Blackwater fever is a severe form of malaria with intravascular hemolysis, dark urine and renal failure. Paasi et al reported predictors of prolonged hospitalization and mortality for children with blackwater fever. The authors are for Mbale Clinical Research Institute and Busitema University in Uganda.
Patient selection: blackwater fever, pediatric patients from 2 months to 15 years of age
Pathogen: Plasmodium falciparum
Predictors of prolonged hospitalization:
(1) mild fever, >= 37.5 and <= 37.9°C (aOR 2.0)
(2) body pain = composite of chest, foot or hand pain (aOR 2.2)
(3) abdominal tenderness (aOR 1.9)
The mortality rate was 3.2%. 69% of patients who died did so in the firs 48 hours after admission.
Predictors of mortality:
(1) noisy or interrupted breathing
(2) tachypnea
(3) chest pain
(4) convulsions
(5) delayed capillary refill time (>= 3 seconds)
(6) severe pallor
(7) high fever (> 38.5°C)
(8) altered level of consciousness
(9) prostration
(10) acidotic breathing (probably Kussmaul breathing)
