Blackwater Fever Followed by Severe Falciparum Malaria in a Child

Blackwater fever is a serious clinical syndrome manifested by acute intravascular hemolysis, fever, and the passage of black or red urine, which is classically associated with falciparum malaria and irregular administration of quinine. In Korea, Plasmodium vivax is the only endemic malaria circulating; a number of imported cases of falciparum malaria have been reported in patients following return from international travel to a malaria endemic area. Therefore, it is important for health care professionals including pediatricians to be aware of the falciparum malaria and its clinical courses. Herein, we report a case of a 14-year-old girl with severe falciparum malaria that was complicated by blackwater fever.

Glucosa 6 fosfato deshidrogenasa: características bioquímicas y moleculares. Prevalencia de la deficiencia / Glucose-6-phosphate dehydrogenase: biochemical and molecular characteristics. Prevalence of deficiency

La glucosa-6-fosfato deshidrogenasa (G6PD) es una enzima citoplasmática que se encuentra distribuida en todas las células del organismo y que cataliza el primer paso de la vía de las pentosas en el cual la glucosa 6 fosfato (G6P) es convertida a 6-fosfogluconato(6FG) y el NADP reducido a NADPH, proceso indispensable para proteger a los eritrocitos del daño oxidativo. La deficiencia de la enzima G6PD es la eritroenzimopatía más común, es recesiva y ligada al cromosoma X, con amplia distribución mundial y elevada heterogeneidad genética y bioquímica. Se realizó una revisión sobre aspectos bioquímicos, estructura, genética, bases moleculares, defecto enzimático, prevalencia de la deficiencia en el mundo y en Venezuela, y el papel de la deficiencia de G6PD en el tratamiento de la malaria por el incremento en el riesgo de hemolisis que lleva consigo la tendencia de aumentar la dosis total de Primaquina en sujetos paludismo,particularmente en las regiones donde predomina la infección por Plasmodium vivax.

Alimentación y estado nutricional de los niños en zonas palúdicas de Antioquia (Colombia) / Food and nutritional status among children of endemic malaria zones of Antioquia (Colombia)

Introducción: Malaria, parasitosis intestinales y desnutrición interactúan en los habitantes de zonas palúdicas, en particular en niños. Objetivo: Medir el estado nutricional de niños (4-10 años) con malaria y algunos aspectos del consumo alimentario familiar en dos zonas maláricas del departamento de Antioquia. Metodología: Estudio transversal en niños que consultaron por paludismo. Diseño muestral aleatorio. Resultados: A) Consumo alimentario familiar: 74% obtenían regularmente alimentos de criar animales menores, huerta casera o ambos; 17% recibían regularmente alimentos, dinero o ambos; consumo de alimentos fuentes de vitamina A (veces/semana): carnes-vísceras animales 1, leche y huevos 2-3 cada uno, frutas con provitamina A. Satisfacción alimentaria de requerimientos nutricionales familiares de fuentes de vitamina A: 55% (grado bajo-medio). B) Estado nutricional infantil: Riesgo de desnutrición: 52% crónica, 15% aguda; parásitos intestinales patógenos 80%; promedio de hemoglobina pretratamiento 10.3 gr/dL (6.39 mmol/L) y al día 30 en 11.8 gr/dL (7.32 mmol/L); promedio de retinol pretratamiento de 19.1 µg/dL (0.67 µmol/L) y al día 30 31.2 µg/dL (1.09 µmol/L). Conclusiones: La desnutrición crónica amenaza a ≥50% de los niños; esa frecuencia es 3-4 veces la encontrada en Colombia. No hubo asociación estadísticamente significativa entre estado nutricional y las variables asociadas a obtención-consumo alimentario. Quizás esta ausencia de relación se deba a que las variables usadas para medir estas condiciones no sean adecuadas o se hayan medido de manera inapropiada.

Introduction: Malaria, intestinal parasites and malnutrition interact in people of malaria areas, particularly in children. Objective: To measure the nutritional status of children (4-10 years) and household food consumption in two endemic malaria areas of Antioquia (Colombia). Methodology: Cross-sectional description in children with malaria. Random sampling design. Results: A) Household food consumption: 74% regularly got food raising small animals and/or home garden; 17% regularly receiving foods, money or both; intake of vitamin A source foods (times/week): once meat-offal, twice or three times milk or eggs; once pro-vitamin A fruits; coverage of nutritional requirements of vitamin A sources: 55% (low-medium level). B) Nutritional status of children: Malnutrition risk: 52% chronic, 47% global, 15% acute; pathogen intestinal parasites 80%; hemoglobin (g/dL): pretreatment 10.3 (6.39 mmol/L); at day 30: 11.8 (7.32 mmol/L); retinol (µg/dL): pretreatment: 19.1 (0.67 µmol/L); at day 30: 31.2 (1.09 µmol/L). Conclusions: chronic malnutrition threat to ≥ 50% of children and that frequency is 3-4 times that found in Colombia; did not found any significant association between nutritional status with the variables associated with obtaining and food consumption, or between the nutritional status with the monthly spend on food; it is possible that this lack of relationship between malnutrition expressed by anthropometric indicators and food conditions due to the variables used to measure these conditions have not been adequate or have been measured so inappropriate. [Carmona-Fonseca J. Food and nutritional status among children of endemic malaria zones of Antioquia (Colombia).

Autopsy findings in severe malaria – a case report.

Severe malaria, caused by Plasmodium falciparum infection, has a high mortality rate and is the main cause of death in malaria. Since clinical autopsy is unpopular in Indonesia, autopsy examination in malaria cases is rarely done. We reported a forty three year old woman from non endemic area that was dead because of severe malaria. Diagnosis was concluded from autopsy, histopathology, and toxicology.

Malaria and maternal mortality in Gezira-Sudan

The objectives of this study include: [1] to identify the magnitude of malaria as a cause of maternal mortality [MM] [2] to study the demographic characteristics of MM cases caused by malaria and [3] to identify the actual cause of MM due to malaria. This is a six years hospital based retrospective review of hospital records of ladies died due to malaria in Wad Medani Teaching Hospital for Obstetrics and Gynaecology [WMTHOG], form 1 January 1998 to 31 December 2003. Malaria caused 10% to 40% of MM per year. The mean age was 27.57 years, most of them were primigravidae and from rural areas. 37.8% of the deaths occurred between 28 and 36 week of gestation. The median duration of stay in hospital was two days. However 32.4% of deaths stayed for less than 24 hours that indicated severe and serious clinical presentations. The main causes of death due to malaria or its complication were: anaemia [24.3], cerebral malaria [21.6%], circulatory failure [12.51] and renal failure [8.1%]. Others were pulmonary oedema, hyperpyrexia, puerperal psychosis, abortion, severe epistaxis, cardiac arrest, black water fever, electrolyte imbalance, and hepatic failure. The study recommended effective prevention of malaria and an intensive care approach in its management

Fiebre amarilla: un peligro latente / Yellow fever: a latent danger

La fiebre amarilla es una zoonosis, aguda, febril que se encuentra catalogada como una fiebre hemorrágica potencialmente mortal. Es causada por un antrópodo del cual se conocen dos modalidades epidemiológicas, con un área endémica que corresponde a la mayoría de América del Sur y parte del continente africano. En Costa Rica la última epidemia de fiebre amarilla ocurrió a principios de los años cincuenta. La fisiopatología de la fiebre amarilla no es bien conocida. La mayoría de las infecciones son sintomáticas, y tienen una alta mortalidad que varía según la epidemia. El diagnóstico se confirma de forma definitiva con la serología y aunque éste examen no se realiza en el país, las muestras de los casos sospechosos son enviadas a laboratorios panameños. Con base en su gran mortalidad y a la ausencia de un tratamiento específico, es obvio que el camino a seguir en el manejo de la fiebre amarilla es la prevención mediante las vacunaciones masivas en las áreas endémicas y grupos de riesgo, así como el control del vector. La fiebre amarilla sigue siendo una entidad que afecta considerablemente la salud pública en varios países del mundo; Costa Rica reúne un conjunto de condiciones que facilitarían su aparición y propagación, por lo que es una patología cuyas características convendría mantener en mente. Descriptores: Arbovirus, fiebre amarilla, Costa Rica, zoonosis, fiebre hemorrágica.

Blackwater fever treated with artemether.

Blackwater fever is a rare manifestation of falciparum malaria characterized by sudden intravascular hemolysis followed by fever and hemoglobinuria. We present a case of blackwater fever, having occurred after administration of quinine, which was treated successfully with artemether.

A case of black water fever treated with peritoneal dialysis and artemether (quinghaosu derivative).

A clinical case of Black Water Fever following Plasmodium falciparum infection is reported. The patient had no previous history of malaria and had not taken anti-malarials as prophylasis. He was free from G-6-PD deficiency and abnormal haemoglobins. He had acute intravascular haemolysis, haemoglobinurea and renal failure after the third dose of quinine infusion. His life was saved by peritoneal dialysis and Artemether injection. In in vitro test, his blood haemolysed suddenly in 36 hours when incubated with quinine (10 mg per lit) at 37 degrees C in test tube while control blood took over a week for natural slow haemolysis. Thus quinine plays an important part in the cause of Black Water Fever.