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

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). 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. 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). 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.在美国，牛胭脂鱼属（Ictiobus spp.）鱼类与食用后24小时内突发横纹肌溶解症所致的肌肉疼痛、乏力症状（即哈夫病（Haff disease））存在散在关联。此前针对病例相关样本的遗传学分析无法区分美国境内分布的3种牛胭脂鱼：大口牛胭脂鱼（Ictiobus cyprinellus，bigmouth buffalo）、小口牛胭脂鱼（Ictiobus bubalus，smallmouth buffalo）以及黑牛胭脂鱼（Ictiobus niger，black buffalo）。2010年至2020年间，本研究共调查10起相关事件，收集了24名个体的人口学特征与临床信息。10起事件中有5起采集了餐食残余样本，另外5起事件则采集了额外的关联样本（n=24）。本研究采用低覆盖度全基因组测序（genome skimming）对餐食残余样本进行物种鉴定。患者年龄介于26~75岁，每起事件涉及1~4名患者，其中90%的事件涉及至少2名患者。报告的临床症状包括肌肉压痛与乏力、恶心呕吐，以及棕褐色或茶色尿液。中位潜伏期为8小时。96%的病例需住院治疗，中位住院时长为4天。最常见的实验室检查异常为肌酸激酶（creatine phosphokinase）与肝转氨酶（liver transaminases）水平升高。治疗采用支持疗法，包括静脉补液以预防肾衰竭。本次事件分布于加利福尼亚州（1起）、伊利诺伊州（2起）、路易斯安那州（1起）、纽约州（1起）、密西西比州（1起）、密苏里州（2起）、新泽西州（1起）与得克萨斯州（1起）；若已知捕捞地点，则为伊利诺伊州、路易斯安那州、密西西比州、密苏里州、得克萨斯州与威斯康星州。餐食残余样本经鉴定为小口牛胭脂鱼（I. bubalus，n=4）与黑牛胭脂鱼（I. niger，n=1）。关联样本经鉴定为小口牛胭脂鱼（n=16）、大口牛胭脂鱼（n=5）与黑牛胭脂鱼（n=3）。本次研究的病程、疾病表现与临床结果均与此前美国境内牛胭脂鱼相关哈夫病的本土病例一致。与此前认为大口牛胭脂鱼是美国病例致病物种的报道不同，本研究数据显示，3种牛胭脂鱼均有被捕捞的情况，但小口牛胭脂鱼是最常与发病相关的物种。