Haff Disease in Salvador, Brazil, 2016-2021: Attack rate and detection of toxin in fish samples collected during outbreaks and disease surveillance
| Autor: | Lázaro José Rodrigues de Souza, Luiz Laureno Mafra Junior, José Fernando Araujo Neto, Antonio Bandeira, Cristiane Wanderley Cardoso, Ana Paula Pitanga Barbuda Prates, Manuela Sampaio Souza Santos, Mirela Maisa da Silva Souza, Guilherme S. Ribeiro, José Jorge Moreno da Silva, Mathias Alberto Schramm, Renan Bispo Silva, Marcela Almeida Muhana, Thiago Pereira Alves, Ênio Silva Soares, Monaise M. O. Silva, Rosildete Silva Santos Pires |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
myalgia
medicine.medical_specialty Disease surveillance Ciguatoxin Haff disease business.industry Attack rate public health Outbreak global health medicine.disease foodborne disease Rhabdomyolysis palytoxin Intensive care Internal medicine medicine medicine.symptom Public aspects of medicine RA1-1270 business |
| Zdroj: | The Lancet Regional Health. Americas, Vol 5, Iss, Pp 100092-(2022) |
| Popis: | Summary Background From late 2016 to early 2021, cases of Haff disease, a rare cause of rhabdomyolysis, possibly due to poisoning by palytoxin-like compounds in seafood, were detected in Salvador, Brazil. Surveillance was established to detect additional cases aiming at describing the clinical characteristics of the cases, identifying associated factors, estimating disease attack rate, and investigating the presence of biotoxins and trace metals in selected fish specimens obtained from cases. Method Between December/2016-January/2021, surveillance investigated Haff disease suspected cases, and obtained clinical and fish samples to test. Findings Of 65 cases investigated during the 2016-2017 outbreak, 43 (66%) had high creatine phosphokinase (CPK) levels. Among those with laboratory-confirmed rhabdomyolysis, 38 (88%) were hospitalized, 11 (26%) required intensive care, and three (7%) dialysis. Ingestion of marine fish 24h before disease onset was reported by 74% of the cases with elevated CPK and by 41% of those without CPK measurement (P=0·02). Attack rate for individuals who ate fish related to the outbreak was 55%. Following this outbreak, surveillance identified 12 suspected cases between 2017-2019, and a second outbreak in 2020-2021, with 16 laboratory-confirmed rhabdomyolysis patients (five required intensive care; one died). No traces of ciguatoxins and metals were detected in fish specimens obtained in 2016, found to be Seriola rivoliana. Some fish samples from 2020 were screened for palytoxin (PlTX)-like compounds and contained detectable levels of molecule fragments characteristics of isobaric PlTX, ovatoxin-a (OVTX-a), OVTX-b and OVTX-d. Interpretation These findings support the hypothesis that compounds related to PlTX accumulated in marine fish may be the toxic agent causing the disease. Haff disease is a life-threatening condition, requiring clinical suspicion for patients with sudden-onset myalgia following fish ingestion. Suspected cases should be reported to health authorities for investigation. |
| Databáze: | OpenAIRE |
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