BLACKWATER FEVER IN SOUTHERN VIETNAM - A PROSPECTIVE DESCRIPTIVE STUDY OF 50 CASES

We prospectively studied 50 Vietnamese patients with blackwater fever (BWF). All patients had fever and hemoglobinuria, 40 (80%) were jaundi ced, 25 (50%) had hepatomegaly, 17 (34%) had splenomegaly, and 9 (18%) had hepatosplenomegaly. Twenty-one patients (42%) had impaired renal function, with creatinine clearances of < 50 mL/min/m(2); however, onl y four (8%) developed oliguric renal failure, three (6%) of whom requi red dialysis, Forty-four patients (88%) developed anemia, which was se vere (hematocrit, < 20%) in 32 (64%). One patient died, representing a death rate for this once-feared disease that is considerably lower th an that reported by earlier investigators, BWF was associated with qui nine ingestion in 28 patients (56%), glucose-6-phosphate dehydrogenase (G6PD) deficiency in 27 (54%), and concurrent malaria infection in 16 (32%), There was no statistically significant difference in the sever ity of BWF associated with each of these three factors, as assessed by creatinine clearance and the hematocrit value on admission and by the number of units of blood transfused, There was considerable overlap i n the occurrence of G6PD deficiency, quinine ingestion, and malaria, s uggesting that these factors may interact and that it may not be justi fiable to regard hemoglobinuria caused by G6PD deficiency as a separat e syndrome.