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Haff Syndrome

Toxic Myoglobinuria


Presentation

  • […] early 1920s of the greatest influenza pandemic in history, direct encounters with FM1 virus at Fort Mon mouth in 1947, the care of influenza patients in the 1950s, the pursuit of the in fluenza virus through the modern pandemics of 1957 and 1968, and a present[books.google.com]
  • Within a few hours her mother presented to the same hospital with similar, but less severe symptoms. Both women were treated and are expected to make full recoveries. No additional cases have occurred.[thedetectologist.blogspot.com]
  • This reference guide will be the must-have of any internist or medical professional, as it takes a vast quantity of data across a sweeping grid of disorders, diseases, and presentations, and boils them down to individual parts, facilely indexed, and located[books.google.com]
  • Make the most of your limited time with easy-to-digest blocks of information, consistently presented for clear readability and quick reference.[books.google.com]
  • (a) Patients may present with more than one comorbidity or symptom/signs. (b) Data available for 11 patients.[outbreakwatch.blogspot.com]
Hemophilia A
  • Stay up to date with new chapters on Clotting Disorders and Hemophilia, Patient-Centered Care, Health Disparities and Diversity in Emergency Medicine, Cost-Effectiveness Analysis, Antibiotic Recommendations for Empirical Treatment of Selected Infectious[books.google.com]
Episodic Weakness
  • Weakness 464 Case 73B An African American Man with Hyperthyroidism and Acute Paralysis 470 Case 74 A Boy with Large Muscles Leg Pain and Elevated Serum Creatine Kinase 472 Case 75 A Woman with Proximal Muscle Weakness Calf Hypertrophy Heel Contractures[books.google.com]
Coarse Facial Features
  • facial features 60 33 hallmark (90%) Very frequent (99-80%) HP:0000280 2 thick vermilion border 60 33 hallmark (90%) Very frequent (99-80%) HP:0012471 3 joint hyperflexibility 60 33 hallmark (90%) Very frequent (99-80%) HP:0005692 4 generalized hirsutism[malacards.org]
Difficulty Walking
  • Walking and Ataxia 415 Case 66 A Man with Progressive Neuropathy and Congestive Heart Failure 422 Case 67 An Elderly Woman with a Progressive Neuropathy 429 Case 68 A Young Woman with Difficulty Swallowing 433 Case 69 A Young Woman with Intermittent[books.google.com]
Vomiting
  • The next day the younger woman, who ate more of the fish, vomited and experienced muscle pain severe enough that she made a visit to a nearby hospital.[thedetectologist.blogspot.com]
  • Symptoms include muscle weakness, pain, dry mouth, chest pain, nausea, vomiting, confusion, and dark urine. Severe symptoms typically resolve quickly though some patients complain of fatigue for months following the onset of the acute symptoms.[fieldandstream.com]
  • Tendonitis Myofascial pain syndrome Headaches and migraines Postoperative pain Digestive Issues & Nausea Heartburn, Acid Reflux Irritable Bowel Syndrome (IBS) Chronic indigestion Chronic loose stools or constipation Acute and chronic gastritis Nausea and vomiting[acupuncturemaui.com]
  • One hour later, the wife vomited. Six hours after the meal, they developed generalized body aches and muscle stiffness.[cdc.gov]
  • Some other symptoms that have been reported include nausea, vomiting, chest pain, dyspnea and pain with light touch.[academic.oup.com]
Nausea
  • The syndrome is characterized by the sudden onset of severe rhabdomyolysis with nausea, vomiting, chest pain, shortness of breath, and pain with light touch. In Europe Haff disease has been associated with consumption of burbot, eel, and pike.[thedetectologist.blogspot.com]
  • […] foot pain Arm, wrist and hand pain Knee pain Hip pain Carpal tunnel syndrome Tennis Elbow Repetitive strain injuries Jaw pain (TMJ) Sciatica Arthritis Tendonitis Myofascial pain syndrome Headaches and migraines Postoperative pain Digestive Issues & Nausea[acupuncturemaui.com]
  • Symptoms include muscle weakness, pain, dry mouth, chest pain, nausea, vomiting, confusion, and dark urine. Severe symptoms typically resolve quickly though some patients complain of fatigue for months following the onset of the acute symptoms.[fieldandstream.com]
  • Some other symptoms that have been reported include nausea, vomiting, chest pain, dyspnea and pain with light touch.[academic.oup.com]
Gingival Overgrowth
  • overgrowth 60 33 frequent (33%) Frequent (79-30%) HP:0000212 10 blepharophimosis 60 33 frequent (33%) Frequent (79-30%) HP:0000581 11 furrowed tongue 60 33 frequent (33%) Frequent (79-30%) HP:0000221 12 intellectual disability 60 33 occasional (7.5%)[malacards.org]
Chest Pain
  • The syndrome is characterized by the sudden onset of severe rhabdomyolysis with nausea, vomiting, chest pain, shortness of breath, and pain with light touch. In Europe Haff disease has been associated with consumption of burbot, eel, and pike.[thedetectologist.blogspot.com]
  • Symptoms include muscle weakness, pain, dry mouth, chest pain, nausea, vomiting, confusion, and dark urine. Severe symptoms typically resolve quickly though some patients complain of fatigue for months following the onset of the acute symptoms.[fieldandstream.com]
  • Following discharge, the patient has reported occasional chest pain that he had not noticed before this episode. His wife did not become ill. St. Louis, Missouri Patients 4 and 5.[cdc.gov]
  • Some other symptoms that have been reported include nausea, vomiting, chest pain, dyspnea and pain with light touch.[academic.oup.com]
  • DISCUSSION Haff disease is a syndrome consisting of unexplained rhabdomyolysis characterized by sudden, extreme muscular rigidity, diffuse myalgia, chest pain, shortness of breath, full-body numbness and weakness, and coffee-colored urine, as well as[ncbi.nlm.nih.gov]
Heart Disease
  • Multivariate prediction of coronary heart disease in the Western Collaborative Group Study compared to the findings of the Framingham Study. ‎ Pagina 90 - Cerami A. Cachectin: more than a tumor necrosis factor. N Engl J Med 1986; 316:379-385. ‎[books.google.it]
  • Cardiovasculare diseases Myocardial infarction Revascularization: CABGS and PTCA or PCI Angina and silent ischemia Atrial Fibrillation Pacemakers and implantable cardioverter defibrillators Valvular heart disease Chronic heart failure Cardiac transplant[capitadiscovery.co.uk]
Hirsutism
  • […] coarse facial features 60 33 hallmark (90%) Very frequent (99-80%) HP:0000280 2 thick vermilion border 60 33 hallmark (90%) Very frequent (99-80%) HP:0012471 3 joint hyperflexibility 60 33 hallmark (90%) Very frequent (99-80%) HP:0005692 4 generalized hirsutism[malacards.org]
Diplopia
  • An Older Woman with Progressive Muscle Weakness 572 Case 92 An HIVInfected Man with Muscle Weakness and Spasms 577 Case 93 A Woman with Limb Swelling and Pain 581 Case 94 A Man with a Bent Spine 584 Case 95 A Man with Muscle Stiffness and Later with Diplopia[books.google.com]
Myalgia
  • The most common causes of myalgia are overuse, injury or stress [1]. However, myalgia can also be caused by diseases, disorders, medications, as a response to vaccination and withdrawal syndromes.[wikidoc.org]
  • The clinical picture presented is compatible with a variant of Epidemic Myalgia Syndrome - usually caused by an Echovirus. Epidemic myalgia is also known as Bornholm's disease.[flutrackers.com]
  • Striated muscle damage leads to full-body myalgia, weakness, and muscle rigidity. Carbon dioxide retention and respiratory failure occur due to respiratory muscle weakness.[ncbi.nlm.nih.gov]
  • His myalgias lasted for about 10–12 h, and then resolved. CPK and myoglobin started to improve on day 4.[academic.oup.com]
  • Symptoms associated with muscle injury include myalgia (muscle aches and pains) and flu-like symptoms. Many of these conditions will likely be associated with elevations of CPK and aldolase.[palpath.com]
Leg Pain
  • […] with Proximal Weakness 448 Case 72 A Young Woman with Distal Upper Extremity Weakness 454 Case 73A A Young Man with Episodic Weakness 464 Case 73B An African American Man with Hyperthyroidism and Acute Paralysis 470 Case 74 A Boy with Large Muscles Leg[books.google.com]
  • […] of cases in outbreak of Haff disease, Salvador, Brazil, 1 December 2016–31 January 2017 (n 15) Characteristics Number or median (range) Male 9 Age, years 43 (14–75) Symptoms/signs at first medical care a Neck/Trapezium pain 14 Arms pain 14 Thighs or legs[ncbi.nlm.nih.gov]
  • pain / 13 Back pain / 10 Thoracic pain / 2 Abdominal pain / 2 Throat pain / 1 Muscle weakness / 6 Fever / 0 Rash / 4 Dark urine / 8 Vital signs SBP, mmHg (b) / 146 (110-168) DBP, mmHg (b) / 79 (60-89) Heart rate, bpm (b) / 74 (60-97) Comorbidities (b[outbreakwatch.blogspot.com]
Foot Deformity
  • Deformities 510 Case 81 A Woman with Droopy Eyelids and Ophthalmoplegia 515 Case 82 A Man with Weakness and Swelling in the Neck 522 Case 83 A Woman with Muscle Pains and Dark Urine 526 Case 84 A Woman with Progressive Proximal Muscle Weakness 533 Case[books.google.com]
Muscle Spasm
  • Spasms 612 Case 100 A Woman with Proximal Muscle Weakness and Neuromuscular Irritability 616 Case 101 A Woman with Focal Spontaneous Muscle Movements 620 Index of Cases by Diagnosis 625 Index 629 حقوق النشر[books.google.com]
Calf Hypertrophy
  • Hypertrophy Heel Contractures and Elevated Serum Creatine Kinase 480 Case 76 A Young Man with Distal Leg Wasting and Normal Sensation 484 Case 77 A Woman with Droopy Eyelids and Difficulty Swallowing 493 Case 78 A Man with Facial and Shoulder Muscle[books.google.com]
Bulbous Nose
  • nose 60 33 hallmark (90%) Very frequent (99-80%) HP:0000414 8 abnormality of the hand 60 33 hallmark (90%) Very frequent (99-80%) HP:0001155 9 gingival overgrowth 60 33 frequent (33%) Frequent (79-30%) HP:0000212 10 blepharophimosis 60 33 frequent (33%[malacards.org]
Irritability
  • Fasciculations 594 Case 97 A Man with Large and Stiff Muscles 601 Case 98 A Boy with Short Stature Small Jaw Muscle Hypertrophy and Stiffness 609 Case 99 An Elderly Woman with Muscle Spasms 612 Case 100 A Woman with Proximal Muscle Weakness and Neuromuscular Irritability[books.google.com]
  • Presentation Haff-C-Plex SYR Haff-C-Plex from Haffkine contains D-Panthenol Below are some of the details of D-Panthenol(generic) D-Panthenol is used for the treatment of neuralgia, Pantothenic acid deficiency, acne, tongue infections, insomnia, irritability[drugsupdate.com]
  • […] pain Knee pain Hip pain Carpal tunnel syndrome Tennis Elbow Repetitive strain injuries Jaw pain (TMJ) Sciatica Arthritis Tendonitis Myofascial pain syndrome Headaches and migraines Postoperative pain Digestive Issues & Nausea Heartburn, Acid Reflux Irritable[acupuncturemaui.com]
Foot Drop
  • Case 58A A Woman with Leg Numbness Pain Weakness and Slow Nerve Conduction Velocities 372 Case 58B A Boy with Leg Weakness 375 Case 59 A Man with Hand Weakness and Numbness After Skiing 383 Case 60 A Man with Recurrent Foot Drop 386 Case 61 An Elderly[books.google.com]
Ataxia
  • Arthritis Who Developed Numbness and Pain in the Feet 399 Case 63 A Woman with Granulomatous Lesions in the Lungs and a Peripheral Neuropathy 405 Case 64 A Man with a Neuropathy Weight Loss and Lung Nodules 411 Case 65 A Woman with Difficulty Walking and Ataxia[books.google.com]
Areflexia
  • 67 An Elderly Woman with a Progressive Neuropathy 429 Case 68 A Young Woman with Difficulty Swallowing 433 Case 69 A Young Woman with Intermittent Weakness and a Positive Family History of Similar Problems 436 Case 70 A Woman with Muscle Weakness and Areflexia[books.google.com]
Dark Urine
  • […] and Later Contractures 503 Case 80 A Woman with Longstanding Weakness and Foot Deformities 510 Case 81 A Woman with Droopy Eyelids and Ophthalmoplegia 515 Case 82 A Man with Weakness and Swelling in the Neck 522 Case 83 A Woman with Muscle Pains and Dark[books.google.com]
  • Symptoms include muscle weakness, pain, dry mouth, chest pain, nausea, vomiting, confusion, and dark urine. Severe symptoms typically resolve quickly though some patients complain of fatigue for months following the onset of the acute symptoms.[fieldandstream.com]
  • Eight patients reported dark urine compatible with myoglobinuria and a mild rash was seen in four.[ncbi.nlm.nih.gov]
  • "The risk is that the person has dark urine, does not hydrate properly and end up having kidney failure, and that can happen," the doctor said.[flutrackers.com]

Workup

Pericardial Effusion
Slow Nerve Conduction Velocities
  • Case 58A A Woman with Leg Numbness Pain Weakness and Slow Nerve Conduction Velocities 372 Case 58B A Boy with Leg Weakness 375 Case 59 A Man with Hand Weakness and Numbness After Skiing 383 Case 60 A Man with Recurrent Foot Drop 386 Case 61 An Elderly[books.google.com]

Treatment

  • Get clear, concise descriptions and evidence-based treatment guidelines for a full range of clinical conditions, ranging from the common to the unusual.[books.google.com]
  • Treatment - Haff disease Treatment consisted of intravenous hydration, with administration of hepatic and stomach protective agents as well as diuretics.[checkorphan.org]
  • […] to alkalize the urine, and other supportive and symptomatic treatments.[ncbi.nlm.nih.gov]
  • The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China 2 Centre for Food and Drug Safety, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China 3 Prince of Wales Hospital Poison Treatment[mdpi.com]
  • Presentation Haff-C-Plex SYR Haff-C-Plex from Haffkine contains D-Panthenol Below are some of the details of D-Panthenol(generic) D-Panthenol is used for the treatment of neuralgia, Pantothenic acid deficiency, acne, tongue infections, insomnia, irritability[drugsupdate.com]

Prognosis

  • Prognosis - Haff disease Not supplied. Treatment - Haff disease Treatment consisted of intravenous hydration, with administration of hepatic and stomach protective agents as well as diuretics.[checkorphan.org]
  • Early diagnosis and proper treatment are essential to improving the prognosis for patients with Haff disease. The etiology of Haff disease remains unclear.[ncbi.nlm.nih.gov]

Etiology

  • The etiology of the disease is unknown, but the ill fish can be toxic for people. The 1st outbreak of the disease was registered in Gaff [Haff] bay.[zoonosesonline.org]
  • Because cases may occur outside of endemic areas, fish consumption should be included in the history for any case of rhabomyolysis of unknown etiology.[ingentaconnect.com]
  • "We already know that it is a virus that causes the disease, but we have not yet determined which type" [is it already known that the etiology is viral? What evidence has already been identified? - Mod RNA], says Dr.[flutrackers.com]
  • Diagnosis of rhabdomyolysis was made, but the etiology was unknown. He was started on intravenous normal saline at a rate of 200 cc/h, with strict monitoring of urine output. His urine output was maintained around 2–3 ml/kg/h.[academic.oup.com]
  • Although the etiology was not determined, epidemiologic investigations linked illness to ingestion of fish, especially burbot. The first reported case of Haff disease in the United States occurred in Texas in 1984 (M.[cdc.gov]

Epidemiology

  • Well, for now, without more robust clinical and epidemiological information, there are only hypotheses to be investigated, which should include viruses and toxins ...[flutrackers.com]
  • The majority of the 15 cases of Haff disease reported here clustered between the epidemiological week 48 and 51 of 2016, however, new cases continued to be reported up to epidemiological week 14 of 2017 ( Figure ).[ncbi.nlm.nih.gov]
  • The majority of the 15 cases of Haff disease reported here clustered between the epidemiological week 48 and 51 of 2016 [26-30 Dec 2016], however, new cases continued to be reported up to epidemiological week 14 of 2017 [week ending 7 Apr 2017] (Figure[outbreakwatch.blogspot.com]
  • Foodborne and Diarrheal Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases; Div of Applied Public Health Training, Epidemiology Program Office; and an EIS Officer, CDC.[cdc.gov]
  • The emergence and epidemiology of Haff disease in China. Toxins (Basel) 2016 ; 8 ( 12 ): 359 - 367. 6. Chen, Y, Yuan, B, Xie, G, et al.[cambridge.org]
Sex distribution
Age distribution

Prevention

  • Get the skills you need now with new information on global humanitarian relief and expedition medicine, plus expanded coverage of injury prevention and environmental preservation.[books.google.com]
  • Prevention - Haff disease All patients reported consumption of fish within 24 hours before the onset of symptoms; some cases occurred in family clusters and no cases were observed after the beginning of the period of prohibition of fishing in the region[checkorphan.org]
  • When Haff disease is suspected, proper treatment should be initiated as soon as possible to prevent deterioration in the condition of the patient.[ncbi.nlm.nih.gov]
  • Treatment is supportive and consists of administering large volumes of fluid early in the course of illness to prevent myoglobin toxicity to the renal tubules.[outbreaknewstoday.com]
  • Aggressive treatment with fluids and bicarbonate prevented renal damage in this case. Because cases may occur outside of endemic areas, fish consumption should be included in the history for any case of rhabomyolysis of unknown etiology.[ingentaconnect.com]

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