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What is Blackwater Fever?

By Andy Josiah
Updated Mar 03, 2024
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Blackwater fever is a form of malaria that involves serious blood-related complications. It is caused when a protozoan parasite called Plasmodium falciparum (P. falciparum) interacts with the body's red blood cells. Blackwater fever is thus occasionally referred to as falciparum malaria, which is considered the deadliest version of this infectious disease.

P. falciparum is transmitted by the female Anopheles mosquito, which is notorious for being the agent of malaria. The parasite enters the liver and causes hemolysis, a process in which the red blood cells burst into the bloodstream. This releases an iron-containing oxygen transport protein called hemoglobin in excess amounts to the urine, a condition known as hemoglobinuria, which destroys the glomerulus, a part of the kidney responsible for filtering blood to form urine. Such a deterioration usually leads to kidney failure.

Discounting the high fever that accompanies it, the most common and identifiable symptom of blackwater fever is anuria, a condition that indicates non-passage of urine, or a passage of less than 50 mm of urine a day. Other symptoms include chills and convulsions, headache, passage of bloody stools, coma, nausea and vomiting, sweating and abdominal pain. Blackwater fever, like other forms of malaria, requires immediate medical attention and hospitalization, as it can be fatal within a few hours of the first appearance of its symptoms.

The most common form of blackwater treatment usually involves anti-malarial chemotherapy and a supply of intravenous fluids. In the more extreme cases, the patient is placed under intensive care and dialysis. Some of the symptoms of blackwater fever can be suppressed. For instance, patients can place ice packs on the forehead, take cold baths or drink herbal tea to reduce fever. Also, greater intake of fluids such as water and juice is encouraged to counteract the loss of protein as a result of blackwater fever.

Due to its classification as falciparum malaria, Blackwater fever is a major problem for people living in the tropical or subtropical areas of the world, where the Anopheles mosquito optimally thrives. It is particularly severe in sub-Saharan Africa, where as much as 75 percent of malaria cases are due to P. falciparum. Moreover, the World Health Organization reported that P. falciparum-induced malaria was accountable for about 91 percent of 247 million malarial infections as of 2006, with 98 percent of them in Africa. The occurrence of blackwater fever itself, however, has drastically decreased since 1950.

The Health Board is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
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