Diagnostic and Differential Diagnostic Significance of Laboratory Markers in Crayfish-Associated Rhabdomyolysis.

CONTEXT: Haff disease is a rare syndrome of myalgia and rhabdomyolysis occurring within 24h of consumption of certain types of cooked freshwater fish or crustacean.

OBJECTIVE: The white blood cell count (WBC), plasma creatine kinase (CK), creatine kinase isoenzyme (CK-MB), CK-MB/CK, troponin T (cTnT) and creatinine (Cr) were analyzed as diagnostic markers for crayfish ( Procambarus clarkii )-associated rhabdomyolysis (Haff disease). The significance of these laboratory markers in differentiating myocardial injury disease and Haff disease was explored.

METHODS: 138 patients with symptoms of acute onset (such as chest pain, muscle pain) and high myocardial enzymes were assigned as the Haff disease group and myocardial injury group, respectively. In parallel, 80 healthy individuals were selected as healthy control. Plasma Cr, CK, and CK-MB levels were detected by the Johnson & Johnson DT60II dry biochemistry analyzer; cTnT level was detected by Roche Elecsys 2010; WBC was detected by Sysmex 5300.

RESULTS: The WBC levels in the Haff disease group and myocardial injury diseases group were higher than the healthy control group ( P <0.05). The plasma CK, CK-MB levels in Haff disease group were the highest, following by the myocardial injury disease group, and the lowest were in the normal control group. There were also statistically significant differences between two groups ( P <0.05): the CK-MB/CK and cTnT's levels in the myocardial injury disease group were higher than those in the Haff disease group and healthy control group ( P <0.05); the plasma Cr level in the Haff disease group was lower than that in the myocardial injury disease group and normal control group ( P <0.05).

CONCLUSION: Our results indicated that WBC, plasma CK, and CK-MB increase significantly, whereas Cr decreases significantly in Haff disease. These laboratory markers may be used for the diagnosis of crayfish-associated rhabdomyolysis. CK may be used as a biomarker to evaluate the severity of Haff disease, while cTnT and CK-MB/CK may be used to differentiate myocardial injury disease and Haff disease.