Poster Presentation First Malaria World Congress 2018

A case of blackwater fever with persistent Plasmodium falciparum parasitaemia detected by PCR after arthemeter-lumefantrine treatment (#414)

Paul Huggan 1 2 , Chin Hin Ng 3 , Jennifer Ho 4 5 , Raymond Lin 6 7 8 , jean-marc chavatte 6
  1. Waikato Hospital, Hamilton, New Zealand.
  2. Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
  3. Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore
  4. Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
  5. South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  6. National Public Health Laboaratory - Malaria Reference Centre, Misnistry of Health, Singapore, Singapore
  7. Department of Laboratory Medicine, National University Hospital, Singapore
  8. Departments of Microbiology and Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

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 being described since the time of Hippocrates, with numerous reports and studies about this condition which do not lead to an unifying mechanism, the pathogenesis of the blackwater fever 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.