Black urine disease: what do we know about the crisis in Amazonas?

Since August 22, municipalities in Amazonas have been worrying local health authorities after confirming more than 40 cases of infections allegedly caused by black urine disease, the popular name for the rare condition of Haff.

Known since the 1920s as a derivative of a toxin from shellfish and fish, the pathology is responsible for destroying muscle fibers and affecting the kidneys, which can lead to death in more serious conditions.

In 1924, the Könisberg Haff coastal region near the Baltic Sea announced a mysterious case of sudden onset, with patients reporting symptoms of “muscle stiffness, often accompanied by dark urine”. For 9 years, the condition has been spreading through the present city of Kaliningrad, Russia, reaching its peak of transmission during the summer and autumn as a result of increased consumption of fish.

(Source: Pixabay / Reproduction)(Source: Pixabay / Reproduction)

Thus, the following decades showed a substantial increase in populations that came into contact with fish and crustacean toxins, resulting in outbreaks recorded in the former Soviet Union, Sweden, the United States and China. In Brazil, the first reports of the disease started in 2008, but only in 2017 was the moment of greatest severity, when 71 patients were diagnosed with black urine disease and almost all the inhabitants of Salvador (Bahia).

Now, Heff’s disease is back to scare Brazilians and, until August 30, 44 people from the municipalities of Itacoatiara, Silves, Manaus, Parintins, Caapiranga and Autazes showed similar symptoms, raising suspicions of a possible new outbreak linked to the pathology. In addition, one death was confirmed in Itacoatiara, while another ten patients are hospitalized for evaluation and treatment.

(Source: Shutterstock / Reproduction)(Source: Shutterstock / Reproduction)

In a statement, the Foundation for Health Surveillance of Amazonas (FVS-AM) commented that it is still investigating the problem, but reassured the population by commenting that it is not necessary to stop eating fish.

“Any situation that puts people’s health at risk must be carefully evaluated, people must be treated as appropriately as possible and we must also be concerned with the economic and nutritional aspects,” said infectologist Antonio Magela, from Fundação de Tropical Medicine Dr. Heitor Vieira Dourado, in Manaus.

“We are still working in the field of hypotheses. It could be a bacterium, a virus or even a toxin. People have a clinical picture suggestive of intoxication after food ingestion, and it evolves rapidly,” he explained.

Symptoms and Prevention

Among the main symptoms of Haff’s disease, chest pain, shortness of breath, numbness, nausea, dizziness and weakness stand out, in addition to rhabdomyolysis, muscle injuries caused by the destruction of fibers in the region. The disease’s popular name is also motivated by the appearance of black colored urine, similar to coffee, supposedly caused by chemicals produced by salmon, pacu, eel and other fish, as well as lobster, crayfish and shrimp.

(Source: Alagoas 24h / Reproduction)(Source: Alagoas 24h / Reproduction)

Its treatment consists of the application of enhanced hydration, since the ingestion of a large amount of fluids can reduce the concentration of impurities in the blood, relieving the activity of the kidneys. One of the great difficulties of the disease is prevention, since it is impossible to detect the presence of the toxin in fish until the first symptoms appear. In such cases, it is recommended to go to a hospital immediately and request a blood test.