Bartonellosis

CASES/YEAR
0 (US); 5,000 (Global)
CATEGORY
Arthropod-Borne
AGENT TYPE
Bacteria
OTHER NAMES
Oroya fever; Verruga peruana; Bartonella bacilliformis; Carrion disease;
ACUITY
Subacute/Chronic
INCUBATION
2-3 weeks; occasionally 3-4 months
INITIAL SYMPTOMS
Irregular fever, flu-like symptoms, anemia, and lymphadenopathy; [CCDM]
PRECAUTIONS
No direct person-to-person transmission other than blood transfusion. [CCDM, p. 66]
COMMENTS
EPIDEMIOLOGY:
This infection is limited to mountain areas of Peru, Ecuador, and Columbia with an asymptomatic carrier rate as high as 5%. There are two syndromes: Oroya fever (fever and anemia) and Verruga peruana (benign verrucous skin lesions). Untreated Oroya fever has a case-fatality rate of 10% to 90%. Infection is transmitted by sandflies that bite between dusk and dawn. Transmission by blood transfusion has been reported. No animal reservoirs have been identified. [CCDM, p. 65-7] Death in Oroya fever is caused by hemolysis or opportunistic infections such as salmonellosis. No mortality from verruga peruana has been reported. [Cecil, p. 1968, 1970] For other Bartonella infections, see "Trench fever" and "Cat-scratch disease."

FINDINGS:
Oroya fever is characterized by flu-like symptoms, generalized lymphadenopathy, and life-threatening hemolytic anemia. Veruga peruana follows Oroya fever or an asymptomatic infection weeks to months earlier. A preeruptive stage of verruga peruana is marked by shifting pains in muscles, bones, and joints lasting minutes to several days. The eruptive stage includes hemangioma-like nodules most prominent on extensor surfaces of the limbs. The nodules may become ulcerated tumor-like masses. The course of verruga peruana is generally prolonged but not fatal. [CCDM, p. 65] Veruga peruana occurs weeks to months after untreated Oroya fever. [PPID, p. 2828] Fever and pain may accompany the appearance of a new crop of verruga peruana. [Merck Manual, p. 1579] Acute renal failure is a complication. [Guerrant, p. 266, 268]
DIAGNOSTIC
Blood culture on special media; Nonspecific histological stains; ELISA and direct immunofluorescence; Serology; PCR; [CCDM]
SCOPE
At altitudes of 600 to 2,800 meters in Peru, Ecuador, and southwest Columbia; In recent years, cases reported in lower altitudes and in coastal lowlands of Ecuador; [CCDM]
SIGNS & SYMPTOMS
  • >arthralgia
  • >fever
  • >myalgia
  • E nasal ulcers
  • E stomatitis
  • G abdominal pain
  • G hepatomegaly
  • G jaundice
  • G nausea, vomiting
  • H anemia
  • H hemolysis
  • H lymphadenopathy
  • H splenomegaly
  • H thrombocytopenia
  • N confusion, delirium
  • N headache
  • N lethargy
  • N seizure
  • R dyspnea
  • S papules or plaques
  • S skin or subcutaneous nodule
  • S ulcer of skin
  • S warty growth of the skin
  • *acute renal failure
  • *encephalitis
  • *meningitis
  • *myocarditis
  • *pericarditis
  • *stupor, coma
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Needle (Includes Drug Abuse), Scalpel or Transfusion
SOURCE
RESERVOIR
Human
RISK FACTORS
  • Have a blood transfusion
  • Travel to endemic area
REFERENCES FOR CASES/YEAR
1.
2. (Global) Oroya fever: most cases in visitors and tourists; Verruga peruana: native populations of Peru, Ecuador, and Columbia; [Gorbach, p. 90] This infection is limited to mountain areas of Peru, Ecuador, and Columbia with an asymptomatic carrier rate as high as 5%. [CCDM, p. 66] Guesstimate: 5% X mountain population of 100,000 = 5000;