Bartonellosis is a bacterial infection of Peru, Ecuador, and Columbia. It is transmitted by sandflies and causes Oroya fever (fever and anemia) or Verruga peruana (benign wart-like skin lesions). Untreated Oroya fever has a case-fatality rate of 10% to 90%.
CASES/YEAR
0 (US); 5,000 (Global)
OTHER NAMES
Oroya fever; Verruga peruana; Bartonella bacilliformis; Carrion disease;
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
ENTRY
Needle (Includes Drug Abuse), Scalpel or Transfusion
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;