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Rodari P, Tamarozzi F, Fittipaldo VA, Buonfrate D, Gobbi F. Physiopathology and clinical management of blackwater fever: a scoping review. Clin Microbiol Infect 2024; 30:59-65. [PMID: 37739261 DOI: 10.1016/j.cmi.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Blackwater fever (BWF) is a severe syndrome occurring in patients with malaria upon antimalarial treatment, characterized by massive intravascular haemolysis and haemoglobinuria. BWF is a neglected condition and management recommendations are unavailable. OBJECTIVES We performed a scoping review to appraise available data on clinical picture, treatment and physiopathology of BWF, which could guide rationally its clinical management. METHODS MEDLINE, EMBASE, LILACS, Web of Science, and Scopus databases, and the reference list of relevant publications, were searched. Papers reporting original data on BWF cases or investigating the physiopathology of BWF were eligible. Data regarding case characteristics, trigger event, clinical management and outcome were extracted. For papers investigating the physiopathology of BWF, study design and principal findings were extracted. No quality assessment was performed. Data are presented as numbers and percentages, and summary of findings, grouped by paper focus (clinical description or physiopathology). RESULTS 101 papers were included. The majority of BWF cases were observed in autochthonous children (75.7%) and adults (15.3%), in contrast with historical perception that BWF patients were typically expatriates. Clinical management was described for 794 cases; corticosteroids were used in 23. Outcome was reported for 535 patients, with 18.1% mortality. The trigger was reported for 552 (47.5%) cases; in 70.4% identified as quinine. However, two RCT comparing artesunate and quinine for falciparum malaria treatment did not find significant difference in BWF occurrence after their administration. Two case-control studies did not find significant difference in G6PDH deficiency between malaria patients with and without BWF. CONCLUSIONS The physiopathology and optimal treatment of BWF remain similarly unknown as they were over a century ago. Empirical supporting treatment approach seems reasonable, while change of antimalarial drug and use of corticosteroids remain object of debate.
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Affiliation(s)
- Paola Rodari
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (Verona), Italy
| | - Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (Verona), Italy.
| | - Veronica A Fittipaldo
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (Verona), Italy
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (Verona), Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (Verona), Italy
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Abstract
Severe malaria is a medical emergency. It is a major cause of preventable childhood death in tropical countries. Severe malaria justifies considerable global investment in malaria control and elimination yet, increasingly, international agencies, funders and policy makers are unfamiliar with it, and so it is overlooked. In sub-Saharan Africa, severe malaria is overdiagnosed in clinical practice. Approximately one third of children diagnosed with severe malaria have another condition, usually sepsis, as the cause of their severe illness. But these children have a high mortality, contributing substantially to the number of deaths attributed to ‘severe malaria’. Simple well-established tests, such as examination of the thin blood smear and the full blood count, improve the specificity of diagnosis and provide prognostic information in severe malaria. They should be performed more widely. Early administration of artesunate and broad-spectrum antibiotics to all children with suspected severe malaria would reduce global malaria mortality.
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Affiliation(s)
- Nicholas J White
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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3
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Paasi G, Ndila C, Alaroker F, Abeso J, Asiimwe G, Okello F, Olupot-Olupot P. Resurgence of blackwater fever among children in sub-Saharan Africa: a scoping review protocol. BMJ Open 2022; 12:e059875. [PMID: 35793920 PMCID: PMC9260813 DOI: 10.1136/bmjopen-2021-059875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Blackwater fever (BWF), a complication of malaria, has in the past been considered as a rare complication of malaria in children living in high transmission settings. More recently, however, a growing number of paediatric clusters of BWF cases have been reported predominantly in sub-Saharan Africa (SSA). The aim of this study is to map evidence on BWF among children in SSA from 1 January 1960 to 31 December 2021. METHODS AND ANALYSIS This review will be guided by Arksey and O' Malley's methodological framework for scoping reviews with methodological refinements by Levac et al and will comply with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews' guidelines. Five electronic databases (MEDLINE via PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO) will be systematically searched using predefined keywords. In addition, reference lists of included articles will be searched. Our multidisciplinary team has formulated search strategies and two reviewers will independently complete study eligibility screening, final selection and data extraction. A third reviewer will adjudicate the final decision on disputed articles. Bibliographic data and abstract content will be collected and analysed using a data-charting tool developed iteratively by the research team. ETHICS AND DISSEMINATION This scoping review being a secondary analysis does not require ethics approval. We anticipate results of this review will broaden understanding of paediatric BWF in SSA and identify its research gaps in SSA. We will be disseminating results through journals and conferences targeting primary care providers.
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Affiliation(s)
- George Paasi
- Department of Public Health, Busitema University, Tororo, Uganda
- Clinical trials unit at Mbale clinical research Institute, Mbale Clinical Research institute, Mbale, Uganda
| | - Carolyne Ndila
- Clinical trials unit at Mbale clinical research Institute, Mbale Clinical Research institute, Mbale, Uganda
| | - Florence Alaroker
- Department of Paediatric and Child Health, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Julian Abeso
- Department of Paediatric and Child Health, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Glorias Asiimwe
- Faculty of Health Sciences university library, Busitema University, Tororo, Uganda
| | - Francis Okello
- Department of Public Health, Busitema University, Tororo, Uganda
| | - Peter Olupot-Olupot
- Department of Public Health, Busitema University, Tororo, Uganda
- Clinical trials unit at Mbale clinical research Institute, Mbale Clinical Research institute, Mbale, Uganda
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Raymond S, Sitompul ARH. Successful Oral Antimalarial Therapy in A 14-Year-Old Child with Blackwater Fever: A Case in a Rural Area of Asmat Regency of Papua, Indonesia. IJID REGIONS 2022; 3:157-159. [PMID: 35755479 PMCID: PMC9216435 DOI: 10.1016/j.ijregi.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
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5
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Paasi G, Ndila C, Okello F, Olupot-Olupot P. Predictors of prolonged hospitalisation and mortality among children admitted with blackwater fever in eastern Uganda. Trop Doct 2021; 52:61-67. [PMID: 34939462 DOI: 10.1177/00494755211046782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our study aimed at determining clinical factors associated with prolonged hospitalisation and death among children admitted with blackwater fever (BWF). We analysed 920 eligible records for the period January - December 2018 from Mbale and Soroti Regional Referral Hospitals in Eastern Uganda. The median hospitalisation was 3 (IQR: 2-5 days) days. Prolonged hospitalisation was in 251/920 (27.3%). Clinical features independently associated with prolonged hospitalisation included abdominal tenderness, body pain and mild fever. 29/920 (3.2%) died, of these 20 (69.0%) within 48 h of admission. Features of severity associated with mortality were noisy or interrupted breathing, tachypnoea, chest pain, convulsions, delayed capillary refill time (≥3 s), severe pallor, high fever (>38.5°C), altered level of consciousness, prostration and acidotic breathing.
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Affiliation(s)
- George Paasi
- Mbale Clinical Research Institute (MCRI), Mbale, Uganda.,183050Busitema University, Tororo, Uganda
| | | | | | - Peter Olupot-Olupot
- Mbale Clinical Research Institute (MCRI), Mbale, Uganda.,183050Busitema University, Tororo, Uganda
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Brebnor Des Isles C, Chitrakar A, Patel H, Finney M. Blackwater Fever in Pregnancy With Severe Falciparum Malaria: A Case of Imported Malaria From Nigeria to the United Kingdom During the COVID-19 Pandemic. Cureus 2021; 13:e20170. [PMID: 34900503 PMCID: PMC8649980 DOI: 10.7759/cureus.20170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 11/05/2022] Open
Abstract
We present the case of imported malaria in pregnancy to the United Kingdom (UK) from Nigeria, where a 28-year-old primigravida presented to our maternity assessment unit (MAU) with complaints of pyrexia, rigors and passing dark coloured urine. She gave a travel history of recent migration from Nigeria 10 days before presenting to our emergency department. She initially became unwell five days after her arrival with general malaise and myalgia. On day six, she developed lower abdominal pain and observed that her urine was dark in colour. This prompted her to contact her general practitioner (GP). Treatment for a urinary tract infection was initiated by the GP after a phone consultation in keeping with COVID-19 contingency guidance, and the patient was prescribed antibiotics for three days. She presented to the emergency department two days after completing the course of antibiotics where she complained of worsening pelvic pain, reduced foetal movements and passing black urine. She was treated as suspected COVID-19 and red flag sepsis. Obstetric review led to investigation and diagnosis of severe malaria in pregnancy, which was accompanied by blackwater fever (BWF). The patient recovered after three doses of artesunate. An ultrasound scan of the foetus revealed a congenital cardiac anomaly, which had not been detected in an earlier scan. There was no evidence of congenital malaria in the neonate after delivery. There are several novel aspects in this case as maternal mortality in severe Plasmodium falciparum can be significantly high. Those who survive the disease in pregnancy are also known to develop several complications such as intrauterine death and preterm labour. There was also the component of blackwater fever, which is a rare event associated with severe malaria, and it also has a mortality rate. Significant in her medical history was a diagnosis of the sickle cell trait, and we postulate that this feature gave an added protection from the complications of severe malaria in pregnancy as well as blackwater fever.
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Affiliation(s)
| | - Anisha Chitrakar
- Obstetrics and Gynaecology, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Heena Patel
- Obstetrics and Gynaecology, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Mark Finney
- Obstetrics and Gynaecology, University Hospitals of Leicester NHS Trust, Leicester, GBR
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Patel H, Dunican C, Cunnington AJ. Predictors of outcome in childhood Plasmodium falciparum malaria. Virulence 2020; 11:199-221. [PMID: 32063099 PMCID: PMC7051137 DOI: 10.1080/21505594.2020.1726570] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 12/16/2022] Open
Abstract
Plasmodium falciparum malaria is classified as either uncomplicated or severe, determining clinical management and providing a framework for understanding pathogenesis. Severe malaria in children is defined by the presence of one or more features associated with adverse outcome, but there is wide variation in the predictive value of these features. Here we review the evidence for the usefulness of these features, alone and in combination, to predict death and other adverse outcomes, and we consider the role that molecular biomarkers may play in augmenting this prediction. We also examine whether a more personalized approach to predicting outcome for specific presenting syndromes of severe malaria, particularly cerebral malaria, has the potential to be more accurate. We note a general need for better external validation in studies of outcome predictors and for the demonstration that predictors can be used to guide clinical management in a way that improves survival and long-term health.
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Affiliation(s)
- Harsita Patel
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
| | - Claire Dunican
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
| | - Aubrey J. Cunnington
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
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Olupot-Olupot P, Engoru C, Nteziyaremye J, Chebet M, Ssenyondo T, Muhindo R, Nyutu G, Macharia AW, Uyoga S, Ndila CM, Karamagi C, Maitland K, Williams TN. The clinical spectrum of severe childhood malaria in Eastern Uganda. Malar J 2020; 19:322. [PMID: 32883291 PMCID: PMC7470679 DOI: 10.1186/s12936-020-03390-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/25/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Few recent descriptions of severe childhood malaria have been published from high-transmission regions. In the current study, the clinical epidemiology of severe malaria in Mbale, Eastern Uganda, is described, where the entomological inoculation rate exceeds 100 infective bites per year. METHODS A prospective descriptive study was conducted to determine the prevalence, clinical spectrum and outcome of severe Plasmodium falciparum malaria at Mbale Regional Referral Hospital in Eastern Uganda. All children aged 2 months-12 years who presented on Mondays to Fridays between 8.00 am and 5.00 pm from 5th May 2011 until 30th April 2012 were screened for parasitaemia. Clinical and laboratory data were then collected from all P. falciparum positive children with features of WHO-defined severe malaria by use of a standardized proforma. RESULTS A total of 10 208 children were screened of which 6582 (64%) had a positive blood film. Of these children, 662 (10%) had clinical features of severe malaria and were consented for the current study. Respiratory distress was the most common severity feature (554; 83.7%), while 365/585 (62.4%) had hyperparasitaemia, 177/662 (26.7%) had clinical jaundice, 169 (25.5%) had severe anaemia, 134/660 (20.2%) had hyperlactataemia (lactate ≥ 5 mmol/L), 93 (14.0%) had passed dark red or black urine, 52 (7.9%) had impaired consciousness and 49/662 (7.4%) had hypoxaemia (oxygen saturations < 90%). In-hospital mortality was 63/662 (9.5%) overall but was higher in children with either cerebral malaria (33.3%) or severe anaemia (19.5%). Factors that were independently associated with mortality on multivariate analysis included severe anaemia [odds ratio (OR) 5.36; 2.16-1.32; P = 0.0002], hyperlactataemia (OR 3.66; 1.72-7.80; P = 0.001), hypoxaemia (OR) 3.64 (95% CI 1.39-9.52; P = 0.008), and hepatomegaly (OR 2.29; 1.29-4.06; P = 0.004). No independent association was found between mortality and either coma or hyperparasitaemia. CONCLUSIONS Severe childhood malaria remains common in Eastern Uganda where it continues to be associated with high mortality. An unusually high proportion of children with severe malaria had jaundice or gave a history of having recently passed dark red or black urine, an issue worthy of further investigation.
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Affiliation(s)
- Peter Olupot-Olupot
- Faculty of Health Sciences, Busitema University, Mbale Campus, P.O. Box 1460, Mbale, Uganda.
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda.
| | - Charles Engoru
- Soroti Regional Referral Hospital, P.O. Box 289, Soroti, Uganda
| | - Julius Nteziyaremye
- Faculty of Health Sciences, Busitema University, Mbale Campus, P.O. Box 1460, Mbale, Uganda
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Martin Chebet
- Faculty of Health Sciences, Busitema University, Mbale Campus, P.O. Box 1460, Mbale, Uganda
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Tonny Ssenyondo
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Rita Muhindo
- Mbale Clinical Research Institute, P.O. Box 1966, Mbale, Uganda
| | - Gideon Nyutu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Alexander W Macharia
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Carolyne M Ndila
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Charles Karamagi
- Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Kathryn Maitland
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- Institute of Global Health Innovation, Imperial College, Medical School Building St Mary's Campus, Imperial College, London, W2 1PG, UK
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- Institute of Global Health Innovation, Imperial College, Medical School Building St Mary's Campus, Imperial College, London, W2 1PG, UK
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9
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Opoka RO, Waiswa A, Harriet N, John CC, Tumwine JK, Karamagi C. Blackwater Fever in Ugandan Children With Severe Anemia is Associated With Poor Postdischarge Outcomes: A Prospective Cohort Study. Clin Infect Dis 2020; 70:2247-2254. [PMID: 31300826 PMCID: PMC7245149 DOI: 10.1093/cid/ciz648] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/11/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Blackwater fever (BWF), one of the complications of severe malaria, has recently re-emerged as a cause of severe anemia (SA) in African children. However, postdischarge morbidity in children with BWF has previously not been described. METHODS This was a descriptive cohort study in which children, aged 0-5 years, admitted to Jinja Regional Referral Hospital with acute episodes of SA (hemoglobin ≤5.0 g/dL) were followed up for 6 months after hospitalization. Incidence of readmissions or deaths during the follow-up period was compared between SA children with BWF and those without BWF. RESULTS A total of 279 children with SA including those with BWF (n = 92) and no BWF (n = 187) were followed for the duration of the study. Overall, 128 (45.9%) of the study participants were readmitted at least once while 22 (7.9%) died during the follow-up period. After adjusting for age, sex, nutritional status, and parasitemia, SA children with BWF had higher risk of readmissions (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.1-2.5) and a greater risk of death (HR. 3.37; 95% CI, 1.3-8.5) compared with those without BWF. Malaria and recurrence of SA were the most common reasons for readmissions. CONCLUSIONS There is a high rate of readmissions and deaths in the immediate 6 months after initial hospitalization among SA children in the Jinja hospital. SA children with BWF had increased risk of readmissions and deaths in the postdischarge period. Postdischarge malaria chemoprophylaxis should be considered for SA children living in malaria endemic areas.
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Affiliation(s)
- Robert O Opoka
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala
| | - Ali Waiswa
- Global Health Uganda (GHU) Research Collaboration, Kampala
| | - Nambuya Harriet
- Nalufenya Children’s Ward, Jinja Regional Referral Hospital, Uganda
| | - Chandy C John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis
| | - James K Tumwine
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala
| | - Charles Karamagi
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala
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Exploring association between MBL2 gene polymorphisms and the occurrence of clinical blackwater fever through a case-control study in Congolese children. Malar J 2020; 19:25. [PMID: 31941497 PMCID: PMC6964107 DOI: 10.1186/s12936-020-3100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background Blackwater fever (BWF), one of the most severe and life-threatening forms of falciparum malaria, is characterized by acute massive intravascular haemolysis, often leading to acute renal failure. Thus far, the genetics of the underlying susceptibility to develop BWF is not fully elucidated. Deficiency in the MBL protein, an important component of the innate immune system, has previously been suggested to be a susceptibility factor for the development of severe malaria. This study aimed to evaluate the association between MBL2 gene polymorphisms, known to affect the MBL protein level/activity, and the occurrence of BWF among Congolese children. Methods This is a case–control study. Cases were patients with BWF, whereas controls, matched for gender and age, had uncomplicated malaria (UM). Dried blood spot was collected for genotyping. Results A total of 129 children were screened, including 43 BWF and 86 UM. The common allele in BWF and UM was A, with a frequency of 76.7 and 61.0%, respectively (OR: 2.67 (0.87–829) and p = 0.079). The frequency of the C allele was 18.6 and 29.1% in BWF and UM groups, respectively, with p = 0.858. Not a single D allele was encountered. Genotype AA was at higher risk for BWF whereas genotypes A0 (AB and AC) were over-represented in UM group (OR: 0.21 (0.06–0.78)) with p = 0.019. Nine haplotypes were observed in this study: 3 high MBL expression haplotypes and 6 low MBL expression haplotype. One new haplotype HYPC was observed in this study. None of these haplotypes was significantly associated with BWF. Conclusion This pilot study is a preliminary research on MBL2 gene and infectious diseases in DRC. The study results show a higher risk for BWF in AA. This suggests that future studies on BWF should further investigate the contribution of a strong immune response to the occurrence of BWF.
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A Report of Four Cases of Blackwater Fever after Quinine Treatment at Zinder National Hospital, Niger Republic. Case Rep Infect Dis 2019; 2019:2346087. [PMID: 31534807 PMCID: PMC6732635 DOI: 10.1155/2019/2346087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Blackwater fever (BWF) is a rare but serious complication of malaria that is a consequence of antimalarial treatment. Its prevalence seems to have increased. Its diagnosis is based on clinical symptoms and urine color. We report on 4 BWF cases admitted to the infectious diseases department of Zinder National Hospital. Results Four patients were hospitalized in September 2017 for a hepatorenal syndrome of jaundice, port wine-colored urine, renal failure, and hepatic cytolysis following antimalarial treatment with quinine salts. Quinine treatment was stopped and treatment was continued with injectable artemether. Three patients underwent extra-renal purification. Their evolution was favorable. One patient died less than 24 hours after admission. Conclusion A rare and severe complication, blackwater fever must be considered for patients under antimalarial treatment who present with jaundice, abdominal pain, and acute renal insufficiency with port wine-colored urine. Rapid diagnosis and management in an intensive care unit are crucial for improving the prognosis.
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Abstract
Malaria is a major cause of anaemia in tropical areas. Malaria infection causes haemolysis of infected and uninfected erythrocytes and bone marrow dyserythropoiesis which compromises rapid recovery from anaemia. In areas of high malaria transmission malaria nearly all infants and young children, and many older children and adults have a reduced haemoglobin concentration as a result. In these areas severe life-threatening malarial anaemia requiring blood transfusion in young children is a major cause of hospital admission, particularly during the rainy season months when malaria transmission is highest. In severe malaria, the mortality rises steeply below an admission haemoglobin of 3 g/dL, but it also increases with higher haemoglobin concentrations approaching the normal range. In the management of severe malaria transfusion thresholds remain uncertain. Prevention of malaria by vector control, deployment of insecticide-treated bed nets, prompt and accurate diagnosis of illness and appropriate use of effective anti-malarial drugs substantially reduces the burden of anaemia in tropical countries.
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Affiliation(s)
- Nicholas J White
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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13
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Rodriguez-Valero N, Castro P, Martinez G, Marco Hernandez J, Fernandez S, Gascon J, Nicolas JM. Blackwater fever in a non-immune patient with Plasmodium falciparum malaria after intravenous artesunate. J Travel Med 2018; 25:4780174. [PMID: 29394389 DOI: 10.1093/jtm/tax094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/28/2017] [Indexed: 11/12/2022]
Abstract
Blackwater fever was typically reported after quinine administration, although it is poor recognized in patients receiving artesunate. This case describes a blackwater fever in a non-immune patient after artesunate for severe malaria. It highlights the importance of monitoring haemolytic parameters in severe malaria to avoid renal impairment or severe anaemia.
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Affiliation(s)
- N Rodriguez-Valero
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - P Castro
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - G Martinez
- Department of Internal Medicine, Hospital Clinic, Barcelona, Spain
| | | | - S Fernandez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - J Gascon
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain
| | - J M Nicolas
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic (Department of International Health), Universitat de Barcelona, Barcelona, Spain.,Department of Internal Medicine, Hospital Clinic, Barcelona, Spain
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Olupot-Olupot P, Engoru C, Uyoga S, Muhindo R, Macharia A, Kiguli S, Opoka RO, Akech S, Ndila C, Nyeko R, Mtove G, Nteziyaremye J, Chebet M, George EC, Babiker AG, Gibb DM, Williams TN, Maitland K. High Frequency of Blackwater Fever Among Children Presenting to Hospital With Severe Febrile Illnesses in Eastern Uganda. Clin Infect Dis 2017; 64:939-946. [PMID: 28362936 PMCID: PMC5848229 DOI: 10.1093/cid/cix003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 01/06/2017] [Indexed: 01/17/2023] Open
Abstract
Background In the Fluid Expansion as a Supportive Treatment (FEAST) trial, an unexpectedly high proportion of participants from eastern Uganda presented with blackwater fever (BWF). Methods We describe the prevalence and outcome of BWF among trial participants and compare the prevalence of 3 malaria-protective red blood cell polymorphisms in BWF cases vs both trial (non-BWF) and population controls. Results Of 3170 trial participants, 394 (12.4%) had BWF. The majority (318 [81.0%]) presented in eastern Uganda and were the subjects of further analysis. BWF cases typically presented with both clinical jaundice (254/318 [80%]) and severe anemia (hemoglobin level <5 g/dL) (238/310 [77%]). Plasmodium falciparum parasitemia was less frequent than in non-BWF controls, but a higher proportion were positive for P. falciparum histidine rich protein 2 (192/246 [78.0%]) vs 811/1154 [70.3%]; P = .014), suggesting recent antimalarial treatment. Overall, 282 of 318 (88.7%) received transfusions, with 94 of 282 (33.3%) and 9 of 282 (3.4%) receiving 2 or 3 transfusions, respectively. By day 28, 39 of 318 (12.3%) BWF cases and 154 of 1554 (9.9%) non-BWF controls had died (P = .21), and 7 of 255 (3.0%) vs 13/1212 (1%), respectively, had severe anemia (P = .036). We found no association with G6PD deficiency. The prevalence of both the sickle cell trait (10/218 [4.6%]) and homozygous α+thalassemia (8/216 [3.7%]) were significantly lower among cases than among population controls (334/2123 [15.7%] and 141/2114 [6.6%], respectively), providing further support for the role of malaria. Conclusions We report the emergence of BWF in eastern Uganda, a condition that, according to local investigators, was rare until the last 7 years. We speculate that this might relate to the introduction of artemisinin-based combination therapies. Further studies investigating this possibility are urgently required.
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Affiliation(s)
- Peter Olupot-Olupot
- Mbale Regional Referral Hospital Clinical Research Unit.,Busitema University Faculty of Health Sciences, Mbale Campus
| | | | - Sophie Uyoga
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Rita Muhindo
- Mbale Regional Referral Hospital Clinical Research Unit
| | - Alex Macharia
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Sarah Kiguli
- Makerere College of Health Sciences, Department of Paediatrics, Kampala, and
| | - Robert O Opoka
- Makerere College of Health Sciences, Department of Paediatrics, Kampala, and
| | - Samuel Akech
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Carolyne Ndila
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | | | - George Mtove
- Joint Malaria Programme, Teule Hospital, Muheza, Tanzania; and
| | | | - Martin Chebet
- Mbale Regional Referral Hospital Clinical Research Unit.,Busitema University Faculty of Health Sciences, Mbale Campus
| | - Elizabeth C George
- Medical Research Council, Clinical Trials Unit, University College London, and
| | - Abdel G Babiker
- Medical Research Council, Clinical Trials Unit, University College London, and
| | - Diana M Gibb
- Medical Research Council, Clinical Trials Unit, University College London, and
| | - Thomas N Williams
- Mbale Regional Referral Hospital Clinical Research Unit.,Busitema University Faculty of Health Sciences, Mbale Campus.,Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.,Faculty of Medicine, Imperial College, London, United Kingdom
| | - Kathryn Maitland
- Mbale Regional Referral Hospital Clinical Research Unit.,Busitema University Faculty of Health Sciences, Mbale Campus.,Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.,Faculty of Medicine, Imperial College, London, United Kingdom
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15
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Barber BE, Grigg MJ, William T, Yeo TW, Anstey NM. Intravascular haemolysis with haemoglobinuria in a splenectomized patient with severe Plasmodium knowlesi malaria. Malar J 2016; 15:462. [PMID: 27613607 PMCID: PMC5017000 DOI: 10.1186/s12936-016-1514-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/02/2016] [Indexed: 12/29/2022] Open
Abstract
Background Haemoglobinuria is an uncommon complication of severe malaria, reflecting acute intravascular haemolysis and potentially leading to acute kidney injury. It can occur early in the course of infection as a consequence of a high parasite burden, or may occur following commencement of anti-malarial treatment. Treatment with quinine has been described as a risk factor; however the syndrome may also occur following treatment with intravenous artesunate. In Malaysia, Plasmodium knowlesi is the most common cause of severe malaria, often associated with high parasitaemia. Asplenic patients may be at additional increased risk of intravascular haemolysis. Case presentation A 61 years old asplenic man was admitted to a tertiary referral hospital in Sabah, Malaysia, with severe knowlesi malaria characterized by hyperparasitaemia (7.9 %), jaundice, respiratory distress, metabolic acidosis, and acute kidney injury. He was commenced on intravenous artesunate, but1 day later developed haemoglobinuria, associated with a 22 % reduction in admission haemoglobin. Additional investigations, including a cell-free haemoglobin of 10.2 × 105 ng/mL and an undetectable haptoglobin, confirmed intravascular haemolysis. The patient continued on intravenous artesunate for a total of 48 h prior to substitution with artemether–lumefantrine, and made a good recovery with resolution of his haemoglobinuria and improvement of his kidney function by day 3. Conclusions An asplenic patient with hyperparasitaemic severe knowlesi malaria developed haemoglobinuria after treatment with intravenous artesunate. There are plausible mechanisms for increased haemolysis with hyperparasitaemia, and following both splenectomy and artesunate. Although in this case the patient made a rapid recovery, knowlesi malaria patients with this unusual complication should be closely monitored for potential deterioration.
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Affiliation(s)
- Bridget E Barber
- Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, NT, 0810, Australia. .,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88586, Kota Kinabalu, Sabah, Malaysia.
| | - Matthew J Grigg
- Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, NT, 0810, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88586, Kota Kinabalu, Sabah, Malaysia
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88586, Kota Kinabalu, Sabah, Malaysia.,Queen Elizabeth Hospital Clinical Research Centre, 88586, Kota Kinabalu, Sabah, Malaysia.,Jesselton Medical Centre, 88300, Kota Kinabalu, Sabah, Malaysia
| | - Tsin W Yeo
- Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, NT, 0810, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88586, Kota Kinabalu, Sabah, Malaysia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 639798, Singapore
| | - Nicholas M Anstey
- Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, NT, 0810, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88586, Kota Kinabalu, Sabah, Malaysia
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16
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Kunuanunua TS, Nsibu CN, Bodi JM, Tshibola TK, Makusi Bura M, Magoga K, Ekila MB, Situakibanza HT, Aloni MN. Severe malaria in children: A descriptive report from Kinshasa, the Democratic Republic of Congo. J Trop Pediatr 2015; 61:272-8. [PMID: 25957436 DOI: 10.1093/tropej/fmv029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The decline of susceptibility of Plasmodium falciparum to chloroquine and sulfadoxine-pyrimethamine resulted in the change of drug policy. This policy has probably changed the facies of the severe form of malaria. A prospective study was conducted in Kinshasa, the Democratic Republic of Congo. Data on children aged ≤13 years, diagnosed with severe malaria were analyzed. In total, 378 children were included with an overall median age of 8 years (age range: 1-13 years). Dark urine was seen in 25.1% of cases. Metabolic acidosis (85.2%), hypoglycemia (62.2%) and hemoglobin ≤5 g/dl (39.1%) were the common laboratories features. Severe malaria anemia, cerebral malaria and Blackwater fever (BWF) were found in 39.1, 30.1 and 25.4%, respectively. Mortality rate was 4%. BWF emerges as a frequent form of severe malaria in our midst. Availing artemisin-based combination treatments in the health care system is a priority to reduce the incidence of BWF in our environment.
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Affiliation(s)
- Thomas S Kunuanunua
- Division of Intensive Care, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo Department of Pediatrics, Hôpital Général de Référence de N'djili, Institut Supérieur de Techniques Médicales, Kinshasa, Democratic Republic of Congo
| | - Célestin N Nsibu
- Division of Intensive Care, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Joseph M Bodi
- Division of Intensive Care, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Thérèse K Tshibola
- Department of Pediatrics, Hôpital Général de Référence de N'djili, Institut Supérieur de Techniques Médicales, Kinshasa, Democratic Republic of Congo
| | - Mimy Makusi Bura
- Department of Pediatrics, Hôpital Général de Référence de N'djili, Institut Supérieur de Techniques Médicales, Kinshasa, Democratic Republic of Congo
| | - Kumbundu Magoga
- Department of Pediatrics, Hôpital Général de Référence de N'djili, Institut Supérieur de Techniques Médicales, Kinshasa, Democratic Republic of Congo
| | - Mathilde B Ekila
- Division of Infectious Diseases, Department of Internal Medicine, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Hypolite T Situakibanza
- Division of Infectious Diseases, Department of Internal Medicine, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Michel N Aloni
- Division of Haemato-oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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17
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Muñoz J, Rojo-Marcos G, Ramírez-Olivencia G, Salas-Coronas J, Treviño B, Perez Arellano JL, Torrús D, Muñoz Vilches MJ, Ramos JM, Alegría I, López-Vélez R, Aldasoro E, Perez-Molina JA, Rubio JM, Bassat Q. Diagnóstico y tratamiento de la malaria importada en España: recomendaciones del Grupo de Trabajo de Malaria de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI). Enferm Infecc Microbiol Clin 2015; 33:e1-e13. [DOI: 10.1016/j.eimc.2013.12.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/21/2013] [Accepted: 12/25/2013] [Indexed: 01/05/2023]
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Abstract
Over 90% of the world's severe and fatal Plasmodium falciparum malaria is estimated to affect young children in sub-Sahara Africa, where it remains a common cause of hospital admission and inpatient mortality. Few children will ever be managed on high dependency or intensive care units and, therefore, rely on simple supportive treatments and parenteral anti-malarials. There has been some progress on defining best practice for antimalarial treatment with the publication of the AQUAMAT trial in 2010, involving 5,425 children at 11 centres across 9 African countries, showing that in artesunate-treated children, the relative risk of death was 22.5% (95% confidence interval (CI) 8.1 to 36.9) lower than in those receiving quinine. Human trials of supportive therapies carried out on the basis of pathophysiology studies, have so far made little progress on reducing mortality; despite appearing to reduce morbidity endpoints, more often than not they have led to an excess of adverse outcomes. This review highlights the spectrum of complications in African children with severe malaria, the therapeutic challenges of managing these in resource-poor settings and examines in-depth the results from clinical trials with a view to identifying the treatment priorities and a future research agenda.
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19
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Thiongane A, Ndongo AA, Faye PM, Sylla A, Kéïta Y, Boiro D, Basse I, Guèye NRD, Ndiaye O. [Blackwater fever (BWF) of late revelation about a case at the University Hospital of Dakar]. Pan Afr Med J 2015; 22:301. [PMID: 26966497 PMCID: PMC4769047 DOI: 10.11604/pamj.2015.22.301.8176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 11/14/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | | | - Assane Sylla
- Service de Pédiatrie de l'Hôpital Aristide Le Dantec, Dakar, Sénégal
| | - Younoussa Kéïta
- Service de Pédiatrie de l'Hôpital Aristide Le Dantec, Dakar, Sénégal
| | - Djibril Boiro
- Service de Pédiatrie de l'Hôpital Abass Ndao, Dakar, Sénégal
| | | | | | - Ousmane Ndiaye
- Service de Pédiatrie de l'Hôpital Abass Ndao, Dakar, Sénégal
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