca spp.). A total of 67 cases were detected, the last case was reported on 5 April 2017.

Outbreak of Haff Disease along the Yangtze River, Anhui Province, China, 2016

“…Most of the cases were reported in Wuhu and Ma’anshan, cities in Anhui Province in eastern China. Epidemiologic features were compatible with Haff disease ( 3 , 6 ). Preliminary investigation implicated crayfish as the vector.…”

“…Over the next 9 years, an estimated 1,000 persons were affected by similar outbreaks, occurring seasonally in the summer and autumn in this area ( 3 ). Although subsequent outbreaks were identified in several other countries, such as Sweden ( 4 ), the former Soviet Union ( 5 ), Brazil ( 6 , 7 ), Japan ( 8 ), and China ( 9 , 10 ), the etiology has not yet been determined. An unidentified heat-stable toxin similar to cyanotoxins or palytoxin, but primarily myotoxic and not neurotoxic, is thought to be the cause of Haff disease ( 1 ); however, evidence supporting this hypothesis has been scant.…”

Febrile rhabdomyolysis of unknown origin in refugees coming from West Africa through the Mediterranean

“…However, possible additional exertional rhabdomyolysis risk factors and multiple required deficiencies in the same individual must be considered (Prince et al, 2015). An outbreak of Haff disease has been described recently in Salvador, Brazil, starting early December 2016, and several cases have occurred in recent years in Eastern Europe, Sweden, China, Japan, and the USA (Bandeira et al, 2017;Diaz, 2015). Haff disease is a syndrome of myalgia and rhabdomyolysis that occurs within 24 h after consuming cooked seafood; it is caused by an as yet unidentified heat-stable toxin.…”

Efficacy of Active Charcoal and Mannitol in Patients with Haff Disease Caused by the Consumption of Crayfish (Procambarus clarkii): A Retrospective Cohort Study

“…From the Electronic Medical Record System at our hospital, we retrospectively reviewed 71 consecutive adult patients who ate boiled freshwater crayfish within 24 hours before onset of Haff disease admitted to our emergency department from June 2016 to August 2017. The diagnostic criteria for Haff disease were as follows: (1) patients presented with rhabdomyolysis-like symptoms, such as (sub)acute-onset myalgia, transient muscle weakness, or hematuria and (2) laboratory results revealed a fivefold or greater elevation in CK levels with an MB fraction < 5% [ 8 ]. The exclusion criteria included patients who had other diseases with elevated CK levels, such as acute coronary syndrome and who had a recent history of trauma or intense exercise and incomplete clinical data.…”