Outbreak of black urine disease raises alert in Amazonas – 09/27/2023 – Health

Health authorities in Amazonas are on alert due to the increase in the number of suspected cases of Haff’s disease, known as the symptom of black urine. According to the state government, there have been 86 notifications since January. Of these, 20 occurred in September alone.

Of the total number of cases registered, 49 were confirmed, 24 discarded and 13 remain under investigation. According to the Amazonas Health Surveillance Foundation (FVS-AM), there are no deaths related to the disease.

The disease is rhabdomyolysis, a type of syndrome that causes the destruction of fibers that make up the body’s muscles. When associated with fish consumption, the syndrome is called Haff disease.

The municipality of Itacoatiara, 176 km from Manaus, has 36 cases, being the center of the state’s outbreak. Residents of four other municipalities, including the capital, were also diagnosed with the disease.

According to the epidemiological bulletin from the Health Surveillance Foundation (FVS-AM), “the compatible cases correspond to people living in Manaus (7), Manacapuru (3), Parintins (2) and Nova Olinda do Norte (1)”. The report began to be published on Mondays on the Foundation’s website.

Also according to FVS-AM, teams made up of members from different agencies set up a task force to track suspected cases in the municipalities. Furthermore, he reported that “the entire health network, including private and public units, in the capital and interior, is oriented to provide care for suspected cases of rhabdomyolysis.”

Known since the 1920s, the disease is related to a toxin found in fish and crustaceans. To date, scientists have not identified the toxic substance behind the disease.

Infectious disease specialist André Siqueira, researcher at the National Institute of Infectious Diseases Evandro Chagas (INI/Fiocruz), explains that this toxin present in fish causes muscle damage and can even seriously damage the kidneys.

The expert states, however, that rhabdomyolysis can have other causes such as trauma, excessive physical activity, infections, consumption of alcohol and other drugs.

According to the infectious disease specialist, there is no specific treatment for the disease, but it is possible to control the symptoms. The most frequent signs, among confirmed cases, are muscle pain, malaise, nausea, weakness, abdominal pain, vomiting and dark urine.

The first report of an outbreak of Haff disease in Brazil occurred in 2008, in the state of Amazonas, and was associated with the ingestion of pacu. The most serious moment occurred in 2017, when Bahia recorded 71 patients with the disease, 66 of them in the capital Salvador. Since then, other suspected or confirmed cases of the disease have also been reported in the states of Ceará, Alagoas, Pernambuco and Goiás.

Siqueira states that cases are rare, but tend to appear during dry periods in these regions. “It’s a phenomenon that rarely happens, but we observe that it occurs mainly during the most severe droughts, causing changes in the environment where the fish live.”