A dangerous complication of malaria turns urine dark with blood \u2013 but only affects some young patients in rural areas and not others. Puzzled experts are trying to find out why.<\/p>\n\n\n\n
By the age of six, Babirye Zainab had already contracted malaria several times. Her grandmother did not see it as a big problem though. \u201cI would treat her with antimalarials and she would be all right,\u201d she says.<\/p>\n\n\n\n
But then she developed a fever and started to have convulsions. Her urine was the colour of tea, and her grandmother, who shares the same name, was worried enough to take her on a motorbike to the local health centre.<\/p>\n\n\n\n
\u201cWe were discharged. A month later, she had another episode. Since then, she has experienced quite a number of episodes of passing tea-coloured urine,\u201d she says.<\/p>\n\n\n\n
Zainab is part of a medical riddle affecting rural\u00a0Uganda<\/a>.<\/p>\n\n\n\n She has blackwater fever, a rare but increasing complication of malaria that researchers are trying to explain. So named because patients\u2019 urine turns dark with blood, it can be deadly.<\/p>\n\n\n\n Blackwater fever happens when red blood cells break down, rapidly, in the bloodstream. They release haemoglobin and this is excreted in urine. It can result in anaemia and jaundice and require blood transfusion.<\/p>\n\n\n\n Prof Kathryn Maitland of Imperial College London, based in Kenya, was part of a team that noticed high numbers of children in eastern Uganda with blackwater almost a decade ago.<\/p>\n\n\n\n In a paper published in the journal Clinical Infectious Diseases<\/a> they reported that the condition \u201caccording to local investigators, was rare until the last seven years\u201d and speculated \u201cthat this might relate to the introduction of artemisinin-based combination therapies\u201d, the most modern type of antimalarial drugs.<\/p>\n\n\n\n Since then, Maitland says, \u201cwe have been digging, digging, digging\u201d, looking for an explanation.<\/p>\n\n\n\n Historically, blackwater fever was seen among European expatriates who took small doses of quinine as an antimalarial, and became less common when other drugs took over.<\/p>\n\n\n\n \u201cIt certainly wasn\u2019t mentioned in the World Health Organization guidelines for severe malaria \u2013 it was recorded as a very rare occurrence. But it is increasing,\u201d says Maitland.<\/p>\n\n\n\n