Introduction
About one person in the United States contracts the rare seafood-related ailment Haff disease each year. In Illinois, there have been three cases of Haff disease reported, with the most recent one occurring in 2019. The previous two events took place in 2004 and 2014. The intake of buffalo fish was linked to every instance of Haff illness in Illinois.
What Is the Haff Disease?
A sickness of unexplained rhabdomyolysis that develops within 24 hours after eating fish is known as Haff illness. A poison that has not been identified is thought to be the culprit. Rhabdomyolysis is the process through which electrolytes and protein from injured muscle tissue are released into the circulation. A deadly medical disorder called rhabdomyolysis can harm the kidneys and result in mortality, abnormal cardiac rhythms, seizures, nausea, and vomiting.
What Is the History of Haff Disease?
The condition was initially noted in 1924 in residents of the northern portion of the Vistula Lagoon (German: Frisches Haff), which is located near Königsberg, Germany (now Kaliningrad, Russia), on the Baltic coast.
A correlation was established between the eating of fish (burbot, eel, and pike) and the approximately 1000 instances that were documented over the course of the following fifteen years in humans, birds, and cats, typically in the summer and fall. Since then, reports of the disease have only seldom surfaced, primarily from the Soviet Union and Germany. Six cases of Haff illness were documented in 1997 in Missouri and California, all of which were brought on by eating buffalo fish (Ictiobus cyprinellus).
Numerous individuals in Nanjing, China, experienced rhabdomyolysis in July and August 2010 after consuming Procambarus clarkii. The Chinese government stated they had Haff sickness a month later.
What Kinds of Fish Are Susceptible to Haff Disease?
Salmon, crawfish, and buffalo fish have all been connected to the Haff sickness in the United States. Buffalo fish, which are routinely fished from major rivers and lakes, were involved in the three cases that were identified in Illinois. Bigmouth, smallmouth, and black buffalo fish all occur in Illinois; however, due to their morphological similarity and shared habitats, it is unclear which of the three species has been linked to Haff disease cases.
What Possible Health Effects Are There?
Extreme muscle stiffness, muscle pain, chest pain, breathing difficulties, numbness, loss of strength all over the body, and dark brown urine are some of the symptoms that are frequently linked to Haff's illness. In most cases, severe symptoms go away in two to three days, while persistent muscle weakness is possible. The Haff disease can lead to acute renal failure and irregular blood coagulation, among other complications. About one percent of Haff disease cases result in death.
What Should Be Done if One Begins to Experience Haff Disease Symptoms?
If a person has recently eaten shellfish and is showing signs of Haff sickness, get medical help right once. To document the sickness and stop it from spreading to others, let the local health department know after seeking medical assistance. Do not discard any leftover fish from the meal if there is any.
How Is Haff Disease Diagnosed?
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History and Symptoms: Haff sickness symptoms appear 24 hours after consuming cooked seafood. Brown urine, myalgia (muscle pain), muscle stiffness, chest pain, diaphoresis (excessive sweating), and nausea are some of these symptoms.
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Visual Inspection: On examination, myoglobinuria (presence of excess myoglobin in the urine), weakness, and soreness of the muscles are possible.
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Laboratory Results: An elevated serum CPK (creatine phosphokinase) level, a CK-MB (Creatine kinase-MB) fraction of less than five percent, and a history of consuming cooked seafood within 24 hours of the onset of symptoms are required for the diagnosis of Haff illness. CBC (complete blood count), creatine kinase, serum electrolytes, liver function tests, urine pH (potential of hydrogen), and urinalysis are all required to be performed as part of the evaluation of Haff disease.
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Electrocardiogram (ECG): Rhabdomyolysis brought on by Haff illness may cause cardiac arrhythmias (irregular heartbeat) because of hyperkalemia (increased potassium in the blood) and hypocalcemia (decreased calcium level in the blood). ECG monitoring of the patient is, therefore, crucial.
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Ultrasound: Haff illness may cause areas to become hypoechoic as a result of fluid infiltration and muscle irritation. Ultrasound images can show the results, if there are any.
How Is Haff’s Disease Managed?
With the release of myoglobin, creatine phosphokinase, and other muscle cell enzymes, including lactate dehydrogenase (LDH), the toxin that causes Haff disease targets and harms striated muscle. Acute renal failure can be brought on by myoglobin obstructing renal tubules. Although this toxin has not yet been identified, some researchers have hypothesized that it might be related to palytoxin, a marine toxin that causes neurotoxicity (brain damage due to toxic substances) and myotoxicity (toxic effect on the muscles) in saltwater fish and has not yet been characterized.
The mainstays of treatment for Haff disease poisoning are analgesia, IV hydration to encourage myoglobin elimination, and avoiding nephrotoxic substances. There is no antidote for the condition.
The use of activated charcoal and Mannitol in patients with Haff disease was compared with standard therapy in a small, retrospective cohort research conducted in China. They discovered that within 24 and 72 hours following admission, serum CK levels had decreased statistically significantly. The clinical benefit was minimal, with just a slight reduction in subjective sensations of anxiety during admission and a half-day shorter hospital stay attaining statistical significance.
How to Reduce the Likelihood of Developing Haff Disease?
There are no known ways to reduce the possibility of Haff disease besides restricting seafood intake. It is impossible to determine whether a fish contains the toxin based on its flavor, aroma, or appearance, and boiling does not render the poison harmless. It is unclear whether the illness is brought on by incorrect fish handling or storage or whether the fish's environment is to blame. Since buffalo fish has been a major factor in the majority of instances in the United States, people who frequently eat buffalo fish should keep an eye out for Haff disease indications.
Conclusion
In conclusion, Haff disease has significant effects on human health, economic development, and stability. It is an idiopathic form of rhabdomyolysis syndrome linked to ingesting freshwater marine items. Given its acute incidence, possible severity, and link to the eating of cooked aquatic foods, Haff sickness can easily cause social panic. Understanding the influencing and pathogenic elements linked to Haff disease will greatly aid in disease prevention, have a favorable impact on healthy eating decisions, and aid in the development of appropriate industrial standards.
