Haff disease

History

It was first described in 1924 in the vicinity of Königsberg, Germany (now Kaliningrad, Russia) on the Baltic coast, in people staying around the northern part of the Vistula Lagoon (German: Frisches Haff).

Over the subsequent fifteen years, about 1000 cases were reported in people, birds and cats, usually in the summer and fall, and a link was made with the consumption of fish (burbot, eel and pike). Since that time, only occasional reports have appeared of the condition, mostly from the Soviet Union and Germany.

In 1997, six cases of Haff disease were reported in California and Missouri, all after the consumption of buffalo fish (Ictiobus cyprinellus).

In July and August 2010, dozens of people contracted rhabdomyolysis after eating Procambarus clarkii in Nanjing, China. A month later, the Chinese authorities claimed they were victims of Haff disease.

An outbreak was reported in Brooklyn, New York on 18 November 2011, when two household members were stricken by the syndrome after eating buffalo fish. On February 4, 2014 two cases of Haff Disease were reported in Cook County, Illinois following the consumption of buffalo fish. A group from Brazil has recently identified a Haff Disease outbreak in Bahia state with 71 cases identified.

Poison

The exact nature of the poison is still unclear. In the U.S. outbreak, the source of the fish was traced by the Centers for Disease Control and Prevention, and studies of other fish from the same sources showed a hexane-soluble (and hence non-polar lipid) substance that induced similar symptoms in mice; other food-borne poisons commonly found in fish could not be detected. It cannot be inactivated by cooking, as all six CDC cases had consumed cooked or fried fish. Palytoxin has been proposed as a disease model. It has also been suggested that the toxin may have thiaminase activity (i.e. it degrades thiamine, also known as vitamin B1).