Global incidence of rhabdomyolysis after cooked seafood consumption (Haff disease)

Clin Toxicol (Phila). 2015 Jun;53(5):421-6. doi: 10.3109/15563650.2015.1016165. Epub 2015 Mar 19.


Context: Haff disease is a syndrome of myalgia and rhabdomyolysis that occurs after consuming cooked seafood.

Objectives: (1) To identify the most common seafood vectors of Haff disease worldwide. (2) To describe and to compare the most commonly recurring clinical and laboratory manifestations of Haff disease. (3) To compare the Haff disease toxidrome with other similar toxidromes.

Methods: Internet search engines were queried with the keywords, and selected articles were stratified by reporting Old World or New World nations. Continuous variables were reported as means with standard deviations; categorical values were reported as proportions.

Results: Over 1,000 cases of Haff disease were initially described in Eastern Europe and Sweden during and following the ingestion of several species of cooked freshwater fish including burbot, pike, freshwater eel, and whitefish. More recent case reports followed consumption of cooked freshwater pomfret and boiled crayfish in China, and cooked or raw boxfish in Japan. There were 29 case reports of Haff disease in the United States with most following consumption of buffalo fish, crayfish, or Atlantic salmon.

Conclusion: The consumption of several species of cooked fish has caused Haff disease outbreaks worldwide. The bioaccumulation of a new heat-stable, fresh, and/or brackish/ salt-water algal toxin in seafood, similar to palytoxin, but primarily myotoxic and not neurotoxic, is suspected for causing Haff disease.

Keywords: Haff disease; Heat-stable; Myotoxins; Rhabdomyolysis; Seafood; Toxic.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Astacoidea*
  • Child
  • Child, Preschool
  • Cooking*
  • Eels
  • Female
  • Fishes*
  • Foodborne Diseases / diagnosis
  • Foodborne Diseases / epidemiology*
  • Foodborne Diseases / therapy
  • Global Health*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myalgia / diagnosis
  • Myalgia / epidemiology*
  • Myalgia / therapy
  • Prognosis
  • Rhabdomyolysis / diagnosis
  • Rhabdomyolysis / epidemiology*
  • Rhabdomyolysis / therapy
  • Risk Factors
  • Seafood / adverse effects*
  • Young Adult