Introduction: Black water fever (BWF) is a complication of severe Plasmodium falciparum infection in hemolysis of erythrocytes into the bloodstream releasing the hemoglobin directly into the blood vessels and causes s...Introduction: Black water fever (BWF) is a complication of severe Plasmodium falciparum infection in hemolysis of erythrocytes into the bloodstream releasing the hemoglobin directly into the blood vessels and causes severe anemia and passage of dark/cola color urine, leading to acute renal failure. Hemoglobinuria or BWF is a rare and severe manifestation of falciparum malaria characterized by sudden intravascular hemolysis followed by fever and presence of abnormal hemoglobin in the urine. Aim: The aim of this study was to diagnose and treat severe malaria infection in a Nigerian patient admitted to the Casualty of the IDH Hospital. Case Presentation: A 20-year-old Nigerian boy came to Kuwait and started complaining abdominal pain, nausea, vomiting and fever two days after his arrival. The investigation revealed high fever (40.8˚C), heart rate 125, blood pressure of 100/60 mmHg. The physical examination was unremarkable, including a normal neurologic examination, no hepatosplenomegaly, rash and neck rigidity. The Giemsa stained thick and thin blood examination confirmed the severe infection of Plasmodium falciparum with 41.0% parasitemia. The patient was admitted to the hospital and started intravenous Quinine (1200 mg loading dose in 5% glucose over 4 hours). The patient was feeling much better on next morning but became unconscious by evening and shifted to ICU. His all CBC parameters were higher and started passing dark/cola color urine. The 12 units of whole blood were exchanged on next morning and became fully conscious on 4<sup>th</sup> day and his anemia and thrombocytopenia were improved and the color of the urine also became normal. Conclusion: Quinine is used in both complicated and uncomplicated malaria and may cause black water fever in severe infection of P. falciparum. It is caused by the hemolysis of erythrocytes due to malaria and also with the metabolism of quinine, making these cells more vulnerable to hemolysis in falciparum malaria and also in G6PD deficiency.展开更多
Introduction: Pediatric Acute Kidney Injury (AKI) seems to be a major cause of morbidity and mortality in Subsahara Africa. However, data on its epidemiology are scare and mainly originate from tertiary and urban heal...Introduction: Pediatric Acute Kidney Injury (AKI) seems to be a major cause of morbidity and mortality in Subsahara Africa. However, data on its epidemiology are scare and mainly originate from tertiary and urban health facilities such as large university Teaching hospitals with a nephrology service. Objective: The aim of this study was to compare the epidemiology of pediatric AKI in urban and semi-urban health facility. Patients and method: We conducted a retrospective study of 16 months in a tertiary urban hospital (General Hospital of Douala) and a secondary semi-urban health facility (Region hospital of Buea). Diagnostic of AKI was done using usual criteria. Age, sex distribution, etiologies of AKI, access to dialysis, renal recovery at hospital discharge, at 1 and 3 months and patient survival at hospital discharge was compared. Results: A total of 31 patients were included (GD 17 and RHB 14). Boys were more prevalent in the semi-urban setting (86% Vs 47% p = 0.029). Median age was comparable in the both group although most semi-rural patient were older (6.5 Vs 10 years p = 0.093). Hospital acquired AKI was only found in urban setting and account for 40% of pediatric urban AKI. Malaria related AKI (mainly black water fever) and sepsis were the main etiologies of AKI in urban and semi-urban milieu. Dialysis access was the same but 30% of children could not access to it in urban setting compare to none in semi-urban area. Reasons of non-access to dialysis were lack of pediatric material and financial constraints. In Hospital mortality was the same but was more severe amount patient who could not receive dialysis. Among the survivor, CKD was only found in urban setting. Conclusion: Although mainly due to malaria, pediatric AKI differs from urban tertiary and semi-urban secondary health facility in Cameroon. Hospital acquired AKI is only found in urban setting where children are younger and less boys. AKI in urban setting seems to be more severe with less access to dialysis and more risks of CKD.展开更多
文摘Introduction: Black water fever (BWF) is a complication of severe Plasmodium falciparum infection in hemolysis of erythrocytes into the bloodstream releasing the hemoglobin directly into the blood vessels and causes severe anemia and passage of dark/cola color urine, leading to acute renal failure. Hemoglobinuria or BWF is a rare and severe manifestation of falciparum malaria characterized by sudden intravascular hemolysis followed by fever and presence of abnormal hemoglobin in the urine. Aim: The aim of this study was to diagnose and treat severe malaria infection in a Nigerian patient admitted to the Casualty of the IDH Hospital. Case Presentation: A 20-year-old Nigerian boy came to Kuwait and started complaining abdominal pain, nausea, vomiting and fever two days after his arrival. The investigation revealed high fever (40.8˚C), heart rate 125, blood pressure of 100/60 mmHg. The physical examination was unremarkable, including a normal neurologic examination, no hepatosplenomegaly, rash and neck rigidity. The Giemsa stained thick and thin blood examination confirmed the severe infection of Plasmodium falciparum with 41.0% parasitemia. The patient was admitted to the hospital and started intravenous Quinine (1200 mg loading dose in 5% glucose over 4 hours). The patient was feeling much better on next morning but became unconscious by evening and shifted to ICU. His all CBC parameters were higher and started passing dark/cola color urine. The 12 units of whole blood were exchanged on next morning and became fully conscious on 4<sup>th</sup> day and his anemia and thrombocytopenia were improved and the color of the urine also became normal. Conclusion: Quinine is used in both complicated and uncomplicated malaria and may cause black water fever in severe infection of P. falciparum. It is caused by the hemolysis of erythrocytes due to malaria and also with the metabolism of quinine, making these cells more vulnerable to hemolysis in falciparum malaria and also in G6PD deficiency.
文摘Introduction: Pediatric Acute Kidney Injury (AKI) seems to be a major cause of morbidity and mortality in Subsahara Africa. However, data on its epidemiology are scare and mainly originate from tertiary and urban health facilities such as large university Teaching hospitals with a nephrology service. Objective: The aim of this study was to compare the epidemiology of pediatric AKI in urban and semi-urban health facility. Patients and method: We conducted a retrospective study of 16 months in a tertiary urban hospital (General Hospital of Douala) and a secondary semi-urban health facility (Region hospital of Buea). Diagnostic of AKI was done using usual criteria. Age, sex distribution, etiologies of AKI, access to dialysis, renal recovery at hospital discharge, at 1 and 3 months and patient survival at hospital discharge was compared. Results: A total of 31 patients were included (GD 17 and RHB 14). Boys were more prevalent in the semi-urban setting (86% Vs 47% p = 0.029). Median age was comparable in the both group although most semi-rural patient were older (6.5 Vs 10 years p = 0.093). Hospital acquired AKI was only found in urban setting and account for 40% of pediatric urban AKI. Malaria related AKI (mainly black water fever) and sepsis were the main etiologies of AKI in urban and semi-urban milieu. Dialysis access was the same but 30% of children could not access to it in urban setting compare to none in semi-urban area. Reasons of non-access to dialysis were lack of pediatric material and financial constraints. In Hospital mortality was the same but was more severe amount patient who could not receive dialysis. Among the survivor, CKD was only found in urban setting. Conclusion: Although mainly due to malaria, pediatric AKI differs from urban tertiary and semi-urban secondary health facility in Cameroon. Hospital acquired AKI is only found in urban setting where children are younger and less boys. AKI in urban setting seems to be more severe with less access to dialysis and more risks of CKD.
