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Archive Number 20100929.3535
Published Date 29-SEP-2010
Subject PRO/AH/EDR> Haff disease - China: (JS)
HAFF DISEASE - CHINA: (JIANGSU)
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 23 Sep 2010
Source: Beijing Today [edited]
<http://www.beijingtoday.com.cn/health/rare-disease-strikes-nanjings-crawfish-eaters>
For many people, last month's [August 2010] crawfish-related poisoning
in Nanjing, Jiangsu Province, was the 1st time they had heard about
Haff disease, a serious condition that causes a breakdown of skeletal
muscles and acute kidney failure.
The condition is caused by eating fish and shellfish that carry an
unknown poison. Symptoms include muscle and joint pain present without
a fever and neural paralysis, according to a report published by the
Chinese Center for Disease Control and Prevention (CDC) last Friday
[17 Sep 2010] in Nanjing.
The precise syndrome caused by the poison is rhabdomyolysis, whereby
skeletal muscle is destroyed and its contents are released into the
blood. Included in the report was a history of worldwide outbreaks.
The disease was first detected and named in 1924 at Haff Beach on the
Baltic coast and more than 1000 poisonings have been identified since
then. In 2000, 6 residents from Beijing were found to have developed
Haff disease after eating crawfish.
"While the risk of the disease is low -- only 23 out of millions of
crawfish eaters across the country during the past decade have ever
been poisoned -- adventurous eaters may want to think twice before
ordering crawfish," said Wu Yongning, a researcher at the Institute
for Nutrition and Food Safety (INFS) under the China CDC.
While symptoms develop within 24 hours of consuming the poison,
"medical experts all over the world have yet to discover the exact
cause of the disease," he said.
Wu speculated that a small number of crawfish may carry an unknown
toxin, possibly absorbed only in certain waters.
Crawfish feed on dead and decaying aquatic life and are farmed in
dirty ditches. Documents showed the crustacean was first brought to
Nanjing by the Japanese during World War II to help eat decaying bodies.
It is best to cook crawfish at home. Thoroughly rinse them in cold,
running water and check that each is alive and active. "Before
cooking, try salting it in water for one hour. Salting can help
disinfect aquatic species," Wu said. At least 10 minutes of boiling is
necessary to kill any bacteria. However, according to a report by the
US CDC, while thorough cooking may kill bacteria, it cannot neutralize
any poison present in contaminated crawdads.
[Byline: Chu Meng]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Haff disease is a syndrome of unexplained rhabdomyolysis following
consumption of certain types of fish; it is caused by an unidentified
toxin. Rhabdomyolysis is a clinical syndrome caused by injury to
skeletal muscle that results in release of muscle cell contents into
the circulation.
During the 1920s, the name "Haff disease" was given to an illness
characterized by severe muscle pain and stiffness that affected
approximately 1000 persons living along the Koenigsberg Haff, a
brackish inlet of the Baltic Sea. Subsequent similar outbreaks were
identified in Sweden and the former Soviet Union. Although the
etiology was not determined, epidemiologic investigations linked
illness to ingestion of fish, especially burbot.
Haff disease typically presents as a paroxysm of rhabdomyolysis, with
accompanying muscle tenderness, rigidity, and dark brown urine, but
milder presentations also occur. Although the median incubation period
for the patients in this report was 8 hours (range: 6-21 hours),
symptoms generally appear approximately 18 hours after eating fish.
Laboratory features of Haff disease include a markedly elevated CK
(creatine kinase) level with an MB (muscle/brain) fraction of less
than 5 percent. Levels of other muscle enzymes (such as, lactate
dehydrogenase, glutamate oxalate transaminase, and glutamate pyruvate
transaminase) also are elevated. Myoglobinuria is often mistaken for
gross hematuria. Diagnosis is based on a compatible clinical history.
Treatment is supportive and consists of administering large volumes of
fluid early in the course of illness to prevent myoglobin toxicity to
the renal tubules. Possible complications include electrolyte
disturbances, renal failure, and disseminated intravascular
coagulation. Symptoms usually resolve within 2-3 days. Historically,
the case-fatality rate is approximately 1 percent.
Clinicians and public health practitioners are encountering an
increasing variety of foodborne illnesses, in part because of a
diversification of food preparation and eating habits. International
travelers, members of ethnic groups with unique cuisines, and
consumers of both imported and domestic specialty food items may be at
risk for foodborne illnesses that are rare or have not been reported
previously.
Clinicians should be aware of food exposures that pose a risk to their
patients and routinely obtain food histories, even from those patients
whose illness may not appear to be food-related.
Physicians who identify or suspect cases of Haff disease, based on the
clinical presentation, laboratory parameters, and food history, should
report them to public health authorities for initiation of traceback
and recall of implicated food items.
Source: CDC. MMWR Morb Mortal Wkly Rep 2010; 47(50): 1091-3; available
at <http://www.cdc.gov/mmwr/preview/mmwrhtml/00056038.htm> (edited). -
Mod.TG]
[Photo of burbot fish:
<http://www.alaskalogcabininn.com/Pictures/Website%20Photos/burbot.JPG>
Photo of Chinese crawfish:
<http://la.curbed.com/uploads/2010.02.crawfish.jpg>- Mod.JW]
[A map of the provinces of China is available at
<http://www.muztagh.com/map-of-china/index.html>.
Nanjing, the capital of Jiangsu Province in eastern China, can be
located via the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/0a0g>. - Sr.Tech.Ed.MJ]