NICHOLAS SEELIGER, MD

Carrion’s disease

Epidemiology

Endemic in Andes mountains Peru, Columbia, and Ecuador “verruga zone”

Dependant on environmental requirements Vector is L verrucarum

Risk factors for infection Tourist Transient workers Children less than 5

Clinical Manifestations

Biphasic IllnessAcute febrile illness (Oroya fever)

40 percent mortality if untreated 3 weeks after inoculation Onset of mild fever, HA, anorexia, and malaise Anemia leading to

infectious and noninfectious complicationsChronic cutaneous phase (verruga peruana)

Lesions appear 2-8 weeks after fever Miliary, nodular, or mular lesions 2 months

Disease Diagnosis

Blood cultures Can be delayed 2 weeks Positive 10-15 % after acute phase

ID on Giemsa-stain blood smears skin biopsy

Serology Antibody testing

Immunoblot IFA

Disease Treatment

Prompt initiation of antimicrobial therapyOroya fever

Chloramphenicol + B-lactam agent Cipro

Verruga peruana Rifampin Streptomycin (best alternative)

Disease Transmission

Bartonella bacilliformis Transmitted by sandflies of genus

Phlebotomus

Worldwide Distribution

Andean Mountains Peru Ecuador Columbia

Prevention

Prevent transmission by blocking inoculationSkin protection

Repellant Protective clothing Bed netting

Disease Control

No vaccine availablePrevention focused on blocking inoculationCorrect identification of infection crucialAccurate reporting of infection required

Outbreaks

Cajamarca – 2002 80 % under age 18

Cusco – 1998 38.5 % age 6-14 Mortality = 23%

Aguaruna – 1992

References

Alexander B., A review of bartonellosis in Ecuador and Colombia. American J Tropical Medicine and Hygeine 1995; 52:354-9.

Chamberlin J, Laughlin LW, Romero S, et al. Epidemiology of endemic Bartonella bacilliformis: a prospective cohort study in a Peruvian mountain valley community. J Infect Dis 2002; 186:983.

Eremeeva ME, Gerns HL, Lydy SL, et al. Bacteremia, fever, and splenomegaly caused by a newly recognized bartonella species. N Engl J Med 2007; 356:2381.

Montoya M., Maguiña C., Vigo B., et al. Bartonellosis en el valle sagrado de los Incas (Cusco). Bol Soc Per Med Interna 1998;11:170-6.

Maguiña C. Bartonellosis o Enfermedad de Carrión, nuevos aspectos de una vieja enfermedad. A.F.A Editores Importadores SA, Lima-Peru, 1998.

Pachas P. La Bartonelosis en el Perú. Módulos Técnicos, Oficina General de Epidemiología – Instituto Nacional de Salud. Lima, 2000.