Within a few days of onset there are chills, with rigor, high fever, jaundice, vomiting, rapidly progressive anemia, and dark red or black urine.
Causes
The cause of hemolytic crises in this disease is unknown. There is rapid and massive destruction of red blood cells resulting in hemoglobinemia, hemoglobinuria, intense jaundice, anuria, and finally death in the majority of cases. The most probable explanation for blackwater fever is an autoimmune reaction apparently caused by the interaction of the malaria parasite and the use of quinine. Blackwater fever is caused by heavy parasitization of red blood cells with Plasmodium falciparum. There has been at least one case, however, attributed to Plasmodium vivax. Blackwater fever is a serious complication of malaria, but cerebral malaria has a higher mortality rate. Blackwater fever is much less common today than it was before 1950. It may be that quinine plays a role in triggering the condition, and this drug is no longer commonly used for malaria prophylaxis. Quinine remains important for treatment of malaria.
Prior to his photography career, Henri Cartier-Bresson contracted blackwater fever while hunting in Western Africa. Expecting to die, he sent instructions to his family on his wishes for a funeral. He made a full recovery.
Zoologist John Samuel Budgett died from the disease in 1904, after returning from a collecting trip to West Africa, in search of specimens of the fish Polypterus.
Missionary and explorer George Grenfell died after a bad attack of blackwater fever at Basoko on 1 July 1906.
Jesse Brand, a missionary to the Chat Mountains in India, died of blackwater fever in 1928.
Actor Don Adams, best known as Maxwell Smart from the popular sitcom Get Smart and as the title character in Inspector Gadget, contracted blackwater fever after being shot in combat at Guadalcanal during World War II. Adams was evacuated from his United States Marine Corps unit to a hospital in New Zealand where he ultimately made a full recovery.
Humanitarian and MMA fighter Justin Wren contracted malaria, which devolved into blackwater fever, while drilling water-wells for Congo Pygmies in 2013. The affliction nearly claimed Wren's life. He was misdiagnosed four times and required airlift to Uganda, where he narrowly recovered from severe symptoms.
Aeneas, Jeannie Gunn's husband, is described as having died from Blackwater Fever or Malarial Dysentry at Elsey Station in the Northern Territory in 1903. She later authored the classic account We of the Never Never.
Bernard Deacon
Cultural references
Out of Africa, a 1985 film based on the experiences of author Isak Dinesen
The Queen’s Nose, a 1983 book in which the protagonist’s uncle contracts Blackwater Fever
Stand on Zanzibar, a 1968 science-fiction novel by John Brunner quotes a linefrom the sea chanty "The Bight of Benin": "The bight of Benin, the bight of Benin! Blackwater fever and pounds of quinine!"
