Blackwater fever
Encyclopedia
Blackwater fever is a complication of malaria
in which red blood cells burst in the bloodstream (hemolysis
), releasing hemoglobin directly into the blood vessels
and into the urine
, frequently leading to kidney failure. The term "blackwater fever was coined by the Sierra Leonean doctor John Farrell Easmon
in his 1884 "Blackwater Fever".
, high fever
, jaundice
, vomiting, rapidly progressive anemia
, and dark red or black urine.
crises in this disease is unknown (mainly due to intravascular haemolysis). There is rapid and massive destruction of red blood cells with the production of hemoglobinemia
(hemoglobin
in the blood, but outside the red blood cells), hemoglobinuria
(hemoglobin in urine), intense jaundice, anuria
(passing less than 50 milliliters of urine in a day), and finally death in the majority of cases.
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. 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
.
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. 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 except when the parasite is resistant to chloroquine
, a problem that has been on the rise since 1990.
chemotherapy, intravenous fluid and sometimes supportive care such as intensive care and dialysis
.
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
in which red blood cells burst in the bloodstream (hemolysis
Hemolysis
Hemolysis —from the Greek meaning "blood" and meaning a "loosing", "setting free" or "releasing"—is the rupturing of erythrocytes and the release of their contents into surrounding fluid...
), releasing hemoglobin directly into the blood vessels
Hemoglobinemia
Hemoglobinemia is a medical condition in which there is an excess of hemoglobin in the blood plasma. This is an effect of intravascular hemolysis, in which hemoglobin separates from red blood cells, a form of anemia. Hemoglobinemia can be caused by intrinisic or extrinsic factors...
and into the urine
Hemoglobinuria
In medicine, hemoglobinuria or haemoglobinuria is a condition in which the oxygen transport protein hemoglobin is found in abnormally high concentrations in the urine. The condition is often associated with hemolytic anemia, in which red blood cells are destroyed, thereby increasing levels of free...
, frequently leading to kidney failure. The term "blackwater fever was coined by the Sierra Leonean doctor John Farrell Easmon
John Farrell Easmon
Dr. John Farrell Easmon, M.R.C.S. MD CMO, was a prominent Sierra Leonean Creole doctor in the British Gold Coast who served as Chief Medical Officer during the 1890's. Easmon was the only West African to be promoted to Chief Medical Officer and served in this role with distinction during the...
in his 1884 "Blackwater Fever".
Symptoms
Within a few days of onset there are chills, with rigorRigor (medicine)
Rigor is a shaking occurring during a high fever. It occurs because cytokines and prostaglandins are released as part of an immune response and increase the set point for body temperature in the hypothalamus....
, high fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
, jaundice
Jaundice
Jaundice is a yellowish pigmentation of the skin, the conjunctival membranes over the sclerae , and other mucous membranes caused by hyperbilirubinemia . This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid...
, vomiting, rapidly progressive anemia
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
, and dark red or black urine.
Causes
The cause of hemolyticHemolysis
Hemolysis —from the Greek meaning "blood" and meaning a "loosing", "setting free" or "releasing"—is the rupturing of erythrocytes and the release of their contents into surrounding fluid...
crises in this disease is unknown (mainly due to intravascular haemolysis). There is rapid and massive destruction of red blood cells with the production of hemoglobinemia
Hemoglobinemia
Hemoglobinemia is a medical condition in which there is an excess of hemoglobin in the blood plasma. This is an effect of intravascular hemolysis, in which hemoglobin separates from red blood cells, a form of anemia. Hemoglobinemia can be caused by intrinisic or extrinsic factors...
(hemoglobin
Hemoglobin
Hemoglobin is the iron-containing oxygen-transport metalloprotein in the red blood cells of all vertebrates, with the exception of the fish family Channichthyidae, as well as the tissues of some invertebrates...
in the blood, but outside the red blood cells), hemoglobinuria
Hemoglobinuria
In medicine, hemoglobinuria or haemoglobinuria is a condition in which the oxygen transport protein hemoglobin is found in abnormally high concentrations in the urine. The condition is often associated with hemolytic anemia, in which red blood cells are destroyed, thereby increasing levels of free...
(hemoglobin in urine), intense jaundice, anuria
Anuria
Anuria means nonpassage of urine, in practice is defined as passage of less than 50 milliliters of urine in a day. Anuria is often caused by failure in the function of kidneys. It may also occur because of some severe obstruction like kidney stones or tumours. It may occur with end stage renal...
(passing less than 50 milliliters of urine in a day), and finally death in the majority of cases.
The most probable explanation for blackwater fever is an autoimmune
Autoimmunity
Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which allows an immune response against its own cells and tissues. Any disease that results from such an aberrant immune response is termed an autoimmune disease...
reaction apparently caused by the interaction of the malaria parasite and the use of quinine. Blackwater fever is caused by heavy parasitization of red blood cells with Plasmodium falciparum
Plasmodium falciparum
Plasmodium falciparum is a protozoan parasite, one of the species of Plasmodium that cause malaria in humans. It is transmitted by the female Anopheles mosquito. Malaria caused by this species is the most dangerous form of malaria, with the highest rates of complications and mortality...
. There has been at least one case, however, attributed to Plasmodium vivax
Plasmodium vivax
Plasmodium vivax is a protozoal parasite and a human pathogen. The most frequent and widely distributed cause of recurring malaria, P. vivax is one of the four species of malarial parasite that commonly infect humans. It is less virulent than Plasmodium falciparum, which is the deadliest of the...
.
Blackwater fever is a serious complication of malaria, but cerebral malaria has a higher mortality rate
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
. Blackwater fever is much less common today than it was before 1950. It may be that quinine
Quinine
Quinine is a natural white crystalline alkaloid having antipyretic , antimalarial, analgesic , anti-inflammatory properties and a bitter taste. It is a stereoisomer of quinidine which, unlike quinine, is an anti-arrhythmic...
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 except when the parasite is resistant to chloroquine
Chloroquine
Chloroquine is a 4-aminoquinoline drug used in the treatment or prevention of malaria.-History:Chloroquine , N'--N,N-diethyl-pentane-1,4-diamine, was discovered in 1934 by Hans Andersag and co-workers at the Bayer laboratories who named it "Resochin". It was ignored for a decade because it was...
, a problem that has been on the rise since 1990.
Treatment
The treatment is antimalarialMalaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
chemotherapy, intravenous fluid and sometimes supportive care such as intensive care and dialysis
Dialysis
In medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
.
Cultural references
- Out of Africa, a film based on the experiences of author Isak Dinesen
- The Power of OneThe Power of One (film)The Power of One is a 1992 dramatic film based on the 1989 novel of the same name by Bryce Courtenay. Set in South Africa during the '30s and '40s, the film centers on the life of Peter Philip 'P.K.' Kenneth-Keith , a young English boy raised during the apartheid era, and his relationship with a...
a film based on the book of the same nameThe Power of OneThe Power of One is a novel by Bryce Courtenay, first published in 1989. Set in South Africa during the 1930s and 1940s, it tells the story of an Anglo-African boy who, through the course of the story, acquires the nickname of Peekay. The Power of One is a novel by Bryce Courtenay, first published... - The Bridge on the River KwaiThe Bridge on the River KwaiThe Bridge on the River Kwai is a 1957 British World War II film by David Lean based on The Bridge over the River Kwai by French writer Pierre Boulle. The film is a work of fiction but borrows the construction of the Burma Railway in 1942–43 for its historical setting. It stars William...
, a film about prisoners of war in a jungle environment - At Play in the Fields of the LordAt Play in the Fields of the Lord (novel)At Play in the Fields of the Lord is a 1965 novel by Peter Matthiessen. A film adapted from the book was made in 1991....
, a novel by Peter MatthiessenPeter MatthiessenPeter Matthiessen is a two-time National Book Award-winning American novelist and non-fiction writer, as well as an environmental activist... - West with the NightWest With the NightWest With the Night is a 1942 memoir by Beryl Markham, chronicling her experiences growing up in Kenya , in the early 1900s, leading to a career as a bush pilot there...
, African memoir by aviatrix Beryl MarkhamBeryl MarkhamBeryl Markham was a British-born Kenyan aviatrix, adventurer, and racehorse trainer. During the pioneer days of aviation, she became the first person to fly solo across the Atlantic from east to west... - Burmese DaysBurmese DaysBurmese Days is a novel by British writer George Orwell. It was first published in the USA in 1934. It is a tale from the time of the waning days of British colonialism, when Burma was ruled as part of the Indian empire - " a portrait of the dark side of the British Raj." At its centre is John...
, a novel by George OrwellGeorge OrwellEric Arthur Blair , better known by his pen name George Orwell, was an English author and journalist...
; several associates of Flory are noted to have died of blackwater fever in chapter 5 - The Heart of the MatterThe Heart of the MatterThe Heart of the Matter , a novel by the English author Graham Greene, won the 1948 James Tait Black Memorial Prize for fiction. During World War II, Greene worked for the Secret Intelligence Service in Sierra Leone, the setting for his novel...
, a novel by Graham GreeneGraham GreeneHenry Graham Greene, OM, CH was an English author, playwright and literary critic. His works explore the ambivalent moral and political issues of the modern world... - Green Hills of AfricaGreen Hills of AfricaGreen Hills of Africa is a 1935 work of nonfiction written by Ernest Hemingway . Hemingway's second work of nonfiction, Green Hills of Africa is an account of a month on safari he and his wife, Pauline Marie Pfeiffer, took in East Africa during December 1933...
, a novel by Ernest HemingwayErnest HemingwayErnest Miller Hemingway was an American author and journalist. His economic and understated style had a strong influence on 20th-century fiction, while his life of adventure and his public image influenced later generations. Hemingway produced most of his work between the mid-1920s and the... - Blackwater Fever, a film by Cyrus FrischCyrus FrischCyrus Frisch is a Dutch avant-garde filmmaker.Filmmaker Magazine called him the wild man of Dutch film. According to Holland Film Frisch is one of the most daring filmmakers currently working in Holland....
- Blackwater Fever, a blues band out of AustraliaAustraliaAustralia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...