Blackwater fever . . .

(This post was drafted on 15th Dec, 2011)

We have been having quite a lot of patients with malaria over the last 2 months and it seems that they would continue to come all through the winter. We have some sort of a cold wave going on here with temperatures around 5-10 degree celsius in the night and it is a bit unnerving that we continue to get very sick malaria patients.

The latest two patients whom we have are quite sick. ND, a young housewife who is 7 months pregnant came today afternoon with long standing fever. She was being treated in Daltonganj for the last 1 week. 50% of her red blood cells were infested by the malarial parasite. And her liver enzymes were mildly elevated. We offered her a referral as we thought that the family looked well off, she was pregnant and her platelet counts were 41,000/cu mm.

Her family ultimately decided to treat her here after much deliberations.

Sometime late in the evening came MS, a middle aged man with history almost very similiar to ND. However, he looked more sick. 20% of his red blood cells were infested by the malarial parasite, but he had a platelet count of only 15,000/cu mm. The worst was his urine. Although his creatinine levels were on the higher side of normal, the colour of the urine was very frightening.

In the earlier days, I understand that this used to be called blackwater fever. And I've read somewhere that Dr Paul Brand's father died of this condition.

I hope that both MS and ND will pull through. As we discussed about these patients, Nandu was quite apprehensive about having to manage such patients alone from Saturday. Shishir has already left for his vacation and I would also be going off south to home from Saturday.