Bruneel F, Gachot B, Wolff M, Régnier B, Danis M, Vachon F
Clinique de Réanimation des Maladies Infectieuses et Tropicales, Groupe Hospitalier Bichat--Claude Bernard, Paris, France.
Clin Infect Dis. 2001 Apr 15;32(8):1133-40. doi: 10.1086/319743. Epub 2001 Apr 2.
Blackwater fever (BWF) is a severe clinical syndrome, characterized by intravascular hemolysis, hemoglobinuria, and acute renal failure that is classically seen in European expatriates chronically exposed to Plasmodium falciparum and irregularly taking quinine. BWF virtually disappeared after 1950, when chloroquine superseded quinine. We report 21 cases of BWF seen in France from 1990 through 1999 in European expatriates who lived in sub-Saharan Africa. All patients had macroscopic hemoglobinuria, jaundice, and anemia. Acute renal failure occurred in 15 patients (71%), 7 of whom required dialysis. The presumed triggers of BWF were halofantrine (38%), quinine (24%), mefloquine (24%), and halofantrine or quinine (14%). Glucose-6-phosphate dehydrogenase (G6PD) activity was normal in the 14 patients who underwent this test. Low-level P. falciparum parasitemia was found in 8 patients. All 21 patients survived. Our data and 13 cases reported in the literature suggest a resurgence of classic BWF among Europeans living in Africa and a need to discuss attendant therapeutic implications.
黑水热（BWF）是一种严重的临床综合征，其特征为血管内溶血、血红蛋白尿和急性肾衰竭，典型见于长期暴露于恶性疟原虫且不定期服用奎宁的欧洲侨民。1950年后，当氯喹取代奎宁时，黑水热实际上已消失。我们报告了1990年至1999年在法国见到的21例黑水热病例，患者均为居住在撒哈拉以南非洲的欧洲侨民。所有患者均有肉眼可见的血红蛋白尿、黄疸和贫血。15例患者（71%）发生急性肾衰竭，其中7例需要透析。推测引发黑水热的因素为卤泛群（38%）、奎宁（24%）、甲氟喹（24%）以及卤泛群或奎宁（14%）。接受此项检测的14例患者葡萄糖-6-磷酸脱氢酶（G6PD）活性正常。8例患者发现有低水平的恶性疟原虫血症。21例患者均存活。我们的数据以及文献报道的13例病例提示，居住在非洲的欧洲人当中经典型黑水热有复发情况，且有必要讨论随之而来的治疗问题。
