title: Rhabdomyolysis After Cooked Seafood Consumption (Haff Disease) in the United States vs China.
abstract: BACKGROUND
  Haff disease is a syndrome of myalgia and rhabdomyolysis that occurs after eating cooked seafood.
  
  
  METHODS
  For this descriptive analytical article, a literature search identified the scientific articles on Haff disease and/or rhabdomyolysis after eating cooked seafood in the United States and China. Analysis of those articles focused on identifying the seafood vectors of Haff disease, describing the most commonly recurring clinical and laboratory manifestations of Haff disease, and comparing the Haff disease toxidrome with other similar seafood-borne toxidromes. Statistically significant differences were determined using unpaired t tests and Fisher exact tests.
  
  
  RESULTS
  Twenty-nine confirmed cases of Haff disease were identified in the United States, and 60 cases were identified in China during 1984-2014. Most of the US cases followed consumption of buffalo fish, and most of the Chinese cases followed consumption of freshwater pomfret. However, Haff disease also followed consumption of the same species of boiled crayfish (Procambarus clarkii) in the United States (n=9) and China (n=6). US patients with crayfish-transmitted Haff disease reported significantly more nausea with and without vomiting, chest pain, body and back pain, dyspnea, and diaphoresis than the Chinese patients and were more frequently misdiagnosed as having myocardial infarctions.
  
  
  CONCLUSIONS
  The bioaccumulation of a new, heat-stable freshwater and/or brackish/saltwater algal toxin, similar to palytoxin but primarily myotoxic and not neurotoxic, is suspected of causing Haff disease. At present, only the rapid identification of the seafood vectors of Haff disease will limit disease outbreaks and prevent further cases.
authors.affiliation: Program in Environmental and Occupational Health Sciences, School of Public Health, and the Department of Anesthesiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: James H
authors.initials: JH
authors.lastname: Diaz
keywords: Neurotoxins; rhabdomyolysis; seafood