With two suspected cases in Ceará registered during the month of August, Haff’s Disease – also known as “black urine disease” – has raised concerns among the medical community. The condition is caused by the rhabdomyolysis syndrome related to the ingestion of contaminated fish or crustaceans, which causes a rupture of muscle tissue.
According to scientific research published in the journal Eurosurveillance and published on the website of the Oswaldo Cruz Foundation (Fiocruz), Haff disease infections were first reported in 1924 in the Baltic region, between Prussia and Sweden. Then the United States and China also identified similar records. In Brazil, currently, the Amazon has a case outbreak in the region, with 44 suspected cases.
In this scenario, the Northeast Diary talked with the infectious disease physician and professor at the Faculty of Medicine of federal University of Ceara (UFC), Mônica Façanha, to understand the situation caused by pathology in the human body.
What is Haff’s Disease or ‘Black Urine Disease’?
“What is known so far is that it is a disease acquired by ingesting fish, shrimp or lobster and that it is caused by a toxin, which we cannot identify macroscopically, that is, we cannot identify by smell or color , to look and find that the fish is spoiled and thus discard the possibility of ingestion. This is a problem, because at first no one knows how to carry out primary prevention”, highlights the infectologist.
What are the symptoms of the disease?
“Symptoms can happen very close to eating the fish, between two hours and a day later or a little longer. The person starts to have body ache, fever, may have nausea also and what draws attention is the dark urine, because this toxin affects the muscle, then the muscle cell breaks down and releases myoglobin, which will give the urine a dark color. And depending on the amount of muscle damage [rabdomiólise] it can even lead to kidney damage”, according to the doctor.
What fish cause black urine disease?
“Several fish have already been identified as suspected of being responsible for the disease. In the cases of Recife, currently, the tambaqui is being accused. But we have had cases with other species of fish. There is a hypothesis that the contamination is in the storage or transport of animals”, explains Mônica Façanha.
According to the Department of Health of Ceará (Sesa), the two suspected cases in the state are linked to ingestion of the fish species arabiana or “bull’s eye”.
In the study released by Eurosurveillance, the disease usually involves the consumption of freshwater fish. Among 15 cases reported in the research, 14 had eaten cooked fish of the “bull’s eye” species (Seriola spp) or “whit” (Mycteroperch spp). The research team is also working with the hypothesis that the most likely cause of the disease is a toxin present in the aquatic food chain.
How to prevent this syndrome?
“At this point, what you can do is eat less fish, try to avoid large amounts of fish to contain the toxin ingestion, if it is present. If you are going to eat, make sure it is as fresh as possible to avoid exactly any problems in storage or transport. There isn’t a very clear definition of what can be done, because we can’t identify the problem before ingesting it”, points out the UFC professor.
According to infectologist Antônio Bandeira, in an interview with Brazilian Society of Infectology (SBI), the toxin present in infected fish and shellfish is heat stable. Thus, “there is no use boiling, frying or cooking contaminated fish”.
How is Haff’s Disease transmitted and what are its main risks?
According to Dr. Mônica Façanha, the disease is transmitted exclusively through the consumption of contaminated fish or crustaceans, and is not a contagious disease among humans. In addition, the disease can generate several complications, but the most frequent and dangerous is kidney failure.
What should people do when they notice dark urine or suspect the disease?
“They need to look for the medical care, because it is necessary to see what is the intensity of this involvement. And then you will need a lot of hydration to protect the kidney. The treatment is basically to hydrate and maintain the functions of Organs vital organs”, concludes the specialist.
*Mônica Façanha has a degree in Medicine from the Federal University of Ceará, a master’s degree in Infectious and Parasitic Diseases from the Federal University of Rio de Janeiro and a Ph.D. in Pharmacology from the Federal University of Ceará.