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Background. Blackwater fever (BWF) is a rare but serious complication of malaria that is a consequence of antimalarial treatment. Its prevalence seems to have increased. Its diagnosis is based on clinical symptoms and urine color. We report on 4 BWF cases admitted to the infectious diseases department of Zinder National Hospital. Results. Four patients were hospitalized in September 2017 for a hepatorenal syndrome of jaundice, port wine-colored urine, renal failure, and hepatic cytolysis following antimalarial treatment with quinine salts. Quinine treatment was stopped and treatment was continued with injectable artemether. Three patients underwent extra-renal purification. Their evolution was favorable. One patient died less than 24 hours after admission. Conclusion. A rare and severe complication, blackwater fever must be considered for patients under antimalarial treatment who present with jaundice, abdominal pain, and acute renal insufficiency with port wine-colored urine. Rapid diagnosis and management in an intensive care unit are crucial for improving the prognosis.

INTRODUCTION: Le paludisme chez la femme enceinte est un problA¨me majeur de santA© publique en Afrique. Il a des consA©quences graves aussi bien sur la mA¨re, le fA“tus que le nouveau-nA©. Il est responsable d´un fort taux de morbi-mortalitA© maternelle et infantile. L´objectif de l´A©tude est de dA©terminer la prA©valence de l´infection plasmodiale chez la femme enceinte, dA©crire ses signes cliniques et ses complications A©ventuelles, analyser les facteurs associA©s et proposer des mesures de prA©vention. METHODES: il s´agit d´une A©tude transversale, conduite du 1er juin au 30 novembre 2017 A la MaternitA© Issaka Gazobi (MIG) de Niamey. Le diagnostic a A©tA© fait par microscopie. RESULTATS: deux cents quarante-neuf (249) femmes ont A©tA© incluses dans cette A©tude. La prA©valence de l´infection plasmodiale A©tait de 36,5% (IC95%; [30,6; 42,9]). La densitA© parasitaire moyenne A©tait de 177 P/µl (DS: 121; [40; 800]). Toutes les infections A©taient A P.falciparum. Un peu plus de soixante-treize pourcent (73,6%) (67/91) des femmes infectA©es A©taient asymptomatiques. Seules 26,4% (24/91) ont fait un paludisme non compliquA©; 9,6% (6/91) ont avortA©; 38,4% des nouveau-nA©s avaient un faible poids A la naissance et 26,51% (66/249) ont dA©veloppA© un paludisme congA©nital. Le taux de lA©talitA© A©tait de 1,1% (1/91). Le traitement prA©ventif intermittent (TPI) protA¨ge significativement contre le paludisme gestationnel (p=0,01). CONCLUSION: l´infection des femmes enceintes par le P.falciparum est trA¨s frA©quente au Niger. Ce portage est le plus souvent asymptomatique mais peut A©voluer vers un paludisme non compliquA© ou mAame sA©vA¨re. Les principales consA©quences sont l´avortement, le faible poids A la naissance, le retard de croissance intra utero, le paludisme congA©nital et le dA©cA¨s maternel. Le TPI et l´utilisation de la moustiquaire imprA©gnA©e d´insecticide A longue durA©e d´action (MILDA) permettent de prA©venir l´infection.

Summary.Problem. Transfusional malaria is an accidental transmission ofPlasmodiumvia a blood transfusion. Its magnitude is underestimated and very little data on the assessment of this risk are available in Niger.Objective. This study aimed to determine the prevalence of plasmodial infection of blood bags at the National Blood Transfusion Center of Niamey (NBTC).Methodology. A cross-sectional study to diagnosePlasmodiuminfection by microscopy and Rapid Diagnostic Test (RDT) was carried out during the rainy season (September to November 2015). Blood grouping was performed by the BETH-VINCENT technique.Results. One thousand three hundred and fifty-seven (1357) blood bags were collected. One hundred and fifty-seven (11.6%) of the donors were infected withPlasmodiumby microscopy and 2.4% (9/369) by rapid diagnostic test. All infections were withP. falciparum(100%). The mean parasite density was 197 parasites/μL (SD=281; [80: 2000]). There were no significant differences in infection prevalence between the ABO blood groups (p=0.3) or the rhesus positivity (p=08). There is also no significant difference in temporal (p=0.1) and spatial (p=0.6) distribution.Conclusion. The transmission of transfusional malaria during the rainy season is a fact in Niger. Such risks were independent of the ABO blood type and positivity for the rhesus antigen. Pretransfusion diagnosis or posttransfusion therapy should be instituted to prevent it.

Background Malaria endemic countries need to assess efficacy of anti-malarial treatments on a regular basis. Moreover, resistance to artemisinin that is established across mainland South-East Asia represents today a major threat to global health. Monitoring the efficacy of artemisinin-based combination therapies is of paramount importance to detect as early as possible the emergence of resistance in African countries that toll the highest burden of malaria morbidity and mortality. Methods A WHO standard protocol was used to assess efficacy of the combinations artesunate–amodiaquine (AS–AQ Winthrop®), dihydroartemisinin–piperaquine (DHA–PPQ, Eurartesim®) and artemether–lumefantrine (AM–LM, Coartem®) taken under supervision and respecting pharmaceutical recommendations. The study enrolled for each treatment arm 212 children aged 6–59 months living in Maradi (Niger) and suffering with uncomplicated falciparum malaria. The Kaplan–Meier 42-day PCR-adjusted cure rate was the primary outcome. A standardized parasite clearance estimator was used to assess delayed parasite clearance as surrogate maker of suspected artemisinin resistance. Results No early treatment failures were found in any of the study treatment arms. The day-42 PCR-adjusted cure rate estimates were 99.5, 98.4 and 99.0% in the AS–AQ, DHA–PPQ and AM–LM arms, respectively. The reinfection rate (expressed also as Kaplan–Meier estimates) was higher in the AM–LM arm (32.4%) than in the AS–AQ (13.8%) and the DHA–PPQ arm (24.9%). The parasite clearance rate constant was 0.27, 0.26 and 0.25 per hour for AS–AQ, DHA–PPQ and AM–LM, respectively. Conclusions All the three treatments evaluated largely meet WHO criteria (at least 95% efficacy). AS–AQ and AL–LM may continue to be used and DHA–PPQ may be also recommended as first-line treatment for uncomplicated falciparum malaria in Maradi. The parasite clearance rate were consistent with reference values indicating no suspected artemisinin resistance. Nevertheless, the monitoring of anti-malarial drug efficacy should continue. Trial registration details Registry number at ClinicalTrial.gov: NCT01755559