‘Ate the fish and started to feel sick’: woman has two children with black urine disease in the AM

RIO — A pirarucu stew is pointed out as the main cause of the hospitalization of two children of 36-year-old cleaning woman Dayana Vasconcelos Lima. The child and adolescent, aged 10 and 12, were diagnosed with rhabdomyolysis, a syndrome associated with Haff’s disease known as “black urine disease”. The main cause of the disease is the ingestion of fish and shellfish. They have been under the care of the medical team at Hospital Regional José Mendes, located in Itacoatiara, 176 kilometers from Manaus, for over a week.

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— I got the pirarucu as a gift and made them dinner at home. We ate the fish and on the same night Miguel started to feel bad, but I didn’t imagine it would be that (rhabdomyolysis). It got better and worse overnight. On Saturday he said he couldn’t stand the weakness any longer, so I took him to the hospital,” Dayana said.

Miguel felt pain in his stomach and headache, had diarrhea, muscle weakness in his legs and arms. The teenager’s urine darkened but never turned black. On Monday, her 10- and 14-year-old siblings also developed symptoms and went to the hospital. The older one was released on the same day, but the younger one remains hospitalized with the syndrome.

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— The improvement is very slow. Doctors said the infection has gone down, but they still have a urinary tract infection. But with no forecast of high, probably in three or four days – said the cleaning lady.

Black urine disease is associated with consumption of contaminated fish Photo: Gabriel de Paiva / Gabriel Paiva
Black urine disease is associated with consumption of contaminated fish Photo: Gabriel de Paiva / Gabriel Paiva

The case of Dayana’s family is not the only one in Itacoatiara. The municipality is the epicenter of an outbreak of black urine disease, with 29 reported cases of rhabdomyolysis. According to the Amazonas Health Surveillance Foundation – Dr. Rosemary Costa Pinto (FVS-RCP), there are still two people with the syndrome in Manaus, one in Caapiranga and the other in Autazes.

Of the total contaminated, 18 remained hospitalized this Sunday, according to the FVS-RCP. Between them two children, precisely Dayana’s children. The eldest was taken to hospital on August 21, a few hours after eating the typical dish of the region, at dinner on Friday. The youngest was admitted to the hospital unit two days later.

Rhabdomyolysis is a condition that causes muscle damage that releases toxic substances into the bloodstream. When the syndrome appears after eating fish, it is associated with Haff disease. However, it can occur as a result of trauma, excessive physical activity, infections, seizures, consumption of alcohol and other drugs.

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— All reported cases may be associated with fish ingestion. There is still no consensus in the scientific community about the toxin that contaminates fish. Surveillance is focusing on early detection of cases and monitoring so that there is adequate clinical management for patients – said the director-president of the FVS-RCP, Cristiano Fernandes.

The FVS-RCP informed that it continues to carry out the epidemiological investigation of the outbreak. According to Dayana, the arapaima consumed by her family was in good shape, fresh and had a good origin. There are reports that the other patients got rhabdomyolysis after eating other types of fish, such as tambaqui, pacu and pirapitinga.