[Blackwater fever].

Abstract

DEFINITION:

Blackwater fever is a clinical entity characterized by acute intravascular hemolysis classically occuring after the re-introduction of quinine in long-term residents in Plasmodium falciparum endemic areas and repeatedly using the product.

CLINICAL PROFILE:

The symptomatology appears brutally with emission of porto-colored urine, icterus, pallor, nausea, fever and acute renal failure. The hemolytic-like anemia is immediately severe. Parasitemia is mild or absent. The mechanism of renal failure is tubular necrosis.

QUININE AND SIMILAR MOLECULES:

Well known at the start of the 20th century, blackwater fever has become exceptional since 1950, when quinine was replaced by chloroquine. The disease reappeared in 1990, following the re-utilization of quinine because of resistance to chloroquine. Thereafter, several cases have been described with halofantrine and mefloquine, two new molecules similar to quinine (amino-alcohol family). The physiopathogenesis of the disease is not well known, however it would appear that the concomitance of a double sensitivization of the red blood cells to the P. falciparum red blood cells and to the amino-alcohols is necessary to provoke the hemolysis.

EVOLUTION:

The severity of the clinical picture often requires initial management in intensive care unit. Nowadays, however, prognosis is good and the disease usually regresses without after effects.

• Authors: F Bruneel, B Gachot, M Wolff, J P Bedos, B Regnier, M Danis, F Vachon
• Journal: Presse medicale (Paris, France : 1983) (Presse Med) Vol. 31 Issue 28 Pg. 1329-34 (Sep 07 2002) ISSN: 0755-4982 [Print] France
• Vernacular Title: Fièvre bilieuse hémoglobinurique.
• PMID: 12355996 (Publication Type: Comparative Study, English Abstract, Journal Article)

Chemical References

• Antimalarials
• Drug Combinations
• Naphthoquinones
• Phenanthrenes
• atovaquone, proguanil drug combination
• fanasil, pyrimethamine drug combination
• Sulfadoxine
• Quinine
• halofantrine
• Proguanil
• Mefloquine
• Atovaquone
• Pyrimethamine

Topics

• Adolescent
• Adult
• Aged
• Antimalarials (adverse effects, therapeutic use)
• Atovaquone
• Blackwater Fever (chemically induced, diagnosis, mortality, physiopathology, therapy)
• Critical Care
• Diagnosis, Differential
• Drug Combinations
• Humans
• Mefloquine (adverse effects)
• Middle Aged
• Naphthoquinones (therapeutic use)
• Phenanthrenes (adverse effects)
• Prognosis
• Proguanil (therapeutic use)
• Pyrimethamine (therapeutic use)
• Quinine (adverse effects)
• Sulfadoxine (therapeutic use)