|
 
 |
| CORRESPONDENCE |
|
|
|
| Year : 2016 | Volume
: 34
| Issue : 3 | Page : 393-394 |
| |
An unusual case of blackwater fever
SN Biswas1, PP Chakraborty1, M Chakraborty2
1 Department of General Medicine, Midnapore Medical College and Hospital, Medinipur, West Bengal, India
2 Department of Microbiology, Calcutta School of Tropical Medicine, Kolkata, West Bengal, India
| Date of Submission | 28-May-2015 |
| Date of Acceptance | 22-Jan-2016 |
| Date of Web Publication | 12-Aug-2016 |
Correspondence Address:
M Chakraborty
Department of Microbiology, Calcutta School of Tropical Medicine, Kolkata, West Bengal
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0255-0857.188373
How to cite this article:
Biswas S N, Chakraborty P P, Chakraborty M. An unusual case of blackwater fever. Indian J Med Microbiol 2016;34:393-4 |
Dear Editor,
A 32-year-old gentleman admitted with high-grade intermittent fever associated with chills, headache and fatigue for 2 days and passage of dark urine for last 6 hours. He had no past history of malaria, and he denied intake of any medicine immediately before this presentation. He had an axillary temperature of 103.6°F, severe pallor, mild icterus, hepatosplenomegaly and coca-cola coloured urine [Figure 1]. Peripheral capillary-blood smear (PBS) showed ring forms of Plasmodium falciparum (28,312 parasites/μl). Haemoglobin and haematocrit levels were 6.4 g/dl and 20.3%, respectively, with normal glucose-6-phosphate-dehydrogenase activity (G6PD). Urine examination was positive for HAEM-test in the absence of red blood cells suggestive of haemoglobinuria. Renal and liver function tests were also deranged. He was managed with intravenous artesunate, crystalloids and packed-red-blood-cell. The PBS became negative for parasite after 48 h, urine colour normalised by day-3. | Figure 1: (From left to right) Urine specimen collected at 0, 12, 36 and 48 hours since presentation
Click here to view |
Blackwater fever (BWF), a rarely encountered clinical entity, is known to occur predominantly in nonimmune individuals residing in P. falciparum-endemic areas and receiving inadequate doses of the anti-malarial drug quinine. [1] This medical emergency is characterised by sudden and severe intravascular haemolysis leading to haemoglobinaemia and haemoglobinuria and clinically manifested by anaemia, passage of dark urine and often oliguric renal failure. [2] Though the underlying pathogenesis is poorly understood, association with partial immunity to malaria, G6PD-deficiency with subsequent oxidative-drug exposure, use of amino-alcohols particularly quinine and severe falciparum malaria with normal G6PD levels have been documented. [3] PBS usually documents low levels or absence of P. falciparum parasitaemia, as they are destroyed by the haemolytic crisis like in this case. [1] Strong clinical suspicion is the cornerstone of early diagnosis and management to reduce mortality and morbidity.
This was a rare scenario in which BWF developed on the first malarial episode in an adult patient from endemic zone who are unlikely to develop severe life-threatening malaria (unless they leave the transmission area and return years later) [4] without underlying G6PD deficiency or use of culprit medications.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| ~ References | |  |
| 1. | Chatterjee KD. Parasitology (Protozoology and Helminthology). 13 th ed. New Delhi, India: CBS Publishers and Distributors Pvt. Ltd.; 2014. p. 90-127.  |
| 2. | Bruneel F, Gachot B, Wolff M, Régnier B, Danis M, Vachon F; Corresponding Group. Resurgence of blackwater fever in long-term European expatriates in Africa: report of 21 cases and review. Clin Infect Dis 2001;32:1133-40. |
| 3. | Lon C, Spring M, Sok S, Chann S, Bun R, Ittiverakul M, et al. Blackwater fever in an uncomplicated Plasmodium falciparum patient treated with dihydroartemisinin-piperaquine. Malar J 2014;13:96. |
| 4. | White NJ. Malaria. In: Farrar J, Junghanss T, Kang G, Lalloo D, White NJ, editors. Manson's Tropical Diseases. Protozoan Infections. 23 rd ed. Edinburgh: Elsevier Saunders; 2014. p. 73-1201. |
[Figure 1]
|
