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      Outbreak of Haff Disease along the Yangtze River, Anhui Province, China, 2016

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          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.

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          Rhabdomyolysis: a review of the literature.

          F Y Khan (2009)
          Rhabdomyolysis is a potentially life-threatening syndrome that can develop from a variety of causes; the classic findings of muscular aches, weakness and tea-coloured urine are non-specific and may not always be present. The diagnosis therefore rests upon the presence of a high level of suspicion of any abnormal laboratory values in the mind of the treating physician. An elevated plasma creatine kinase (CK) level is the most sensitive laboratory finding pertaining to muscle injury; whereas hyperkalaemia, acute renal failure and compartment syndrome represent the major life-threatening complications. The management of the condition includes prompt and aggressive fluid resuscitation, elimination of the causative agents and treatment and prevention of any complications that may ensue. The objective of this review is to describe the aetiological spectrum and pathophysiology of rhabdomyolysis, the clinical and biological consequences of this syndrome and to provide an appraisal of the current data available in order to facilitate the prevention, early diagnosis and prompt management of this condition.
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            Rhabdomyolysis: a review.

            Jason Warren, Peter C. Blumbergs, Philip D Thompson (2002)
            Rhabdomyolysis, a syndrome of skeletal muscle breakdown with leakage of muscle contents, is frequently accompanied by myoglobinuria, and if sufficiently severe, acute renal failure with potentially life-threatening metabolic derangements may ensue. A diverse spectrum of inherited and acquired disorders affecting muscle membranes, membrane ion channels, and muscle energy supply causes rhabdomyolysis. Common final pathophysiological mechanisms among these causes of rhabdomyolysis include an uncontrolled rise in free intracellular calcium and activation of calcium-dependent proteases, which lead to destruction of myofibrils and lysosomal digestion of muscle fiber contents. Recent advances in molecular genetics and muscle enzyme histochemistry may enable a specific metabolic diagnosis in many patients with idiopathic recurrent rhabdomyolysis. Copyright 2002 Wiley Periodicals, Inc.
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              Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features.

              Ivan Comelli, Giuseppe Lippi, Gianfranco Cervellin (2010)
              Rhabdomyolysis, a term used to describe the rapid breakdown of striated muscle, is characterized by rupture and necrosis of muscle fibers. This process results in the release of cell breakdown products into the bloodstream and extracellular space. Although direct muscle injury remains the most common cause of muscle injury, additional causes include hereditary enzyme disorders, drugs, toxins, endocrinopathies, malignant hyperthermia, neuroleptic malignant syndrome, heatstroke, hypothermia, electrolyte alterations, diabetic ketoacidosis and non-ketotic hyperosmolar coma, severe hypo- or hyperthyroidism and bacterial or viral infections. The classic triad of symptoms includes muscle pain, weakness and dark urine, although more than 50% of the patients do not complain of muscle pain or weakness. Additional systemic symptoms include fever, general malaise, tachycardia, nausea and vomiting. The laboratory diagnosis is based essentially on the measurement of creatine kinase in serum or plasma. Plasma and urine myoglobin measurement might be useful in the early stages of the syndrome and for identifying a subset of patients with minor skeletal muscle injury. Patient monitoring is pivotal (the mortality rate is as high as 8%), and should be focused on preventing the detrimental consequences, that often include renal disease and coagulopathy. In the pre-hospital setting, forced hydration with 1.5-2 L of sterile saline solution should be started immediately, followed by 1.5-2 L/h. Following hospital admission, continuous hydration should be ensured, alternating the saline solution with a 5% glucose solution. In the presence of myoglobinuria, urine should be alkalinized by use of sodium bicarbonate solution. Clin Chem Lab Med 2010;48:749-56.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (iso-abbrev): Emerg Infect Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): December 2020
                Volume: 26
                Issue: 12
                Pages: 2916-2921
                Affiliations
                [1]Chinese Center for Disease Control and Prevention, Beijing, China (H. Ma, W. Qin, C. Lin, D. Li, Q. Chen, Y. Ma, T. Zhou, S. Li, Q. Li);
                [2]Anhui Center for Disease Control and Prevention, Hefei, China (J. Wu, L. Gong, W. Ma);
                [3]Lu’an Center for Disease Control and Prevention, Lu’an (W. Qin); Wuhu Center for Disease Control and Prevention, Wuhu, China (C. Lin, Z. Cheng);
                [4]Ma’anshan Center for Disease Control and Prevention, Ma’anshan (B. Zha, D. Ge, J. Chen)
                Author notes
                Address for correspondence: Qun Li, Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China; email: liqun@ 123456chinacdc.cn
                Article
                Publisher ID: 19-1186
                DOI: 10.3201/eid2612.191186
                PMC ID: 7706968
                PubMed ID: 33219647
                SO-VID: 0ae3cbe0-3015-4ca7-b7b7-57fad26193d4
                History
                Categories
                Subject: Research
                Subject: Research
                Subject: Outbreak of Haff Disease along the Yangtze River, Anhui Province, China, 2016

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: haff disease,rhabdomyolysis,outbreak,crayfish,toxin,epidemiology,food safety,china
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: haff disease, rhabdomyolysis, outbreak, crayfish, toxin, epidemiology, food safety, china

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