Cardoso Cristiane Wanderley, Oliveira E Silva Monaise Madalena, Bandeira Antônio Carlos, Silva Renan Bispo, Prates Ana Paula Pitanga Barbuda, Soares Ênio Silva, Silva José Jorge Moreno, de Souza Lázaro José Rodrigues, Souza Mirela Maisa da Silva, Muhana Marcela Almeida, Pires Rosildete Silva Santos, Araujo Neto José Fernando, Santos Manuela Sampaio Souza, Mafra Junior Luiz Laureno, Alves Thiago Pereira, Schramm Mathias Alberto, Ribeiro Guilherme Sousa
Secretaria Municipal de Saúde de Salvador, Salvador, Brazil.
Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
Lancet Reg Health Am. 2021 Nov 1;5:100092. doi: 10.1016/j.lana.2021.100092. eCollection 2022 Jan.
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.
Between December/2016-January/2021, surveillance investigated Haff disease suspected cases, and obtained clinical and fish samples to test.
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 . 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.
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.
2016年末至2021年初，巴西萨尔瓦多发现了哈夫病病例，这是一种罕见的横纹肌溶解病因，可能是由于食用受类似岩沙海葵毒素化合物污染的海鲜所致。已建立监测机制以发现更多病例，旨在描述病例的临床特征、确定相关因素、估计疾病发病率，并调查从病例中获取的选定鱼类样本中生物毒素和微量金属的存在情况。
2016年12月至2021年1月期间，监测工作对哈夫病疑似病例进行了调查，并获取临床样本和鱼类样本进行检测。
在2016 - 2017年疫情期间调查的65例病例中，43例（66%）肌酸磷酸激酶（CPK）水平升高。在实验室确诊为横纹肌溶解的病例中，38例（88%）住院治疗，11例（26%）需要重症监护，3例（7%）需要透析。74%的CPK升高病例和41%未进行CPK检测的病例报告在发病前24小时食用过海鱼（P = 0·02）。食用与疫情相关鱼类的个体发病率为55%。此次疫情之后，监测在2017 - 2019年期间发现了12例疑似病例，并在2020 - 2021年发现了第二起疫情，有16例实验室确诊的横纹肌溶解患者（5例需要重症监护；1例死亡）。在2016年获取的鱼类样本中未检测到雪卡毒素和金属痕迹。对2020年的一些鱼类样本进行了类似岩沙海葵毒素（PlTX）化合物的筛查，发现含有可检测水平的等压PlTX、卵毒素-a（OVTX-a）、OVTX-b和OVTX-d的分子片段特征。
这些发现支持了以下假设，即海洋鱼类中积累的与PlTX相关的化合物可能是导致该病的有毒物质。哈夫病是一种危及生命的疾病，对于食用鱼类后突然出现肌痛的患者需要临床怀疑。疑似病例应报告给卫生当局进行调查。
