Infections with Bartonella bacilliformis result in Carrion's disease. The Bartonella organisms can cause hemolytic fever ("Oroya fever") with fatality rates as high as 90%.
The early phase is followed by a chronic phase (eruptive phase or tissue phase) in which angiogenic skin lesions (verruga peruana or Peruvian warts) may appear.
Carrion's disease is named after Daniel Alcides Carrión.
Bartonella bacilliformis is mainly found in South American (Andean valley) and a few other areas. It is known to be transmitted by sand flies (Lutzomyia spp.) and possibly other vectors such as ticks.
QUOTE- "Noguchi suggested already in 1926 that ticks might represent possible vectors for B. bacilliformis as he demonstrated that B. bacilliformis was transmitted by bites of Dermacentor andersoni from two experimentally-infected to two healthy Macacus rhesusmonkeys [29].
In a recent study, B. bacilliformis DNA was detected in ticks (Amblyommaspp. and Rhipicephalus microplus) collected from Tapirus terrestris and Pecari tajacu from Madre de Dios (Peru) suggesting that ticks might be at least considered as potential vectors for B. bacilliformis [30]." Source
Symptoms- severe illness, mild or asymptomatic illness or chronic asymptomatic bacteremia [3]. plethora of symptoms including headache, muscle aches, and general abdominal pain. fever, hemolytic anemia, pallor, myalgia, anorexia, tachycardia and hepatomegaly
pale appearance, malaise, painless liver enlargement, jaundice, enlarged lymph nodes, and enlarged spleen. (Wiki)
with an immune-compromised state that facilitates secondary infections such as Toxoplasma gondii myocarditis or bacteremia with Staphylococcus aureus or Salmonella enterica
Under all human pathogenic bacteria, only the family of Bartonella has the ability to trigger angiogenic disease entities (B. bacilliformis: verruga peruana; B. henselae, B. quintana: bacillary angiomatosis, peliosis hepatis [10]).
heart murmurs due to the disease's impact on the circulatory system. In children, symptoms of anorexia, nausea, and vomiting have been investigated as possible symptoms of the disease.
t is suggested that the abnormal endothelial cell proliferation is induced by a chronic Bartonella-infection in which the bacteria are included into vacuoles inside the capillary endothelium. Peruvian warts are mostly found on the head and extremities persisting from weeks to months.
In a study focusing on pediatric and gestational effects of the disease, mortality rates for pregnant women with the acute phase were estimated at 40% and rates of spontaneous abortion in another 40%.
Chronic- The lesions often ulcerate and bleed. The most common findings are bleeding of verrugas, fever, malaise, arthralgias (joint pain), anorexia, myalgias, pallor, lymphadenopathy, and liver and spleen enlargement.
Mortality is often thought to be due to subsequent infections due to the weakened immune symptoms and opportunistic pathogen invasion, or consequences of malnutrition due to weight loss in children.
mortality has been estimated as low as just 1% in studies of hospitalized patients, to as high as 88% in untreated, unhospitalized patients.
Diagnosis- Diagnosis during the acute phase can be made by obtaining a peripheral blood smear with Giemsa stain, Columbia blood agar cultures, immunoblot, indirect immunofluorescence, and PCR. Diagnosis during the chronic phase can be made using a Warthin-Starry stain of wart biopsy, PCR, and immunoblot.
Treatment-
Because Carrion's disease is often comorbid with Salmonella infections, chloramphenicol has historically been the treatment of choice.[5]
Fluoroquinolones (such as ciprofloxacin) or chloramphenicol in adults and chloramphenicol plus beta-lactams in children are the antibioticregimens of choice during the acute phase of Carrion's disease.[5] Chloramphenicol-resistant B. bacilliformis has been observed.[2][5]
During the eruptive phase, in which chloramphenicol is not useful, azithromycin, erythromycin, and ciprofloxacin have been used successfully for treatment. Rifampin or macrolides are also used to treat both adults and children.[2][5]
Because of the high rates of comorbid infections and conditions, multiple treatments are often required. These have included the use of corticosteroids for respiratory distress, red blood cell transfusions for anemia, pericardiectomies for pericardial tamponades, and other standard treatments." (WIKI)
2019- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434794/
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2019- QUOTE- "Recently, bloodstream infections with various Bartonella spp. have been documented in nonimmunocompromised individuals in association with a spectrum of cardiovascular, neurologic, and rheumatologic symptoms.
Serial serologic and molecular microbiological findings supported exposure to or infection with Bartonella spp. in all seven family members. " Source