Cases of ‘black urine disease’ advance in 7 states

Symptoms range from feeling weak, headache and muscle pain to a change in urine color. THE Haff’s Disease, which is mainly identified by the darkening of the liquid expelled from the urethra and related to fish consumption, was diagnosed in dozens of residents of at least seven Brazilian states. The Health Departments of Bahia, Ceará, Pará and Amazonas monitor 91 suspects. Just this Thursday, the Amazon identified six new cases. Two deaths in the Northern States are also under investigation.

Health departments from different states monitor 91 suspected cases

Health departments from different states monitor 91 suspected cases

Photo: Camila Hampf Mendes/Disclosure Hospital Pequeno Príncipe / Estadão Content

Through a note sent to the report, the Ministry of Health informed that there is a record of 61 infected in Amazonas and that it is awaiting confirmation of another 22 “compatible with the disease in six other federated units”. The folder did not answer, however, which other states are also on alert and whether there is a standard sanitary protocol in the different regions.

One of the deaths, also under investigation, is that of a 55-year-old man on the morning of Tuesday, 7. He was admitted to the Municipal Hospital of Santarém, in Pará. Genivaldo Cardoso Azevedo began to feel the first symptoms hours after eat fish. The medical report indicated a “generalized infection” as the cause of death.

The Secretariat of Public Health of Pará (Sespa) said that two other cases are being investigated in Belém and Trairão. Blood and urine samples were sent to the Central Laboratory of Pará (Lacen). The folder also said that the municipalities are oriented to increase attention to the packaging of fish and reinforced that the patient should seek care at the first sign.

Of the 61 cases already reported in Amazonas, since the 21st of August, 37 are in Itacoatiara, 176 kilometers from Manaus. On the 28th of the same month, a 51-year-old woman died in the city. The others are distributed in the municipalities of Silves (4), Borba (4), Manaus (3), Parintins (4), Maués (4), Urucurituba (2), Caapiranga (1), Autazes (1) and Manacapuru (1 ). The Health Surveillance Foundation (FVS) said that six people are hospitalized and the outbreak is still being investigated. According to the folder, a task force with sanitary technicians monitors the cases in Itacoatiara.

Causes under investigation

The symptoms were noticed by Bahian public servant Ademir Clavel hours after a family lunch, at the end of July. He, his wife and son felt pain in the musculature, head and also weakness after ingesting whiting. Vânia Clavel noticed the brown urine and lost her movements, says Ademir to state.

“I felt much lighter pain, compared to my wife, but everything was fine,” he recalls, who sought immediate care in the emergency room at Hospital Cárdio Pulmonar, in Salvador. Ademir was hospitalized for one day, while his wife remained in the hospital for ten days. After the scare, he told the story that the family is still accompanied by doctors. “But it’s okay and I don’t think people should panic, there are still studies going on.”

Director of Epidemiological Surveillance of Bahia, Eleuzina Falcão says that the first cases were registered in the state between December 2016 and January 2017. Two deaths were confirmed at the time. There were no records in 2018 and 2019. In 2020, it counted 40 patients in seven municipalities, including Salvador. In 2021, of the 18 cases reported, 13 have already been confirmed in the capital, in Alagoinhas, Simões Filho, Mata de São João and Maraú.

Eleuzina explains that the haff it is caused by a toxin present in some fish and one of the possibilities is that, after feeding on a toxic alga, the fish becomes infected and starts transmitting the disease. “It is a low-effectiveness infection, that is, it affects few people. It is an inflammatory process that causes the muscle to rupture. The kidney loses its filtering capacity and, therefore, the urine darkens”, she says, which alerts to the need for hydration of patients.

Symptoms can appear within 24 hours after consuming the fish, adds Eleuzina, who considers the situation controlled in Bahia. “Epidemiological, Sanitary and Environmental surveillance accompany notifications in municipalities.” According to her, Lacen examines, together with researchers from the Federal University of Santa Catarina, they examine fish samples. There is no forecast for the first results.

In Ceará, according to the Ministry of Health, nine suspicions of Haff’s disease, identified since August 21, are awaiting laboratory confirmation. Of these, four were men and five women, with a mean age of 51 years. The main symptoms identified by the patients are sudden pain in the cervical region 44.44%, in the lower and upper limbs (100%), dark urine (100%); joint pain (44.44%) and fever (11.11%).

Wanted, the National Health Surveillance Agency (Anvisa) and the Ministry of Agriculture, Livestock and Supply (Mapa) did not return contact until the end of this report.