Carrion's disease
Oroya fever or Carrion's Disease is an infectious disease produced by Bartonella bacilliformis infection.
History
Carrion's disease has been known since Pre-Inca times. Numerous artistic representations in clay (called "huacos")of the chronic phase have been found in endemic areas. The spanish chronist, Garcilazo De La Vega described a disease with warts in spanish troops during the conquest of Inca Empire, in Coaque-Ecuador. During a long time was thought that the disease was endemic inly in Peru and that it had only one phase, the "peruvian wart" or "verruga peruana"[1]
In 1875 an outbreak, characterized by fever and anemia ("oroya fever") occurred in the region of construction of the railroad line between Lima and Oroya
In August 1885, Daniel Alcides Carrión, a Peruvian medical student, inoculated with the help of Evaristo Chavez the material taken from a verruga lesion of a patient in chroic phase (Carmen Paredes) and after 3 weeks developed classic symptoms of the acute phase of the disease, thus establishing a common source for these 2 diseases. He died from bartonellosis the October 5th, 1885 and was recognized like a martyr of peruvian medicine and the term Carrion´s disease was used until our times (peruvian medicine day is october 5th in honor to him).
Alberto Barton, a peruvian microbiologist, identified Bartonella bacilliformis within erythrocytes in 1905, an announced the discovery of the etiologic agent (Barton bacillus)in 1909, which was called Bartonella bacilliformis.
Etiologic agent
Epidemiology
Carrion's disease is found only in Peru, Ecuador, and Colombia.[2] It is Endemic in some areas of Peru,[3] and is caused by infection with the bacterium Bartonella bacilliformis and transmitted by sandflies of genus Lutzomyia.
Clinical signs and symptoms
The clinical symptoms of bartonellosis are pleomorphic and some patients from endemic areas may be asymptomatics. The two classical clinical presentations are the acute phase and the chronic phase, corresponding to the two different host cell types invaded by the bacterium (red blood cells and endothelial cells).
Acute phase: (Carrion´s disease) the most common findings are fever (usually sustained, but with temperature no greater that 39ºC), pallor, malaise, nonpainful hepatomegaly, jaundice, lymphadenopathy, splenomegaly.
This phase is characterized by severe hemolytic anemia and transient immunosuppression.
The case fatality ratios of untreated patients exceded 40% but reach around 90% when opportunistic infection with Salmonella spp occurs.
In a recent study the attack rate was 13.8% (123 cases) and the case-fatality rate was 0.7%.
Chronic phase:(Verruga Peruana or Peruvian Wart) it is characterized by an eruptive phase, in which the patients develop a cutaneus rash produced by a proliferation of endothelial cells and is known as "peruvian warts" or "verruga peruana". Depending of the size and characteristics of the lesions, there are three types: miliary (1-4 mm), nodular or subdermic and mular (>5mm). Miliary lesions are the most common.
The most common findings are bleeding of verrugas, fever, malaise, arthralgias, anorexia, myalgias, pallor, lymphadeopathy, and hepato-splenomegaly.
Diagnosis
For the diagnosis during the acute phase is used the thin blood film with Giemsa stain, Columbia-blood agar cultures, immunoblot, IFI, and PCR.
For the chronic phase is used blood culture, Warthin-Starry stain of wart biopsy, PCR, and immunoblot.
Treatment
The drug of choice during the acute phase is Quinolones or Chloramphenicol in adults and Chloramphenicol plus beta lactams in children. For the chronic phase Rifampin or macrolides are the drug of choice for adults and children
References
- ^ Maguiña, C., 1998. Bartonellosis o Enfermedad de Carrión. A.F.A. Editores Importadores S.A., Lima.
- ^ Maguina C, Garcia P, Gotuzzo E, Cordero L, Spach D. Bartonellosis (Carrion’s Disease)in the Modern Era. CID 2001;33:772-779
- ^ Maco V, Maguiña C, Tirado A, Maco V, Vidal JE (2004). "Carrion's disease (Bartonellosis bacilliformis) confirmed by histopathology in the High Forest of Peru". Rev. Inst. Med. Trop. Sao Paulo. 46 (3): 171–4. doi:/S0036-46652004000300010. PMID 15286824.
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