For these Fishermen, a glass Haff empty
ABSTRACT & COMMENTARY
By Stan Deresinski, MD, FACP, FIDSA, Clinical Professor of Medicine, Stanford University, Hospital Epidemiologist, Sequoia Hospital, Redwood City, CA, Editor of Infectious Disease Alert.
SYNOPSIS: Three new cases of rhabdomyolysis after eating buffalo fish are reported.
SOURCE: The Mississippi State Department of Health Reports New Cases of Rare Disease: http://ow.ly/nX6gk
In early July 2013, three members of a Mississippi family became ill after eating buffalo fish that had been caught in the Yazoo River and that they had purchased and stored in a freezer prior to cooking. They recovered uneventfully.
COMMENTARY
Haff disease describes a syndrome of rhabdomyolysis within 24 hours of eating fish. It was first recognized in 1924 when individuals living along the shores of the Königsberg Haff (in German, a "haff" is a lagoon separated from the sea by a narrow sandbar) in East Prussia experienced an epidemic of rhabdomyolysis.1 Mostly fishermen were affected. Seabirds and foxes died, as did village cats. All the affected humans had eaten fish.
Buffalo fish (genus Ictiobus) were caught by members of the Lewis and Clark expedition. It is a freshwater fish that may be mistaken for carp. The first case of Haff disease in the U.S. was recognized in 1984 in Texas and there have been only a total of approximately 33 identified to date. Many have been related to eating buffalo fish. Other fish, mostly bottom-feeding omnivores, that have been implicated in cases in Europe and China include burbot, eel, pike, crayfish, salmon, silver dollars, black-finned colossoma, freshwater pompano, and marine box fish.
Symptoms usually begin within 12 hours of eating the implicated fish. The include muscle weakness, chest and generalized pain, dry mouth, nausea and vomiting, confusion and, in some cases, dark urine. These symptoms are usually short-lived, but fatigue persists for months in some. Treatment is supportive with usual management, the key element of which is rapid fluid administration. Bicarbonate is often administered in an attempt to alkalinize the urine to prevent acute kidney injury, but its value is uncertain.
The etiologic toxin remains unknown, but since cooking does not prevent illness, it is not heat-labile. Cicutoxin produced by the water hemlock has been suggested as the cause, but this remains unproven.
References
1. Buchholz U, et al. Haff disease: from the Baltic Sea to the U.S. shore. Emerg Infect Dis 2000; 6:192-5.
