Letters to the Editor

Blackwater fever after halofantrine

Blackwater fever (BWF), one of the commonest causes of death of Europeans living in Africa at the beginning of the twentieth century, but rarely diagnosed since the 1950s, is related to Plasmodium falciparum malaria but there is considerable debate and controversy about its aetiology. From 1990 to 2000, the whole population of Dielmo, a village in Senegal, was involved in a prospective study of malaria. Three cases of BWF occurred in 3 children aged 4, 7 and 10 years, belonging to a subgroup of children who suffered malaria attacks every 4 to 6 weeks over many years, who had received repeated quinine treatment. The spread of chloroquine resistance, by increasing the use of more toxic alternative drugs, may expose endemic populations to a high incidence of severe side effects of antimalarials.

À partir des données de la littérature disponible sur Medline et Pascal, une revue du traitement des formes graves de paludisme à Plasmodium falciparum a été effectuée. Les mesures générales de prise en charge restent essentielles. Le développement des unités de soins intensifs, l'amélioration des techniques de réanimation dans les domaines de la ventilation mécanique, de l'épuration extrarénale et du traitement du choc ont permis une prise en charge plus adaptée. La quinine s'est maintenue comme l'antimalarique de choix. Les dérivés de l'artémisinine ne constituent pour l'instant qu'une alternative thérapeutique. Jamais correctement évalué, le bénéfice de l'exsanguino-transfusion reste une hypothèse d'école. Aucun progrès thérapeutique majeur n'est intervenu dans les 20 dernières années et la mortalité est restée pratiquement inchangée.

A comprehensive review of treatment for severe forms of Plasmodium falciparum malaria in adults was made using the data available on Medline and Pascal. Supportive therapy remains essential for optimal management. The widespread access to intensive care facilities, the technical progress in mechanical ventilation, hemodialysis and hemofiltration, and in the management of shock now permit the most adapted care for these patients. Quinine is still the choice antimalarial drug, although artemisinin derivatives offer a good therapeutic alternative. The benefit of blood exchange transfusion remains hypothetical due to the lack of adequate evaluation. The absence of any major breakthrough in therapy is correlated to an unchanged death rate over the last 20 years.