Black water fever

Black water fever is a severe but life-threatening complication. Acute massive haemolysis occurs. It has been observed after taking halofantrine, artemisinin-derivatives and after irregular use of quinine. The precise mechanism is not known. The parasitaemia is generally very low. There is high fever, jaundice, back pain, shock and very dark urine. Renal insufficiency occurs: the urine production is very low (oliguria) or zero (anuria). Mortality is very high. When quinine was no longer used prophylactically, black water fever became very rare. As this product is increasingly back into use, it can be assumed that this complication will again become more common. Differential diagnosis should be made with leptospirosis and viral haemorrhagic fever. Acute renal failure may also be caused by shock, hypovolaemia with reduced renal circulation, DIC (diffuse intravascular coagulation), obstruction of the renal glomeruli by parasitised red blood cells and by the precipitation of released haemoglobin in the kidney (pigment nephropathy). The combination of these factors can result in acute tubular necrosis. Glomerulonephritis may occur in chronic quartan malaria, but this complication plays no part in acute renal problems.

Category: Medicine Notes