A case of blackwater fever with persistent Plasmodium falciparum parasitaemia detected by PCR after artemether-lumefantrine treatment.

BACKGROUND: Blackwater fever is a complication of malaria infection consisting of a syndrome of febrile intra-vascular haemolysis with severe anaemia and intermittent passage of dark-red to black colour urine. Despite numerous reports and studies of this condition, its pathogenesis remains incompletely understood. CASE PRESENTATION: This report describes a case of classic blackwater fever in a returning traveller, without prior history of malaria infection nor usage of anti-malarial prophylaxis, treated with two courses of oral artemether-lumefantrine combination therapy. Unusual persistence of submicroscopic Plasmodium falciparum parasitaemia was detected by PCR for 18 days after initiation of treatment. CONCLUSION: To the authors' knowledge this is the first reported occurrence of a case of blackwater fever associated with prolonged submicroscopic parasitaemia. This unusual case challenges the current knowledge of the pathogenesis of this condition and opens questions that may have important diagnostic and treatment implications.

Effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions.

OBJECTIVE: To develop and pilot test the effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report symptoms of acute deteriorating conditions. METHOD: Using cluster randomization, acute care general wards were randomized to the experimental and control groups. 34 patients in the experimental group received a 30-minute patient education intervention on Alert Worsening conditions And Report Early (AWARE) while 33 patients in the control group received the routine care only. Levels of self-efficacy to recognize and report symptoms were measured before and after the intervention. RESULTS: The level of self-efficacy reported by the experimental group was significantly higher than the control group (p<0.0001). CONCLUSION: The AWARE intervention was effective in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions. PRACTICAL IMPLICATIONS: Patient engagement through patient education could be included in the rapid response system which aims to reduce hospital mortality and cardiac arrest rates in the general wards.