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The major risk factor associated with Haff disease is consumption of aquatic foods (e.g., crayfish, burbot, buffalo fish).
The major risk factor associated with Haff disease is consumption of aquatic foods (e.g., crayfish, burbot, buffalo fish).


==Natural History, Complications and Prognosis==
==Natural History, Complications, and Prognosis==
Haff disease has an incubation period of eight hours and presents with nausea, vomiting, muscle rigidity, chest pain, diaphoresis, and brown urine (myoglobinuria). Though it is a self-limiting condition with a good prognosis, some cases may develop complications such as [[acute kidney injury]] and [[disseminated intravascular coagulation]].
Haff disease has an incubation period of eight hours and presents with nausea, vomiting, muscle rigidity, chest pain, diaphoresis, and brown urine (myoglobinuria). Though it is a self-limiting condition with a good prognosis, some cases may develop complications such as [[acute kidney injury]] and [[disseminated intravascular coagulation]].



Revision as of 17:54, 14 July 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: M. Hassan, M.B.B.S

Overview

Haff disease is the development of rhabdomyolysis (swelling and breakdown of skeletal muscle, with a risk of acute kidney failure) within 24 hours of ingesting fish.[1]

Historical Perspective

The first case of Haff disease was reported in 1924 in the vicinity of Königsberg on the Baltic coast, in people staying around the haff; hence the name "Haff disease". From 1925 to 1940, about 1000 cases were reported not only in humans, but in birds and cats as well, and were linked to the consumption of fish (burbot, eel, and pike). Only twenty-six cases of Haff disease were reported in the US from 1984 to 2014.[2]  As the standards of living are improving, the availability of fish for consumption is increasing, and thus, resulting in an increased number of cases.  

Pathophysiology

Haff disease is a rare clinical syndrome, the pathophysiology of which remains unclear. Palytoxin, a heat-stable toxin with thiaminase activity, has been proposed to play a role in the development of this condition. Due to the heat-stable nature of this toxin, it cannot be inactivated by cooking.

Causes

The etiology of Haff disease remains unclear, and further investigations are required.

Differential Diagnosis

Haff disease causes rhabdomyolysis and must be differentiated from other causes of rhabdomyolysis, which may be categorized as physical, non-physical, and genetic factors. Physical factors include trauma, excessive muscular activity, status epilepticus, high-grade fever, heatstroke, and electric shock. Non-physical factors include medications, infections, drugs, and electrolyte abnormalities. Genetic factors consist of autoimmune diseases, metabolic diseases, and various inherited conditions.

Epidemiology and Demographics

Cases of Haff disease are seen worldwide, but the causative organisms vary with the geographical location. Burbot, pike, freshwater eel, and whitefish are predominant causative fish in Eastern Europe and Sweden. Cases of Haff disease in China were related to freshwater pomfret and crayfish. In Japan, boxfish was associated with Haff disease and in the United States buffalo fish, crayfish and atlantic salmon were the culprits.

Risk Factors

The major risk factor associated with Haff disease is consumption of aquatic foods (e.g., crayfish, burbot, buffalo fish).

Natural History, Complications, and Prognosis

Haff disease has an incubation period of eight hours and presents with nausea, vomiting, muscle rigidity, chest pain, diaphoresis, and brown urine (myoglobinuria). Though it is a self-limiting condition with a good prognosis, some cases may develop complications such as acute kidney injury and disseminated intravascular coagulation.

Diagnosis

History and Symptoms

Symptoms of Haff disease develop within 24 hours of consumption of cooked seafood. These symptoms include nausea, vomiting, myalgia, muscle rigidity, chest pain, diaphoresis, dyspnea, and brown urine.

Physical Examination

On examination there may be muscle tenderness, weakness, as well as myoglobinuria.

Laboratory Findings

The diagnostic criteria for defining a case of Haff disease include a history of consumption of cooked seafood within 24 hours prior to the onset of symptoms, elevated serum CPK, and CK-MB fraction of less than 5%.

Evaluation of Haff disease should include CBC, creatine kinase, serum electrolytes, liver function tests, urine pH, and urinalysis.

EKG

Haff disease may result in cardiac arrhythmias due to hyperkalemia and hypocalcemia, as a result of rhabdomyolysis. Therefore, it is essential to monitor the patient with an ECG.

Ultrasound

Hypoechoic areas due to inflammation of the muscles as well as fluid infiltration may be seen in Haff disease.

Other Diagnostic Studies

Other diagnostic studies are not required for the diagnosis of Haff disease.

Treatment

Medical Therapy

The medical therapy of Haff disease consists of managing rhabdomyolysis by aggressive fluid hydration, managing electrolyte abnormalities (hyperkalemia and hypocalcemia), and other supportive care.

Surgical Therapy

There is no surgical treatment indicated for Haff disease.

Primary Prevention

The primary prevention of Haff disease is avoiding the consumption of seafood that is associated with Haff disease.

References

  1. Buchholz U, Mouzin E, Dickey R, Moolenaar R, Sass N, Mascola L (2000). "Haff disease: from the Baltic Sea to the U.S. shore". Emerging Infect. Dis. 6 (2): 192–5. PMID 10756156.
  2. Diaz J (2015). "Don't be Half-Educated About Haff Disease in Louisiana". J La State Med Soc. 167 (1): 6–10. PMID 25978748.

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