Haff disease associated with consumption of buffalofish (Ictiobus spp.) in the United States, 2010–2020, with confirmation of the causative species

Abstract

Background

In the United States, buffalofish (Ictiobus spp.) are sporadically associated with sudden onset muscle pain and weakness due to rhabdomyolysis within 24 h of fish consumption (Haff disease). Previous genetic analyses of case-associated samples were unable to distinguish the three species of buffalofish that occur in the US, Ictiobus cyprinellus (bigmouth buffalo), Ictiobus bubalus (smallmouth buffalo), and Ictiobus niger (black buffalo).

Methods

Ten events were investigated between 2010 and 2020 and demographic and clinical information was collected for 24 individuals. Meal remnants were collected from 5 of 10 events with additional associated samples (n = 24) collected from another five of 10 events. Low-coverage whole-genome sequencing (genome skimming) was used to identify meal remnants.

Results

Patients (26–75 years of age) ranged from 1–4 per event, with 90% involving ≥2 individuals. Reported symptoms included muscle tenderness and weakness, nausea/vomiting, and brown/tea-colored urine. Median incubation period was 8 h. Ninety-six percent of cases were hospitalized with a median duration of four days. The most commonly reported laboratory finding was elevated creatine phosphokinase and liver transaminases. Treatment was supportive including intravenous fluids to prevent renal failure. Events occurred in California (1), Illinois (2), Louisiana (1), New York (1), Mississippi (1), Missouri (2), New Jersey (1), and Texas (1) with location of harvest, when known, being Illinois, Louisiana, Mississippi, Missouri, Texas, and Wisconsin. Meal remnants were identified as I. bubalus (n = 4) and I. niger (n = 1). Associated samples were identified as I. bubalus (n = 16), I. cyprinellus (n = 5), and I. niger (n = 3).

Discussion

Time course, presentation of illness, and clinical findings were all consistent with previous domestic cases of buffalofish-associated Haff disease. In contrast to previous reports that I. cyprinellus is the causative species in US cases, data indicate that all three buffalofish species are harvested but I. bubalus is most often associated with illness.

Keywords:

• Haff disease
• rhabdomyolysis
• CPK
• transaminases
• buffalofish
• genome skimming

Acknowledgements

The authors wish to acknowledge the following organizations for assistance in collecting epidemiologic information and/or meal remnants from Haff disease cases described in this study: County of Los Angeles Department of Public Health, Cook County Department of Public Health, Illinois Department of Public Health, New York City Department of Health and Mental Hygiene, Mississippi Department of Environmental Quality, Louisiana Department of Public Health, New Jersey Department of Health, Texas Department of State Health Services. The following FDA district offices, emergency response coordinators, and/or consumer complaint coordinators also contributed to this study through the collection of information or samples: Los Angeles (LOS-DO), New Orleans (NOL-DO), Kansas (KAN-DO), Chicago (CHI-DO), and Minnesota (MIN-DO). Finally, the authors wish to acknowledge the following additional past and present FDA personnel for assistance on these cases: Harold Flores-Quintana, Edward Jester, Robert Dickey, Alison Robertson, Elizabeth Hunter, Tracy DuVernoy, Elisa Elliott, Susan Lance (CDC liaison), Hudson Granade (retired), Steven Plakas (retired), Capt. Thomas Hill (retired), and Richard Kanwall (retired). This project was supported in part by an appointment to the FDA Research Participation Program administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and the US Food and Drug Administration to Robert Literman.

Disclosure statement

No potential conflict of interest was reported by the author(s).