1
|
Ma H, Wu J, Qin W, Lin C, Li D, Zha B, Chen Q, Ma Y, Zhou T, Li S, Gong L, Ma W, Ge D, Cheng Z, Chen J, Li Q. Outbreak of Haff Disease along the Yangtze River, Anhui Province, China, 2016. Emerg Infect Dis 2020; 26:2916-2921. [PMID: 33219647 PMCID: PMC7706968 DOI: 10.3201/eid2612.191186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated a large outbreak of Haff disease that occurred along the Yangtze River in Anhui Province, China, in 2016. Of the 672 cases identified during the outbreak, 83.3% (560/672) occurred in Wuhu and Ma’anshan. Patients experienced myalgia (100%) and muscle weakness (54.7%). The mean value of myoglobin was 330 + 121.2 ng/mL and of serum creatine kinase 5,439.2 + 4,765.1 U/L. Eating crayfish was the only common exposure among all cases; 96.8% (240/248) of implicated crayfish were caught on the shores of the Yangtze River or its connected ditches. Mean incubation period was 6.2 + 3.8 hours. This case–control study demonstrated that eating the liver of crayfish and eating a large quantity of crayfish were associated with an increased risk for Haff disease. The seasonal increases in crayfish population along the Yangtze River might explain the seasonal outbreaks of Haff disease.
Collapse
|
2
|
Gao X, Song X, Zuo R, Yang D, Ji C, Ji H, Peng L, Qiu Y, Guo D, Jiang S. Ionophore Toxin Maduramicin Produces Haff Disease-Like Rhabdomyolysis in a Mouse Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7882. [PMID: 33121157 PMCID: PMC7663665 DOI: 10.3390/ijerph17217882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 11/21/2022]
Abstract
Maduramicin is a toxic ionophore antibiotic that is isolated from Streptomyces, frequently occurring in an aquatic environment. To understand the potential role of maduramicin in crayfish consumption related Haff disease, a mouse model was established in this study. Two exposure routes of maduramicin in the abdominal muscle and the hepatopancreas tissue homogenates of crayfish were given intragastrically to mice in different doses for seven days. Action changes, clinical symptoms, feed consumption, body weight, blood biochemistry, and histopathology examination of mice were observed and analyzed. In the natural exposure group, relatively low concentration of maduramicin in crayfish muscle and hepatopancreas had no obvious effects on mental state, body weight, blood biochemical indexes, or histologic appearance. However, in the artificial exposure group, with increasing concentrations, maduramicin in crayfish muscle and hepatopancreas homogenates both induced mental sluggishness and weight loss of mice. Blood biochemical examination showed that 3.5 mg·kg-1 and 7 mg·kg-1 maduramicin in crayfish tissue homogenates significantly increased levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), lactate dehydrogenase (LDH), and creatine kinase (CK). Additionally, histopathological examination showed that multiple organs were damaged by maduramicin, including degeneration of liver cells, shedding of renal epithelial cells, and disturbance and partial lysis of myocardial and skeletal muscle filaments in the mice. In summary, maduramicin may not cause Haff disease through contamination of the aquatic environment under normal conditions. Maduramicin can be used as a potential toxin tool to establish a rhabdomyolysis disease animal model for drug development.
Collapse
Affiliation(s)
- Xiuge Gao
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Xinhao Song
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Runan Zuo
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Dan Yang
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Chunlei Ji
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Hui Ji
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Lin Peng
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Yawei Qiu
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Dawei Guo
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China
| | - Shanxiang Jiang
- Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.G.); (X.S.); (R.Z.); (D.Y.); (C.J.); (H.J.); (L.P.); (Y.Q.); (D.G.)
| |
Collapse
|
3
|
Almeida LKR, Gushken F, Abregu-Diaz DR, Muniz R, Degani-Costa LH. Rhabdomyolysis following fish consumption: a contained outbreak of Haff Disease in São Paulo. Braz J Infect Dis 2019; 23:278-280. [PMID: 31351034 PMCID: PMC9427941 DOI: 10.1016/j.bjid.2019.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/14/2019] [Accepted: 06/21/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Lyna K R Almeida
- Hospital Israelita Albert Einstein - Avenida Albert Einstein, 627/701 - Morumbi, São Paulo, SP CEP: 05652-900, Brazil
| | - Fernanda Gushken
- Hospital Israelita Albert Einstein - Avenida Albert Einstein, 627/701 - Morumbi, São Paulo, SP CEP: 05652-900, Brazil
| | - Dario R Abregu-Diaz
- Hospital Israelita Albert Einstein - Avenida Albert Einstein, 627/701 - Morumbi, São Paulo, SP CEP: 05652-900, Brazil
| | - Roberto Muniz
- Hospital Israelita Albert Einstein - Avenida Albert Einstein, 627/701 - Morumbi, São Paulo, SP CEP: 05652-900, Brazil.
| | - Luiza H Degani-Costa
- Hospital Israelita Albert Einstein - Avenida Albert Einstein, 627/701 - Morumbi, São Paulo, SP CEP: 05652-900, Brazil
| |
Collapse
|
4
|
Guo B, Xie G, Li X, Jiang Y, Jin D, Zhou Y, Dai Y, Zhen S, Sun G. Outbreak of Haff disease caused by consumption of crayfish (Procambarus clarkii) in nanjing, China. Clin Toxicol (Phila) 2018; 57:331-337. [PMID: 30451016 DOI: 10.1080/15563650.2018.1529318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CONTEXT This paper reports a detailed epidemiological investigation of a large Haff disease outbreak in Nanjing, China, including laboratory analysis of water, river sediment, and fish. METHODS Structured questionnaires were administered to all case-patients. An unmatched case-control study was conducted to identify the factors affecting the incidence of Haff disease. Thirteen samples of crayfish, together with four samples of water and four samples of sediment were collected and sent for laboratory analysis. RESULTS The disease onset of 494 patients occurred between 2 am on 30 June 2016 and 3 am on 29 August 2016. The median incubation time for onset of symptoms after crayfish ingestion was 7.1 hours (range: 1-20 hours). All patients presented with or developed local or diffuse myalgia. However, no kidney injury was observed. Serum creatinine kinase was elevated in all patients (mean: 4614 U/L, median: 2000 U/L, range: 81-55200 U/L). The average number of crayfish consumed by patients on the day of illness was 20 (2-80). The case-control study revealed that eating a large quantity of crayfish, drinking alcohol, and eating the crayfish head and/or intestines were associated with an increased risk of disease. Chemical analysis of crayfish, river water and sediment did not identify known or novel toxins including anticoccidiosis drugs, niclosamide, organophosphorus pesticides, and microcystins. CONCLUSION An outbreak of Haff Disease was associated with consumption of crayfish from the Yangtze River and its surrounding water system. Eating a large quantity of crayfish, eating the head and/or intestines, and consuming alcohol with the crayfish were associated with the development of Haff Disease.
Collapse
Affiliation(s)
- Baofu Guo
- a Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health , Southeast University , Nanjing , China.,b Nanjing Municipal Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Guoxiang Xie
- b Nanjing Municipal Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Xiaocheng Li
- b Nanjing Municipal Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Yun Jiang
- b Nanjing Municipal Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Di Jin
- b Nanjing Municipal Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Yonglin Zhou
- c Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Yue Dai
- c Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Shiqi Zhen
- c Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , Jiangsu , China
| | - Guiju Sun
- a Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health , Southeast University , Nanjing , China
| |
Collapse
|
6
|
The Emergence and Epidemiology of Haff Disease in China. Toxins (Basel) 2016; 8:toxins8120359. [PMID: 27916937 PMCID: PMC5198553 DOI: 10.3390/toxins8120359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/23/2016] [Accepted: 11/28/2016] [Indexed: 11/17/2022] Open
Abstract
Haff disease is a rare syndrome of unexplained myalgia and rhabdomyolysis occurring within 24 h of consumption of certain types of cooked freshwater fish or crustacean. It is caused by a yet unidentified heat-stable toxin. In the present review of published case studies and official press releases, the main objective is to report the emergence and epidemiology of Haff disease in China. Haff disease first occurred in Beijing in 2000 and in Lianzhou and Liannan, Guangdong Province in 2009. Subsequent outbreaks mostly occurred in the Jiangsu Province—Nanjing, Yangzhou, Huai’an, and Yancheng. Isolated outbreaks occurred in other cities since 2010—Shijiazhuang, Yueyang, Shanghai, Wuhu, Baoding, Shenzhen, and Hong Kong (imported cases from Shenzhen). Outbreaks occurred predominately in the summer. Crayfish accounted for almost all the outbreaks. Two large outbreaks occurred in Lianzhou and Liannan in 2009 (n = 54) after eating pomfrets and in Nanjing in 2010 (n = 42) after eating crayfish. Other reports or outbreaks involved only 1–9 subjects (median 2 subjects). Variability in individual susceptibility and attack rates were noted, with many subjects remaining asymptomatic despite sharing the same seafood meal as the index cases. Adults were predominately involved. Symptoms occurred within 3–20 h of seafood ingestion, including myalgia, weakness, and, less frequently, nausea, vomiting, abdominal pain, and diarrhea. Myalgia and muscle weakness should normally subside within 2–3 days. Serum creatine phosphokinase became normal within 5–6 days. Abnormal renal function was uncommon. Serious complications (renal failure, multi-organ failure, and prolonged myopathy) and death were rare. In any subjects with unexplained myalgia and rhabdomyolysis, seafood consumption should be included in the history. All suspected cases of Haff disease, including milder presentations, should be reported to public health authorities.
Collapse
|