What happens during black water fever?

Wednesday, 19/10/2016

1.What is Black water fever?

●Black water fever, also called malarial hemoglobinuria , is one of the less common but the most dangerous complication of malaria.

●It is a type of malaria, in which red blood cells burst in the bloodstream which is also called haemolysis, releasing the haemoglobin directly into blood vessels and into the urine, which frequently leads to kidney failure.

●This disease was first linked to malaria by the Sierra Leonean physician, Dr. John Farrell Easmon in1884 in his pamphlet entitled “The Nature and Treatment of Blackwater Fever”. Dr. Easmon coined the name “black water fever”. He was the first one to successfully treat such cases following the publication of his pamphlet.

2.Signs and symptoms


●Within a few days of onset of this disease, there are chills, with rigor, jaundice, and vomiting, high fever. Its symptoms also include a rapid pulse, high fever and chills,extreme prostration.

●Rapidly developing or progressive anaemia. Patients develop anaemia frequently because of the low numbers of red blood cells.

●In the early course of this disease, the presence of blood pigments in the blood serum also usually produces jaundice.

●The passage of urine which is black or dark red in colour (hence the disease’s name) is also a sign. The distinctive colour of urine is because of the presence of large amounts of haemoglobin, which are released when malarial parasites cause the
extensive destruction of the patient’s red blood cells.


●The cause of haemolytic crises in this disease (mainly due to intravascular haemolysis) is unknown. There is massive and rapid destruction of red blood cells along with the production of hemoglobinemia (hemoglobin in the blood, but outside
the red blood cells), intense jaundice, hemoglobinuria (hemoglobin in urine), anuria (passing less than 50 milliliters of urine in a day), and finally death in the majority of cases.

●The most likely explanation for this fever is an auto immune reaction caused by the interaction (apparently) of the malaria parasite and the use of quinine.

●This fever is caused by heavy parasitisation of red blood cells with Plasmodium falciparum. There has been at least one case, however, attributed to Plasmodium vivax.

●Although blackwater fever is a serious complication of malaria, yet cerebral malaria has a higher mortality rate.

●Blackwater fever is much less common at present than it was before 1950. It may be the reason that quinine plays a role in further triggering the condition, and that this drug is no longer used commonly for malaria prophylaxis. Quinine remains an
important treatment of malaria except when the parasite is resistant to chloroquine, a problem that has been on the rise since 1990.


●Treatment for blackwater fever includes whole-blood transfusions, anti-malarial drugs, complete bed rest, however, even with these measures the mortality remains about 25 to 50 percent.

●The treatment is an anti-malarial chemotherapy, intravenous (inside the veins) fluid and intensive care and dialysis.

5.Prominent Victims

●Actor Don Adams, the best known as Maxwell Smart, contracted Blackwater Fever after being shot in combat at Guadalcanal during World War II. He was evacuated from his United States Marine Corps unit to a hospital in New Zealand where he at last made a full recovery.

●Black water fever occurs almost exclusively with infection from the parasite Plasmodium falciparum.

●The fever has a high mortality.



A micrograph of blood cells, showing ring-forms (circular organisms within the cells).

●Blackwater fever is most prevalent in Africa and Southeast Asia.

●Individuals, such as non-immune individuals or immigrants who are chronically exposed to malaria (with increased susceptibility), are classic sufferers from this complication.

●This fever seldom appears until or unless a person has had at least four attacks of malaria and has been in an endemic area for six months.

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