According to the Ministry of Health, Haff disease is caused by a toxin that can be found in fish such as tambaqui, whiting, arabaiana or in crustaceans such as lobster, crayfish and shrimp. As it is poorly studied, it is believed that these animals may have fed on algae with certain types of toxins that, when consumed by humans, these toxins cause symptoms. However, the odorless and tasteless toxin arises when fish is not properly stored and packaged.
VIDEO: Meet Black Urine Disease
Amazonas recorded at least 61 cases of black urine disease in ten municipalities in the state. A 51-year-old woman died in Itacoatiara.
The Amazonas Health Surveillance Foundation (FVS-AM) reported that this is the third time that black urine disease outbreaks occur in Amazonas. The first was in 2008, with 27 cases in the cities of Manaus and Careiro. No deaths were recorded. The second was in 2015, with 74 cases registered in Manaus, Itacoatiara, Itapiranga, Nova Olinda do Norte, Autazes and Urucurituba. No deaths were recorded.
Bahia has identified thirteen cases of the syndrome so far. According to the Health Department of the State of Bahia (Sesab), notifications were made in the municipalities of Alagoinhas, Salvador, Maraú, Mata de São João, Camaçari and Simões Filho. In total, five remain under investigation.
According to Sesab, the 13 cases confirmed between January and September this year, are patients aged 20 to 79 years. The most affected age group is 35-49 years with seven cases (53.8%), followed by the age group of 20-34 years with five cases (38.5%) and unknown age (7.7%). Among confirmed cases, 66% were male.
In Ceará, the State Health Department investigates the occurrence of nine suspected cases. The numbers correspond to the records until the 21st of August and await laboratory confirmation of the toxin present in possibly contaminated fish. Of the nine suspected cases, four are men and five are women, with an average age of 51 years.
Three suspected cases of Haff’s Disease are investigated in Pará. Most of them have been concentrated in the lower Amazon region, which is in the dry period, when there is a reduction in the volume of water renewal in natural environments, allowing the proliferation of algae , which may have led to the appearance of the toxin.
Haff’s Disease is transmitted through toxins present in poorly packaged fish and crustaceans. — Photo: Fabiane de Paula/SVM
The Ministry of Health points out that hydration is “essential in the hours following the onset of symptoms, since this way it is possible to reduce the concentration of the toxin in the blood, which favors its elimination through the urine”. In more severe cases, hemodialysis may be required.
In most cases, the condition usually evolves well, but there is a risk of death, especially in people with comorbidities. It is recommended to seek help soon after the appearance of the first symptoms so that the diagnosis can be made as soon as possible.
There is nothing specific that can be done to prevent the illness. There are no ways to identify the toxin: it has no smell, taste or color and does not disappear after cooking the meat. The indication is to reduce the consumption of fish or buy them in places where the transport and storage process is known.
According to an article written in 2013 by specialists at Hospital São Lucas Copacabana, in Rio de Janeiro, the name of the disease has to do with its origin.
The first reports of it are from 1924 and come from the coastal region Könisberg Haff, which is close to the Baltic Sea. Currently, this site is part of the city of Kaliningrad, which belongs to Russia and borders Lithuania and Poland.
At the time, the doctors who worked at the site described a condition of sudden onset, with “muscle rigidity, often accompanied by dark urine”.
After the publication of the first reports, new cases were registered at the site for the next nine years. They occurred mainly between summer and autumn and had one factor in common: fish consumption.
“Due to the absence of fever and the rapid onset of symptoms after eating cooked fish, it is believed that Haff’s disease is caused by a toxin,” write the Brazilian authors.
Since then, new outbreaks have been registered in other countries, such as the former Soviet Union, Sweden, the United States and China.
In Brazil, the first cases were identified in 2008 and 2009.
The most serious moment happened in 2017, when Bahia counted 71 patients with the disease, 66 of them in the capital Salvador.