blackwater fever

Blackwater fever is a complication of malaria characterized by intravascular haemolysis, haemoglobinuria and kidney failure. Blackwater fever is caused by heavy parasitization of red blood cells with Plasmodium falciparum. There has been at least one case, however, attributed to Plasmodium vivax.^[1]

Presentation

Within a few days of onset there are chills, with rigor, high fever, jaundice, vomiting, rapidly progressive anemia and the passage of dark red or black urine.

The cause of hemolytic crises in this disease is unknown. There is rapid and massive destruction of red blood cells (RBCs) with the production of hemoglobinemia (hemoglobin in the blood, but outside the RBCs), hemoglobinuria (hemoglobin in urine), intense jaundice, anuria (passage of less than 50 milliliter of urine in a day), and finally death in the majority of cases.

The most probable explanation for blackwater fever is an autoimmune reaction.

Treatment

The treatment is antimalarial chemotherapy, intravenous fluid and sometimes supportive care such as intensive care and dialysis.

Blackwater fever is a serious complication of malaria, but cerebral malaria has a higher mortality rate. Blackwater fever is much less common today than it was before 1950.^[2] It may be that quinine plays a role in triggering the condition, and this drug is no longer commonly used for malaria prophylaxis. Quinine remains important for treatment of malaria.

Cultural references

• Out of Africa, a film based on the experiences of author Isak Dinesen
• The Power of One a film based on the book of the same name
• The Bridge on the River Kwai, a film about prisoners of war in a jungle environment
• At Play in the Fields of the Lord, a novel by Peter Matthiessen
• West with the Night, African memoir by aviatrix Beryl Markham
• Burmese Days, a novel by George Orwell; several associates of Flory are noted to have died of blackwater fever in chapter 5
• The Heart of the Matter, a novel by Graham Greene
• Green Hills of Africa, a novel by Ernest Hemingway
• Blackwater Fever, a film by Cyrus Frisch

References

1. ^ Katongole-Mbidde E, Banura C, Kizito A (1988 Mar 19). "Blackwater fever caused by Plasmodium vivax infection in the acquired immune deficiency syndrome". Br Med J (Clin Res Ed) 296 (6625): 827. PMID 3130932. 
2. ^ Bruneel F, Gachot B, Wolff M, et al. (2002). "[Blackwater fever]" (in French). Presse médicale (Paris, France : 1983) 31 (28): 1329–34. PMID 12355996. 

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