Investigation of cases compatible with Haff’s disease, municipality of Santarém, Pará State, Northern Region of Brazil, August to October 2021

  • Other
  • Environmental Health (Including Water & Sanitation)
  • One Health
  • Toxicology
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In September 2021, the first cases consistent with Haff's disease were reported in the state of Pará. This is rhabdomyolysis of unknown origin that occurs within 24 hours after ingestion of fish, generating impacts on the health and economy of the population. The objective was to investigate cases compatible with Haff's disease.

A descriptive study was conducted from August 1 to October 26, 2021, in Santarém, Pará. A confirmed case was defined as "an individual with rhabdomyolysis of unknown etiology who ingested fish 24 hours before the onset of symptoms. A retrospective search was carried out in medical records of two health care units and an interview was conducted using a semi-structured questionnaire.

We reviewed 6,012 records and identified eight cases compatible with Haff's disease, four women and four men, median age 53 years (24-65a). Of these, 4/8 had comorbidity; 5/8 consumed Mylossoma duriventre fish; 6/8 consumed whole fish individually. The most commonly reported symptoms were myalgia, report of gradual, ascending pain (6/8), and nausea (7/8). The median time from symptom onset was 2 hours and hospitalization 2 days, one case progressed to death. The median change in CPK was 5,728 (4,314-53,129). Laboratory analysis found palytoxin in the urine sample of one case. Considering the origin of the fish, seven were free-living; four of these were from the Amazon River.

It was observed that the individuals evolved with rapid clinical improvement when adequately treated. Although the cases lived in the same municipality no epidemiological link was found. There are hypotheses in the literature that one of the probable causes of the disease is palytoxin, which was found in a sample of one of the cases. It was recommended to promote the inclusion of Haff's disease as a potential cause of rhabdomyolysis and if possible to collect samples of suspect fish.

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