Blood Trials: Transfusions, Injections, and Experiments in Africa, 1890-1920.

From about 1880 to 1920, a culture of medical experimentation promoted blood transfusion as a therapy for severe anemia in Europe, which was applied in German East Africa in 1892 for a case of blackwater fever, a complication of malaria afflicting mainly Europeans. This first case of blood transfusion in Africa, in which an African's blood was transfused into a German official, complicates the dominant narrative that blood transfusions in Africa came only after World War I. Medical researchers moreover experimented with blood serum therapies on human and animal subjects in Europe and Africa, injecting blood of different species, "races" and ethnicities into others to demonstrate parasite transmissibility and to discover vaccines for diseases such as malaria, sleeping sickness, and yellow fever. While research in German colonies is highlighted here, this was a transnational medical culture that crossed borders and oceans. This research is of interest as a possible early pathway for the epidemic spread of HIV and other zoonoses in Africa and the world, which biomedical researchers have identified as emerging in West-Central Africa sometime around the turn of the twentieth century.

Black water fever associated with acute renal failure among Congolese children in Kinshasa.

Acute renal failure (ARF) is reported in some severe forms of malaria such as black water fever (BWF). It is associated with a high mortality rate and can be managed effectively with adequate renal replacement. A prospective survey of children with dark urine after a malarial infection with Plasmodium falciparum was coupled with a chart review study of patients managed in the past 11 years in the Pediatrics' Kinshasa University Hospital. Eighty-nine cases of ARF were identified, but data from only 63 patients were available, of whom 44 (69.8%) had severe malaria (39 with BWF and 5 with cerebral malaria). The mean age of the patients was 8.2±1.73 years. Of the 39 cases of BWF, an association with quinine ingestion was observed in 32 children (82%). Urea and creatinine levels were elevated in all cases (135.4±88.2 and 3.83±2.81 mg/dL, respectively). Oligo-anuria was observed in 44.4%, severe metabolic acidosis (bicarbonate<15 mEq/L) in 61.5% and hyponatremia (<130 mEq/L) in 33.3%. Peritoneal dialysis was required in 36 patients, including 20 with BWF. The remaining patients were managed with conservative treatment. Twenty-eight children (44.4%), including 20 on dialysis, fully recovered and 14 died (22.2%), including eight cases of BWF. Our study suggests that ARF is commonly associated with BWF in Congolese children. Elevated urea and creatinine and severe metabolic acidosis were observed more often than other clinical/metabolic disturbances. Severe renal impairment remains a significant complication with a high mortality rate in low-resource settings.

[Methemalbuminnemia after massive hemolysis during blackwater fever]. / Methémmalbuminémie après hémolyse massive au cours d'une fièvre bilieuse hémoglobinurique.

We report a case of blackwater fever with brown plasma due to the presence of methemalbumin. The discovery of plasma with this color is a rare event at the laboratory. This compound appears during intravascular hemolysis or hemorrhagic pancreatitis when the ability of haptoglobin and hemopexin to bind free hemoglobin has been exceeded. In these cases some of heme is oxidized to hematin and taken up by serum albumin to form an albumin-hematin complex called methemalbumin. The major clinical problem is to evoke the diagnosis of methemalbuminemia and not confuse with methemoglobinemia. In our case, methemalbumin was detected and quantified using a scanning spectrophotometer. Its diagnostic and clinicals consequences are discussed.

Fiebre de aguas negras: reporte de un caso / Blackwater fever: a case report

Se presentó el primer reporte de blackwater fever en la literatura médica cubana. Es una complicación infrecuente del paludismo por Plasmodium falciparum, caracterizada por fiebre, hemoglobinuria y fallo renal, con desarrollo dramático y alta mortalidad. El paciente provenía de la República Popular de Angola donde permaneció durante 7 años, con antecedentes de varios episodios de malaria; ingresó en el Instituto de Medicina Tropical ôPedro Kouríö, con fiebre e íctero y gota gruesa positiva a P. falciparum. Se comenzó tratamiento con quinina y 12 h después aparecieron orinas de color rojo vino e incremento del íctero, se retiró el tratamiento con quinina. Se transfundieron glóbulos rojos y plaquetas, se realizó hemodiálisis y plasmaféresis. Fue egresado 2 semanas después asintomático con gota gruesa negativa. Se discutió la patogenia de esta complicación, en especial lo referente al fallo renal; se hizo énfasis en la importancia del tratamiento sintomático y de sostén, en la evolución del paciente(AU)

[Blackwater fever]. / Fièvre bilieuse hémoglobinurique.

DEFINITION: Blackwater fever is a clinical entity characterized by acute intravascular hemolysis classically occuring after the re-introduction of quinine in long-term residents in Plasmodium falciparum endemic areas and repeatedly using the product. CLINICAL PROFILE: The symptomatology appears brutally with emission of porto-colored urine, icterus, pallor, nausea, fever and acute renal failure. The hemolytic-like anemia is immediately severe. Parasitemia is mild or absent. The mechanism of renal failure is tubular necrosis. QUININE AND SIMILAR MOLECULES: Well known at the start of the 20th century, blackwater fever has become exceptional since 1950, when quinine was replaced by chloroquine. The disease reappeared in 1990, following the re-utilization of quinine because of resistance to chloroquine. Thereafter, several cases have been described with halofantrine and mefloquine, two new molecules similar to quinine (amino-alcohol family). The physiopathogenesis of the disease is not well known, however it would appear that the concomitance of a double sensitivization of the red blood cells to the P. falciparum red blood cells and to the amino-alcohols is necessary to provoke the hemolysis. EVOLUTION: The severity of the clinical picture often requires initial management in intensive care unit. Nowadays, however, prognosis is good and the disease usually regresses without after effects.

Blackwater fever at the Kenyatta National Hospital in Kenya: a case report.

Blackwater fever was an important cause of morbidity and mortality in the beginning of this century particularly in West and Central Africa. There has been a marked reduction in the incidence of blackwater fever since 1950 and only sporadic cases occur nowadays. At the Kenyatta National Hospital, three cases of blackwater fever have been seen in the past four years whereas not a single case had been reported between 1975 and 1988. Two of the patients fit into the classical description of blackwater fever and one was possibly due to drug induced haemolysis in a G6PD deficiency patient.

[Tropical malaria and sickle-cell anemia: a tropical surprise]. / Malaria tropica en sikkelcel-anemie: een tropische verrassing.

A case of a very sick 2.5-year-old, Ghanese boy with fever, who fell in coma in the emergency room, is described. He was diagnosed as having blackwater fever (BWF) on clinical grounds. He also had a sickle cell anaemia. A short review of BWF is given and we discuss possible causes of the anaemia in this case. The anaemia in sickle cell anaemia is described and it appears that malaria tropica can lead to a severe hemolytic sickle cell crises. We discuss the combination of sickle cell anaemia and malaria tropica.

A case of black water fever treated with peritoneal dialysis and artemether (quinghaosu derivative).

A clinical case of Black Water Fever following Plasmodium falciparum infection is reported. The patient had no previous history of malaria and had not taken anti-malarials as prophylasis. He was free from G-6-PD deficiency and abnormal haemoglobins. He had acute intravascular haemolysis, haemoglobinurea and renal failure after the third dose of quinine infusion. His life was saved by peritoneal dialysis and Artemether injection. In in vitro test, his blood haemolysed suddenly in 36 hours when incubated with quinine (10 mg per lit) at 37 degrees C in test tube while control blood took over a week for natural slow haemolysis. Thus quinine plays an important part in the cause of Black Water Fever.

[Severe forms of imported malaria concerning three pernicious attacks and a black water fever (hemoglobinuria) (author's transl)]. / Formes graves du paludisme d'importation a propos de trois accès pernicieux et d'une fièvre bilieuse hémoglobinurique.

Four severe cases of imported malaria are reported here. Three of them are pernicious and the fourth is a black water fever (hemoglobinuria). The difficulties of initial diagnosis are exposed. There was no mortality in these four cases which represent the annual recruiting of a multipurpose intensive care unit. But the complications are severe in contradiction with easy effective chemoprophylaxis. The principles of treatment and prophylaxis are resumed in the light of these four observations.

[Report of two cases of acute or cerebral malaria with atypic on-set (author's transl)]. / Deux cas de paludisme aigu ou accés pernicieux de paludisme á dèbut atypique.

Report and comments on one case of cerebral malaria with myocardial infarction, icterus and renal insufficiency, and of another one with a black-water-like syndrome with complete recovery under quinine treatment.