Blackwater fever

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Malignant tertian malaria

Overview

Blackwater fever is a complication of malaria characterized by intravascular hemolysis, hemoglobinuria and kidney failure. Blackwater fever is caused by heavy parasitization of red blood cells with Plasmodium falciparum. Plasmodium vivax may also cause the disease.

Historical Perspective

The term Black water fever was coined by the Sierra Leonean doctor John Farrell Easmon in his 1884 pamphlet entitled "Blackwater Fever." Easmon was the first to treat cases of black water fever following the publication of his pamphlet.

Pathophysiology

Pathogenesis

When red blood cells burst, hemoglobin leaks into the blood plasma. This free hemoglobin damages the glomerulus in the kidney, and begins to leak into the urine where it causes further damage to the tubules of the kidney.

The presence of hemoglobin in the urine causes a dark discoloration, hence the name. When it is passed, it is raven black.

The most probable explanation for Blackwater fever is an autoimmune reaction apparently caused by the interaction of the malaria parasite and the use of quinine.

Causes

The cause of hemolytic crises in this disease is unknown (mainly due to intravascular haemolysis). 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.

Epidemiology and Demographics

Blackwater fever is much less common today than it was before 1950. 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.

Natural History, Complications and Prognosis

Complications

Blackwater fever is a serious complication of malaria, but cerebral malaria has a higher mortality rate.

History and Symptoms

Symptoms

• Chills with rigor

• High fever

• Jaundice

• Vomiting

• Rapidly progressive anemia

• Dark red or black urine

Medical Therapy

Pharmacotherapy

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