For five days, Ademir Clavel’s family lived a drama at Hospital Cardio Pulmonar, in Salvador. Hours after a simple lunch with a couple of friends, the civil servant’s wife and son began to experience symptoms such as weakness, headache and muscle pain. Later, Vânia Clavel even presented coffee-colored urine and lost movement after her muscles ‘locked’, managing to move only her neck. They called medical neighbors, who instructed them: “Run to the emergency room”. That’s how they discovered an infection with the mysterious Haff Disease.
And why mysterious? Thanks to the low infectivity, the causes of the disease are still unclear, according to the doctor and professor at the Federal University of Bahia, Washington Luís. To give you an idea, the first cases of the disease in the state were registered between 2016 and 2017. 71 contaminated, 66 of them in Salvador, resulting in two deaths.
What is known is that the cases are linked to the ingestion of fish, such as Olho de Boi fish, also known as Arabaiana. That’s what Ademir, Vânia, and their son, Matheus, ate on the day of the infection, a fresh whiting, prepared at home and bought at a famous fishmonger in the city, which delivers on Fridays by delivery and has up to 15,000 followers on Instagram. Ademir preferred not to reveal the name of the place.
He says that he buys from the store regularly, and this was the first time the incident would have occurred. At the time of the infection, he had also invited two friends to lunch. One of them was hospitalized for 10 days at the Evangelical Hospital, in Brotas. Sought, she chose not to grant an interview, as she said she was still shaken by the case.
Ademir, on the other hand, did not present such a serious case, he was hospitalized for only one day. “I went for a walk on the Dique do Tororó and I started to feel tired. My wife took pilates classes in the afternoon. So at night, when she started to feel her muscles ‘locked’ after her shower, we thought that was it. A while later, she could only move her neck”, she says.
“We called our medical neighbors, and when we told them about the black urine, they sent us to the emergency room immediately. I was hospitalized for one day, my son, three, and my wife, five”.
The case took place at the end of July. But even after hospital discharge, he says that the side effects remain, with muscles still weakened, headache and malaise. The family and the Hospital notified the Sanitary Surveillance, an agency linked to the Municipal Health Department (SMS). Sought, SMS did not give a return until the publication of the report.
But the cases are not isolated in the state and, according to the health professional, the tendency is for them to grow in quantity. “In general, these are cases that we can control. They are the result of eating fish. It turns out that the algae they feed on produce, during the metabolization of fish, a toxin that we still don’t know well. When ingested by humans, this toxin provokes an inflammatory reaction in the muscles, and, depending on the degree of inflammation, it can lead to organ failure, due to the destruction of muscles in large quantities”, he explains.
Washington Luís explains that the reason why science still does not have a large amount of information about the toxin is due to the low infectivity of the disease, which is recent, and does not receive as much attention among scientists. In 2021, eight cases were reported in the municipalities of Alagoinhas, Simões Filho, Maraú, Mata de São João and Salvador, in January, March, May, June and August respectively. So far two cases have been discarded and six remain in the investigation process, according to the State Health Department (Sesab). Also according to Sesab, all reported cases that required hospitalization have already been discharged.
Biologist Francisco Kelmo says that the suspicion in the scientific community is that the fish is feeding from some contaminated source and that the toxin is stored in its body. “The other possibility is that the fish, when eating a certain type of food, produces the toxin, which is not harmful to them, but to those who eat them”, explains Kelmo.
Experts explain symptoms and prevention
According to the director of the Institute of Biology at UFBA, symptoms usually appear between 2 and 24 hours after eating fish. “Muscles get stiff quickly, there are muscle pains, abdominal or chest pain, sometimes there can be difficulty breathing, in addition to a generalized loss of strength and the characteristic black urine. The kidneys are the organs that suffer the most, as they try to eliminate the toxin from the body”, explains Kelmo.
Usually, the patient experiences symptoms progressively. “The most important sign is the coffee-colored urine and, from a laboratory point of view, the serum elevation of an enzyme called creatine phosphokinase (CPK), responsible for muscle contraction,” says Washington. Therefore, Sesab’s recommendation is to verify the origin before purchasing freshwater fish and crustaceans.
“Before purchasing any food, check the origin, the quality of the product being purchased, check if the establishment has a business license and if the good practices of packaging and handling of food are respected. The ideal is to purchase these products in places whose origin offers security,” says the note.
The State Health Department also states that, through the Directorate of Epidemiological Surveillance and Sanitary and Environmental Surveillance, it has been monitoring all notified cases and supporting the municipalities regarding the importance of notification, investigation of cases, collection of material for laboratory tests, treatment and recommendations.
In case of onset of symptoms, such as acute and very intense muscle pain, of sudden onset, and dark urine after consumption of fish or shellfish, the recommendation is to immediately seek a health care unit. “It is important that the disease is identified and treated quickly, because the disease can progress quickly and bring complications for the person, such as kidney failure and multiple organ failure,” concludes Washington.
*With guidance from Deputy Reporting Chief Monique Lôbo.