Black Water Fever

What is Black Water Fever ?

Black water fever (BWF) is a severe clinical syndrome and complication of Falciparum malaria characterized by intra vascular haemolysis , haemoglobinuria and kidney failure . Black water fever is caused by heavy parasitization of red blood cells with Plasmodium falciparum . When the 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.

BWF virtually disappeared after 1950, when chloroquine superseded quinine. We report 21 cases of BWF seen in France from 1990 through 1999 in European expatriates who lived in sub-Saharan Africa. All patients had macroscopic hemoglobinuria, jaundice, and anemia. Acute renal failure occurred in 15 patients (71%), 7 of whom required dialysis. The presumed triggers of BWF were halofantrine (38%), quinine (24%), mefloquine (24%), and halofantrine or quinine (14%).

What are the Causes of Black Water Fever?

Malaria is caused by a parasite that is transmitted from one human to another by the bite of infected Anopheles mosquitoes. In humans, the parasites (called sporozoites) migrate to the liver where they mature and release another form, the merozoites. These enter the bloodstream and infect the red blood cells.

Malaria can also be transmitted congenitally (from a mother to her unborn baby ) and by blood transfusions. Malaria can be carried by mosquitoes in temperate climates, but the parasite disappears over the winter.

The disease is a major health problem in much of the tropics and subtropics. The CDC estimates that there are 300 to 500 million cases of malaria each year, and more than one million people die. It presents the greatest disease hazard for travelers to warm climates.

What are the Symptoms of Black Water Fever?

Some of the symptoms of black water fever are listed below-

• Sequential chills.
• Headache.
• Nausea and vomiting.
• Muscle pain.
• Anemia.
• Stools, bloody.
• Jaundice.
• Convulsion.
• Coma.
• Fever.
• Sweating.
• Abdominal pain (lever and spleen).

What treatment can be done for black water fever?

Some of the treatments of black water fever are given below-

• If the fever gets too high (above 102 o F. in adults or 103 o F. in children), immediately immerse the body in tepid water to lower the temperature.
• Other suggestions would include: ice packs on the forehead, running cool water over the wrists, cool baths and drinking certain herb teas, such as feverfew, cinchona bark, and/or white willow. Others include meadow-sweet, sea buckthorn, European holly, and mugwort. A poultice can be made from echinacea root to lower fever. Linden tea can induce sweating to break a fever. Black elder tea is also good.
• Keep in mind that the fever is not the infection; the infection must be solved, as well as the fever.
• Vitamin C and lemon juice are especially helpful. Other nutrients include vitamin A, B complex, B1, D, calcium, potassium, and sodium.
• There is a loss of protein during a fever. Caloric needs are higher, and metabolism is increased. Greater fluid intake is required. As fluid is lost, sodium and potassium are lost. Drink plenty of distilled water; also fruit and vegetable juices. It is important that solid food be avoided until the fever reduces.
• Nutrient-rich juices are especially helpful: beet juice, carrot juice, etc.
• For a feverish child, embed a grape or strawberry in a cube of frozen fruit juice, and let him suck on it.
• Never give aspirin to children. It can trigger Reye’s syndrome, a potentially fatal neurological illness.
• He needs lots of oxygen. Make sure there is a current of air in the room; open the window. Get smokers out of the house.
• Wet compresses help reduce temperature. Remove them and apply new ones as he heats the old ones. Apply them to the forehead, wrists, and calves. Keep the rest of the body covered.