Bartonellosis is a disease of humans caused by a hemo-trophic bacterium, Bartonella bacilliformis (Fig. 9.4), transmitted by sand flies. It occurs sporadically and in epidemics at 500-3000 m in the Andes mountain valleys of Peru, Ecuador, and Colombia and at low elevations in the coastal provinces of Ecuador. B. bacilliformis is a small, motile, aerobic, gram-negative coccobacillus which attaches to red blood cells and invades the endothelial cells of the human host.

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Verruga Peruana
FIGURE 9,4 Bartonella bacilliformis, causative agent of Orova fever and verruga peruana. (Courtesy of US Armed Forces Institute of Pathology, (AFIP) 75-8592.)
FIGURE 9.5 Verruga peruana, or Peruvian wart; nodutar lesions on hands and forearms of Peruvian patient. (From Young and Duncan, 1994.)

Bartonellosis occurs in two distinct clinical forms: an acute, febrile anemia {Oroya fever) and a chronic cutaneous eruption {verruga peruana or Peruvian wart). Bartonellosis is also known as Carrion's disease, named in honor of Daniel Akides Carrion, a Peruvian medical student who lost his life in 1885 proving that Oroya fever and verruga peruana are different manifestations of the same disease. Oroya fever often precedes verruga peruana by several weeks or months. It is characterized by fever, headache, muscle and joint pain, enlargement of the lymph nodes, weakness, anemia, pallor, and sometimes delirium and coma. The case-fatality rate of untreated Oroya fever is 10—40%. Verruga peruana has a pre-eruptive stage characterized by muscle, bone, and joint pain, which is followed by a disseminated or nodular eruption (Fig. 9.5). The lesions occur in clusters, usually on the face and limbs; they are typically wartlike, 0.2—4 cm in diameter, and sometimes can enlarge and ulcerate. Verruga peruana may persist for months or years but is seldom fatal.

The intrinsic incubation period of bartonellosis is usually 2—3 weeks. The agent appears in the blood before the onset of illness and may persist for years afterward. The vectors are believed to be L. verrucarum and L. columbiana. Reservoirs are unknown.

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