Bartonellosis
Encyclopedia
Bartonellosis is an infectious disease
produced by bacteria
of the genus
Bartonella
. Bartonella
species cause diseases such as Carrión´s disease
, trench fever
, and cat scratch disease
, and other recognized diseases, such as bacillary angiomatosis
, peliosis hepatis
, chronic bacteremia
, endocarditis
, chronic lymphadenopathy
, and neurological disorders.
from Cerro de Pasco
, Peru
. Carrión described the disease after being inoculated on his request by Doctor Evaristo M. Chávez, a close friend and coworker in Dos de Mayo National Hospital. Carrión kept a meticulous clinical history until the disease rendered him incapable of so doing. Carrión proved that "Oroya fever" and "Verruga Peruana" were two stages of the same disease, not two different diseases as thought at the time.
Carrión was inoculated with the pus of the purple lesion from a patient (Carmen Paredes) in 1885. He developed the disease 3 weeks after the inoculation and died several weeks later. Bartonella bacilliformis
is considered the most deadly bartonella to date, with a death rate of up to 90% during the acute phase. His sacrifice demonstrated the connection between the 2 phases of the disease. Subsequently, 23 subspecies of bartonella were discovered. His work did not result in a cure at that time, but his research started the process. Peru named 5 October as Peruvian Medicine Day in his honor.
Peruvian microbiologist Alberto Barton
discovered the causative bacterial agent of bartonellosis in 1905, but his results were not published until 1909. Barton originally identified them as endoglobular structures, bacteria living inside red blood cells. Until 1993, the Bartonella genus
contained only one species; there are now 23 identified species, all of them within family Bartonellaceae.
, reported in 1992. In 1993 Dolan and col isolated Rochalimae henselae (now called Bartonella henselae
) from the lymph nodes of patients with CSD. Also, Bartonella henselae
was associated bacteremia, bacillary angiomatosis, and peliosis hepatis in HIV
patients, and bacteremia and endocarditis in immunocompetent and immunocompromised patients.
. Also known as 5-day fever or quintan fever or Wolhinie fever. This disease is also known as "urban trench fever" because it is described in homeless and alcoholic people.
Bartonella spp. is commonly treated with antibiotics including rifampin and azithromyacin and treatment may take up to one year to completely eliminate the disease.
, or Oroya fever, or Peruvian Wart is a rare infectious disease
found only in Peru
, Ecuador
, and Colombia
. It is endemic
in some areas of Peru
, and is caused by infection with the bacterium Bartonella bacilliformis
and transmitted by sandflies
of genus
Lutzomyia
.
Cat scratch disease
is a worldwide disease. Cats are the main reservoir of Bartonella henselae
(etiologic agent), and the bacterium is transmitted to cats by the cat flea Ctenocephalides felis.
Trench fever
is produced by Bartonella quintana
infection, and the bacterium is transmitted by the human body louse Pediculus humanus corporis. Humans are the only known reservoir.
In November 2011, Bartonella rochalimae
, B. quintana
, and B. elizabethae DNA was first reported in Rhipicephalus sanguineus
and Dermacentor nitens ticks in Peru; a possible role for ticks in transmission of Bartonella species remains to be elucidated.
. Bartonella also have a tropism for endothelial cells, observed in the chronic phase of Carrión´s disease
(also known as Verruga Peruana) and bacillary angiomatosis
.
Pathological response can vary with the immune status of the host. Infection with Bartonella henselae
can result in a focal suppurative reaction (CSD in immunocompetent patients), a multifocal angioproliferative response (bacillary angiomatosis
in immunocompromised patients), endocarditis
or meningitis
.
Some of the diseases can resolve spontaneously without treatment.
(eruptive) phase associated with skin
eruptions. In the acute phase (also known as Oroya fever or Fiebre de la Oroya), Bartonella bacilliformis
infection is a sudden, potentially life-threatening infection associated with high fever
and decreased levels of circulating red blood cell
s (i.e., hemolytic anemia
)and transient immunosuppression. The acute phase typically lasts two-to-four weeks. Peripheral blood smears shows anisomacrocytosis with many bacilli
adherent to red blood cells. Thrombocytopenia
is also seen and can be very severe. Neurologic involvement is sometimes seen (neurobartonellosis) and the prognosis
in this case is very guarded. It can present as spinal meningitis
or as paralysis
. In the acute stage, the most feared complication is overwhelming infections by mainly enterobacterias, Salmonella
, and other parasites such as Toxoplasmosis
.
The chronic manifestation—Verruga Peruana—consists of a benign
skin eruption with raised, reddish-purple nodule
s (angiomatous tumours
). Visualization of the bacterium is possible using a silver stain
(the Warthin–Starry method) of biopsy .
, neck
) and a distal scratch
and/or red-brown skin papule
(not always seen at the time of the disease). The enlarged lymph node is painful and tender. The Bartonella henselae
infection is self-limited and the lymph nodes compromise last 2–3 months or longer. The lymph nodes may suppurate and most patients can remain afebrile or asymptomatic. Atypical presentations include Unknown Origin Fever
, Parinaud's oculoglandular syndrome, encephalopathy
and neuroretinitis.
infection. Clinical manifestations range from asymptomatic infection to severe illness. Classical presentation include a febrile illness of acute onset, headache
, dizziness
and shin
pain. Chronic infection manifestation include attacks of fever and aching in some cases and persistent bacteremia in soldiers and homeless people. Lice, rather than cat exposure, are thought to be the mode of transmission and extensive washing of clothing may have a role in breaking the cycle of infection.
proliferative disease involving mainly the skin, and other organs. The disease was first described in Human Immunodificiency Virus (HIV
)patients and organ transplant
recipients. Severe, progressive and disseminated disease may occur in HIV patients. Differential diagnosis include Kaposi
´s sarcoma, pyogenic granuloma
, hemangioma
, Verruga peruana
, subcutanous tumors. Lesions can affect bone marrow
, liver
, spleen
or lymph nodes. Bartonella henselae
and Bartonella quintana
can cause bacillary angiomatosis
.
is recognized as the etiologic agent in HIV
patients and organ transplant recipients. Peliosis hepatis can be associated by peliosis of the spleen, as well as bacillary angiomatosis
of the skin in HIV
patients.
species.
While some authorities recommend the use of azithromycin
, it's difficult to gauge what, if any significant benefit, is afforded given the often self-limiting course in patients with intact immune function.
Infectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...
produced by bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
of the genus
Genus
In biology, a genus is a low-level taxonomic rank used in the biological classification of living and fossil organisms, which is an example of definition by genus and differentia...
Bartonella
Bartonella
Bartonella is a genus of Gram-negative bacteria. Facultative intracellular parasites, Bartonella species can infect healthy people but are considered especially important as opportunistic pathogens. Bartonella are transmitted by insect vectors such as ticks, fleas, sand flies and mosquitoes...
. Bartonella
Bartonella
Bartonella is a genus of Gram-negative bacteria. Facultative intracellular parasites, Bartonella species can infect healthy people but are considered especially important as opportunistic pathogens. Bartonella are transmitted by insect vectors such as ticks, fleas, sand flies and mosquitoes...
species cause diseases such as Carrión´s disease
Carrion's disease
Oroya fever or Carrion's Disease is an infectious disease produced by Bartonella bacilliformis infection.It is named for Daniel Alcides Carrión.-History:...
, trench fever
Trench fever
Trench fever is a moderately serious disease transmitted by body lice. It infected armies in Flanders, France, Poland, Galicia, Italy, Salonika, Macedonia, Mesopotamia, and Egypt in World War I Trench fever (also known as "Five day fever", "Quintan fever" (febris Quintana in Latin), "Urban trench...
, and cat scratch disease
Cat scratch disease
Cat scratch disease is a usually benign infectious disease caused by the intracellular bacterium Bartonella. It is most commonly found in children following a scratch or bite from a cat by about one to two weeks...
, and other recognized diseases, such as bacillary angiomatosis
Bacillary angiomatosis
Bacillary angiomatosis is a form of angiomatosis associated with bacteria of the Bartonella genus.-Causes:It is caused by either Bartonella henselae or Bartonella quintana....
, peliosis hepatis
Peliosis hepatis
Peliosis Hepatis is an uncommon vascular condition characterised by randomly distributed multiple blood-filled cavities throughout the liver. The size of the cavities usually ranges between a few millimetres to 3 cm in diameter...
, chronic bacteremia
Bacteremia
Bacteremia is the presence of bacteria in the blood. The blood is normally a sterile environment, so the detection of bacteria in the blood is always abnormal....
, endocarditis
Endocarditis
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices...
, chronic lymphadenopathy
Lymphadenopathy
Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". It could be due to infection, auto-immune disease, or malignancy....
, and neurological disorders.
Carrión's disease
The disease was named after a medical student Daniel Alcides CarriónDaniel Alcides Carrión
Daniel Alcides Carrión García was a Peruvian medical student after whom Carrion's disease is named. He described the disease in the course of what proved to be a fatal experiment upon himself in 1885, in order to demonstrate definitively the cause of the illness...
from Cerro de Pasco
Cerro de Pasco
Cerro de Pasco is a city in central Peru. It is the capital of the Pasco region, and an important mining center. It is connected by road and by rail to the city of Lima.- Overview :...
, Peru
Peru
Peru , officially the Republic of Peru , is a country in western South America. It is bordered on the north by Ecuador and Colombia, on the east by Brazil, on the southeast by Bolivia, on the south by Chile, and on the west by the Pacific Ocean....
. Carrión described the disease after being inoculated on his request by Doctor Evaristo M. Chávez, a close friend and coworker in Dos de Mayo National Hospital. Carrión kept a meticulous clinical history until the disease rendered him incapable of so doing. Carrión proved that "Oroya fever" and "Verruga Peruana" were two stages of the same disease, not two different diseases as thought at the time.
Carrión was inoculated with the pus of the purple lesion from a patient (Carmen Paredes) in 1885. He developed the disease 3 weeks after the inoculation and died several weeks later. Bartonella bacilliformis
Bartonella bacilliformis
Bartonella bacilliformis is a proteobacterium, Gram negative aerobic, pleomorphic, flagellated, motile, coccobacillary, 2–3 μm large and 0.2–0.5 μm wide and facultative intracellular bacterium.-History:...
is considered the most deadly bartonella to date, with a death rate of up to 90% during the acute phase. His sacrifice demonstrated the connection between the 2 phases of the disease. Subsequently, 23 subspecies of bartonella were discovered. His work did not result in a cure at that time, but his research started the process. Peru named 5 October as Peruvian Medicine Day in his honor.
Peruvian microbiologist Alberto Barton
Alberto Barton
Alberto Barton, was a Peruvian microbiologist who discovered the etiologic agent of Carrion´s disease or Oroya fever. The bacteria was named: Bartonella bacilliformis, in his honor.-Youth and education:...
discovered the causative bacterial agent of bartonellosis in 1905, but his results were not published until 1909. Barton originally identified them as endoglobular structures, bacteria living inside red blood cells. Until 1993, the Bartonella genus
Genus
In biology, a genus is a low-level taxonomic rank used in the biological classification of living and fossil organisms, which is an example of definition by genus and differentia...
contained only one species; there are now 23 identified species, all of them within family Bartonellaceae.
Cat scratch disease
In 1988, English et al. isolated and cultured a bacterium that was named Afipia felis in 1992. This agent was considered the etiologic agent of Cat Scratch Disease (CSD) but further studies failed to support this conclusion. Serologic studies associated CSD with Bartonella henselaeBartonella henselae
Bartonella henselae, formerly Rochalimæa, is a proteobacterium that can cause bacteremia, endocarditis, bacillary angiomatosis, and peliosis hepatis. It is also the causative agent of cat-scratch disease which, as the name suggests, occurs after a cat bite or scratch...
, reported in 1992. In 1993 Dolan and col isolated Rochalimae henselae (now called Bartonella henselae
Bartonella henselae
Bartonella henselae, formerly Rochalimæa, is a proteobacterium that can cause bacteremia, endocarditis, bacillary angiomatosis, and peliosis hepatis. It is also the causative agent of cat-scratch disease which, as the name suggests, occurs after a cat bite or scratch...
) from the lymph nodes of patients with CSD. Also, Bartonella henselae
Bartonella henselae
Bartonella henselae, formerly Rochalimæa, is a proteobacterium that can cause bacteremia, endocarditis, bacillary angiomatosis, and peliosis hepatis. It is also the causative agent of cat-scratch disease which, as the name suggests, occurs after a cat bite or scratch...
was associated bacteremia, bacillary angiomatosis, and peliosis hepatis in HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
patients, and bacteremia and endocarditis in immunocompetent and immunocompromised patients.
Trench fever
Detailed descriptions of the disease were reported in soldiers during the First World WarWorld War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
. Also known as 5-day fever or quintan fever or Wolhinie fever. This disease is also known as "urban trench fever" because it is described in homeless and alcoholic people.
Bartonella spp. bacteremia
Several new related species of bartonella were noted in the 1990s by veterinarians as a new infectious agent of animals and humans. Bartonella infection in cats is very common with a prevalence estimated between 40-60%.Link Cats are usually immune to the infection while dogs are very symptomatic. The illness is blood born, affecting monocytes, and humans acquire it through flea or tick bites from infected dogs, cats, coyotes, foxes and humans. Once bitten the victim develops a localized infection. The first sign of infection is a raised skin papule which resolves on its own. As the illness progresses the symptoms develop including: fatigue, headaches, memory loss, disorientation, insomnia and loss of coordination. The bacteria blocks the normal immune response by suppressing the NF-KB apoptosis pathway.Link Disease progression will be accelerated if the host is subsequently infected by an immunesuppressing virus such as Epstein Barr or XMRV and likewise, as the host's infectious load increases the immune system will be more prone to infection due to the weakening response.Bartonella spp. is commonly treated with antibiotics including rifampin and azithromyacin and treatment may take up to one year to completely eliminate the disease.
Epidemiology
Carrión's diseaseCarrion's disease
Oroya fever or Carrion's Disease is an infectious disease produced by Bartonella bacilliformis infection.It is named for Daniel Alcides Carrión.-History:...
, or Oroya fever, or Peruvian Wart is a rare infectious disease
Infectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...
found only in Peru
Peru
Peru , officially the Republic of Peru , is a country in western South America. It is bordered on the north by Ecuador and Colombia, on the east by Brazil, on the southeast by Bolivia, on the south by Chile, and on the west by the Pacific Ocean....
, Ecuador
Ecuador
Ecuador , officially the Republic of Ecuador is a representative democratic republic in South America, bordered by Colombia on the north, Peru on the east and south, and by the Pacific Ocean to the west. It is one of only two countries in South America, along with Chile, that do not have a border...
, and Colombia
Colombia
Colombia, officially the Republic of Colombia , is a unitary constitutional republic comprising thirty-two departments. The country is located in northwestern South America, bordered to the east by Venezuela and Brazil; to the south by Ecuador and Peru; to the north by the Caribbean Sea; to the...
. It is endemic
Endemic (epidemiology)
In epidemiology, an infection is said to be endemic in a population when that infection is maintained in the population without the need for external inputs. For example, chickenpox is endemic in the UK, but malaria is not...
in some areas of Peru
Peru
Peru , officially the Republic of Peru , is a country in western South America. It is bordered on the north by Ecuador and Colombia, on the east by Brazil, on the southeast by Bolivia, on the south by Chile, and on the west by the Pacific Ocean....
, and is caused by infection with the bacterium Bartonella bacilliformis
Bartonella bacilliformis
Bartonella bacilliformis is a proteobacterium, Gram negative aerobic, pleomorphic, flagellated, motile, coccobacillary, 2–3 μm large and 0.2–0.5 μm wide and facultative intracellular bacterium.-History:...
and transmitted by sandflies
Sandfly
thumb|Sandfly biting a human's little fingerthumb|Sandfly biteSandfly is a colloquial name for any species or genus of flying, biting, blood-sucking Dipteran encountered in sandy areas...
of genus
Genus
In biology, a genus is a low-level taxonomic rank used in the biological classification of living and fossil organisms, which is an example of definition by genus and differentia...
Lutzomyia
Lutzomyia
Lutzomyia is a genus of "sand flies" in the Psychodidae subfamily Phlebotominae and in the order Diptera. In the New World, Lutzomyia sand flies are responsible for the transmission of leishmaniasis, an important parasitic disease and Carrion's disease. Leishmaniasis is generally transmitted in...
.
Cat scratch disease
Cat scratch disease
Cat scratch disease is a usually benign infectious disease caused by the intracellular bacterium Bartonella. It is most commonly found in children following a scratch or bite from a cat by about one to two weeks...
is a worldwide disease. Cats are the main reservoir of Bartonella henselae
Bartonella henselae
Bartonella henselae, formerly Rochalimæa, is a proteobacterium that can cause bacteremia, endocarditis, bacillary angiomatosis, and peliosis hepatis. It is also the causative agent of cat-scratch disease which, as the name suggests, occurs after a cat bite or scratch...
(etiologic agent), and the bacterium is transmitted to cats by the cat flea Ctenocephalides felis.
Trench fever
Trench fever
Trench fever is a moderately serious disease transmitted by body lice. It infected armies in Flanders, France, Poland, Galicia, Italy, Salonika, Macedonia, Mesopotamia, and Egypt in World War I Trench fever (also known as "Five day fever", "Quintan fever" (febris Quintana in Latin), "Urban trench...
is produced by Bartonella quintana
Bartonella quintana
Bartonella quintana, originally known as Rochalimaea quintana, and "Rickettsia quintana", is a microorganism that is transmitted by the human body louse. This microorganism is the caustative agent of trench fever...
infection, and the bacterium is transmitted by the human body louse Pediculus humanus corporis. Humans are the only known reservoir.
In November 2011, Bartonella rochalimae
Bartonella rochalimae
Bartonella rochalimae is a recently discovered strain of Gram-negative bacteria in the Bartonella genus, isolated by researchers at the University of California at San Francisco , Massachusetts General Hospital, and the United States Centers for Disease Control and Prevention...
, B. quintana
Bartonella quintana
Bartonella quintana, originally known as Rochalimaea quintana, and "Rickettsia quintana", is a microorganism that is transmitted by the human body louse. This microorganism is the caustative agent of trench fever...
, and B. elizabethae DNA was first reported in Rhipicephalus sanguineus
Rhipicephalus sanguineus
The brown dog tick, Rhipicephalus sanguineus, is a species of tick which is found world-wide, but more commonly in warmer climates. This species is unusual among ticks in that its entire life cycle can be completed indoors.-Hosts:...
and Dermacentor nitens ticks in Peru; a possible role for ticks in transmission of Bartonella species remains to be elucidated.
Microbiology
Members of the genus Bartonella are facultative intracellular bacteria, alpha 2 subgroup Proteobacteria. The genus comprises:| Bartonella species | Reservoir | Disease |
|---|---|---|
| Bartonella bacilliformis Bartonella bacilliformis Bartonella bacilliformis is a proteobacterium, Gram negative aerobic, pleomorphic, flagellated, motile, coccobacillary, 2–3 μm large and 0.2–0.5 μm wide and facultative intracellular bacterium.-History:... |
human | Carrion´s disease/Verruga peruana Verruga peruana Verruga peruana is the chronic delayed stage of infection by Bartonella bacilliformis.... |
| Bartonella quintana Bartonella quintana Bartonella quintana, originally known as Rochalimaea quintana, and "Rickettsia quintana", is a microorganism that is transmitted by the human body louse. This microorganism is the caustative agent of trench fever... |
human | Trench fever Trench fever Trench fever is a moderately serious disease transmitted by body lice. It infected armies in Flanders, France, Poland, Galicia, Italy, Salonika, Macedonia, Mesopotamia, and Egypt in World War I Trench fever (also known as "Five day fever", "Quintan fever" (febris Quintana in Latin), "Urban trench... , bacteremia Bacteremia Bacteremia is the presence of bacteria in the blood. The blood is normally a sterile environment, so the detection of bacteria in the blood is always abnormal.... , bacillary angiomatosis Bacillary angiomatosis Bacillary angiomatosis is a form of angiomatosis associated with bacteria of the Bartonella genus.-Causes:It is caused by either Bartonella henselae or Bartonella quintana.... , endocarditis Endocarditis Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices... |
| Bartonella henselae Bartonella henselae Bartonella henselae, formerly Rochalimæa, is a proteobacterium that can cause bacteremia, endocarditis, bacillary angiomatosis, and peliosis hepatis. It is also the causative agent of cat-scratch disease which, as the name suggests, occurs after a cat bite or scratch... |
cats | Cat scratch disease Cat scratch disease Cat scratch disease is a usually benign infectious disease caused by the intracellular bacterium Bartonella. It is most commonly found in children following a scratch or bite from a cat by about one to two weeks... , bacillary angiomatosis Bacillary angiomatosis Bacillary angiomatosis is a form of angiomatosis associated with bacteria of the Bartonella genus.-Causes:It is caused by either Bartonella henselae or Bartonella quintana.... , bacteremia Bacteremia Bacteremia is the presence of bacteria in the blood. The blood is normally a sterile environment, so the detection of bacteria in the blood is always abnormal.... , endocarditis Endocarditis Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices... |
| Bartonella elizabethae | rats | Endocarditis Endocarditis Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices... |
| Bartonella grahamii | Retinitis | |
| Bartonella vinsoni | dogs | Endocarditis Endocarditis Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices... , bacteremia Bacteremia Bacteremia is the presence of bacteria in the blood. The blood is normally a sterile environment, so the detection of bacteria in the blood is always abnormal.... |
| Bartonella washonsis | rodents | Myocarditis Myocarditis Myocarditis is inflammation of heart muscle . It resembles a heart attack but coronary arteries are not blocked.Myocarditis is most often due to infection by common viruses, such as parvovirus B19, less commonly non-viral pathogens such as Borrelia burgdorferi or Trypanosoma cruzi, or as a... |
| Bartonella clarridgiae | cats | Bacteremia Bacteremia Bacteremia is the presence of bacteria in the blood. The blood is normally a sterile environment, so the detection of bacteria in the blood is always abnormal.... |
| Bartonella rochalimae Bartonella rochalimae Bartonella rochalimae is a recently discovered strain of Gram-negative bacteria in the Bartonella genus, isolated by researchers at the University of California at San Francisco , Massachusetts General Hospital, and the United States Centers for Disease Control and Prevention... |
human | Carrion´s disease like syndrome |
Pathophysiology
In mammals, each Bartonella species is highly adapted to its reservoir host as the result of intracellular parasitism and can persist in the bloodstream of the host. Intraerythrocytic parasitism is only observed in the acute phase of Carrión´s diseaseCarrion's disease
Oroya fever or Carrion's Disease is an infectious disease produced by Bartonella bacilliformis infection.It is named for Daniel Alcides Carrión.-History:...
. Bartonella also have a tropism for endothelial cells, observed in the chronic phase of Carrión´s disease
Carrion's disease
Oroya fever or Carrion's Disease is an infectious disease produced by Bartonella bacilliformis infection.It is named for Daniel Alcides Carrión.-History:...
(also known as Verruga Peruana) and bacillary angiomatosis
Bacillary angiomatosis
Bacillary angiomatosis is a form of angiomatosis associated with bacteria of the Bartonella genus.-Causes:It is caused by either Bartonella henselae or Bartonella quintana....
.
Pathological response can vary with the immune status of the host. Infection with Bartonella henselae
Bartonella henselae
Bartonella henselae, formerly Rochalimæa, is a proteobacterium that can cause bacteremia, endocarditis, bacillary angiomatosis, and peliosis hepatis. It is also the causative agent of cat-scratch disease which, as the name suggests, occurs after a cat bite or scratch...
can result in a focal suppurative reaction (CSD in immunocompetent patients), a multifocal angioproliferative response (bacillary angiomatosis
Bacillary angiomatosis
Bacillary angiomatosis is a form of angiomatosis associated with bacteria of the Bartonella genus.-Causes:It is caused by either Bartonella henselae or Bartonella quintana....
in immunocompromised patients), endocarditis
Endocarditis
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices...
or meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...
.
Some of the diseases can resolve spontaneously without treatment.
Carrión's disease
Patients can develop two clinical phases: an acute (hematic) stage and a chronicChronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
(eruptive) phase associated with skin
Dermatology
Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
eruptions. In the acute phase (also known as Oroya fever or Fiebre de la Oroya), Bartonella bacilliformis
Bartonella bacilliformis
Bartonella bacilliformis is a proteobacterium, Gram negative aerobic, pleomorphic, flagellated, motile, coccobacillary, 2–3 μm large and 0.2–0.5 μm wide and facultative intracellular bacterium.-History:...
infection is a sudden, potentially life-threatening infection associated with high fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
and decreased levels of circulating red blood cell
Red blood cell
Red blood cells are the most common type of blood cell and the vertebrate organism's principal means of delivering oxygen to the body tissues via the blood flow through the circulatory system...
s (i.e., hemolytic anemia
Hemolytic anemia
Hemolytic anemia is a form of anemia due to hemolysis, the abnormal breakdown of red blood cells , either in the blood vessels or elsewhere in the human body . It has numerous possible causes, ranging from relatively harmless to life-threatening...
)and transient immunosuppression. The acute phase typically lasts two-to-four weeks. Peripheral blood smears shows anisomacrocytosis with many bacilli
Bacilli
Bacilli refers to a taxonomic class of bacteria. It includes two orders, Bacillales and Lactobacillales, which contain several well-known pathogens like Bacillus anthracis .-Ambiguity:...
adherent to red blood cells. Thrombocytopenia
Thrombocytopenia
Thrombocytopenia is a relative decrease of platelets in blood.A normal human platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. These limits are determined by the 2.5th lower and upper percentile, so values outside this range do not necessarily indicate disease...
is also seen and can be very severe. Neurologic involvement is sometimes seen (neurobartonellosis) and the prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
in this case is very guarded. It can present as spinal meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...
or as paralysis
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
. In the acute stage, the most feared complication is overwhelming infections by mainly enterobacterias, Salmonella
Salmonella
Salmonella is a genus of rod-shaped, Gram-negative, non-spore-forming, predominantly motile enterobacteria with diameters around 0.7 to 1.5 µm, lengths from 2 to 5 µm, and flagella which grade in all directions . They are chemoorganotrophs, obtaining their energy from oxidation and reduction...
, and other parasites such as Toxoplasmosis
Toxoplasmosis
Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii. The parasite infects most genera of warm-blooded animals, including humans, but the primary host is the felid family. Animals are infected by eating infected meat, by ingestion of feces of a cat that has itself...
.
The chronic manifestation—Verruga Peruana—consists of a benign
Benign
A benign tumor is a tumor that lacks the ability to metastasize. Common examples of benign tumors include moles and uterine fibroids.The term "benign" implies a mild and nonprogressive disease. Indeed, many kinds of benign tumors are harmless to human health...
skin eruption with raised, reddish-purple nodule
Nodule (medicine)
For use of the term nodule in dermatology, see Nodule In medicine, a nodule refers to a relatively hard, roughly spherical abnormal structure....
s (angiomatous tumours
Angioma
Angiomas are benign tumors derived from cells of the vascular or lymphatic vessel walls or derived from cells of the tissues surrounding these vessels....
). Visualization of the bacterium is possible using a silver stain
Silver stain
Silver staining is the use of silver to selectively alter the appearance of the target.-Use in medicine:It is used to stain histologic sections. This kind of staining is important especially to show proteins and DNA. It is used to show both substances inside and outside cells...
(the Warthin–Starry method) of biopsy .
Cat scratch disease
Cat scratch disease is manifested by gradual regional lymph nodes enlargement (axilla, groinGroin
In human anatomy, the groin areas are the two creases at the junction of the torso with the legs, on either side of the pubic area. This is also known as the medial compartment of the thigh. A pulled groin muscle usually refers to a painful injury sustained by straining the hip adductor muscles...
, neck
Neck
The neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates, that distinguishes the head from the torso or trunk. The adjective signifying "of the neck" is cervical .-Boner anatomy: The cervical spine:The cervical portion of the human spine comprises seven boney...
) and a distal scratch
Scratch
Scratch may refer to:* A mark or indentation on a surface: Abrasion It may also refer to:- Recordings :* Scratch , by Kaela Kimura* Scratch , the soundtrack to the 2001 documentary Scratch...
and/or red-brown skin papule
Papule
A papule is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to 1 cm.With regard to the quote "...varying in size from a pinhead to 1cm," depending on which text is referenced, some authors state the cutoff between a papule and a plaque as 0.5cm,...
(not always seen at the time of the disease). The enlarged lymph node is painful and tender. The Bartonella henselae
Bartonella henselae
Bartonella henselae, formerly Rochalimæa, is a proteobacterium that can cause bacteremia, endocarditis, bacillary angiomatosis, and peliosis hepatis. It is also the causative agent of cat-scratch disease which, as the name suggests, occurs after a cat bite or scratch...
infection is self-limited and the lymph nodes compromise last 2–3 months or longer. The lymph nodes may suppurate and most patients can remain afebrile or asymptomatic. Atypical presentations include Unknown Origin Fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
, Parinaud's oculoglandular syndrome, encephalopathy
Encephalopathy
Encephalopathy means disorder or disease of the brain. In modern usage, encephalopathy does not refer to a single disease, but rather to a syndrome of global brain dysfunction; this syndrome can be caused by many different illnesses.-Terminology:...
and neuroretinitis.
Trench fever
Trench fever, also known as 5-day fever or quintan fever is the initial manifestation of Bartonella quintanaBartonella quintana
Bartonella quintana, originally known as Rochalimaea quintana, and "Rickettsia quintana", is a microorganism that is transmitted by the human body louse. This microorganism is the caustative agent of trench fever...
infection. Clinical manifestations range from asymptomatic infection to severe illness. Classical presentation include a febrile illness of acute onset, headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
, dizziness
Dizziness
Dizziness refers to an impairment in spatial perception and stability. The term is somewhat imprecise. It can be used to mean vertigo, presyncope, disequilibrium, or a non-specific feeling such as giddiness or foolishness....
and shin
Tibia
The tibia , shinbone, or shankbone is the larger and stronger of the two bones in the leg below the knee in vertebrates , and connects the knee with the ankle bones....
pain. Chronic infection manifestation include attacks of fever and aching in some cases and persistent bacteremia in soldiers and homeless people. Lice, rather than cat exposure, are thought to be the mode of transmission and extensive washing of clothing may have a role in breaking the cycle of infection.
Bacillary Angiomatosis
Bacillary Angiomatosis is a vascularBlood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
proliferative disease involving mainly the skin, and other organs. The disease was first described in Human Immunodificiency Virus (HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
)patients and organ transplant
Organ transplant
Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be...
recipients. Severe, progressive and disseminated disease may occur in HIV patients. Differential diagnosis include Kaposi
Kaposi
Kaposi can refer to:* Moritz Kaposi, a Hungarian physicist and dermatologist* Kaposi's sarcoma, a disease named for Kaposi...
´s sarcoma, pyogenic granuloma
Granuloma
Granuloma is a medical term for a tiny collection of immune cells known as macrophages. Granulomas form when the immune system attempts to wall off substances that it perceives as foreign but is unable to eliminate. Such substances include infectious organisms such as bacteria and fungi as well as...
, hemangioma
Hemangioma
A hemangioma of infancy is a benign self-involuting tumor of endothelial cells, the cells that line blood vessels. It usually appears during the first weeks of life and sometimes resolves by age 10. In more severe case hemangioma may have permanency, if not treated by a physician...
, Verruga peruana
Verruga peruana
Verruga peruana is the chronic delayed stage of infection by Bartonella bacilliformis....
, subcutanous tumors. Lesions can affect bone marrow
Bone marrow
Bone marrow is the flexible tissue found in the interior of bones. In humans, bone marrow in large bones produces new blood cells. On average, bone marrow constitutes 4% of the total body mass of humans; in adults weighing 65 kg , bone marrow accounts for approximately 2.6 kg...
, liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
, spleen
Spleen
The spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...
or lymph nodes. Bartonella henselae
Bartonella henselae
Bartonella henselae, formerly Rochalimæa, is a proteobacterium that can cause bacteremia, endocarditis, bacillary angiomatosis, and peliosis hepatis. It is also the causative agent of cat-scratch disease which, as the name suggests, occurs after a cat bite or scratch...
and Bartonella quintana
Bartonella quintana
Bartonella quintana, originally known as Rochalimaea quintana, and "Rickettsia quintana", is a microorganism that is transmitted by the human body louse. This microorganism is the caustative agent of trench fever...
can cause bacillary angiomatosis
Bacillary angiomatosis
Bacillary angiomatosis is a form of angiomatosis associated with bacteria of the Bartonella genus.-Causes:It is caused by either Bartonella henselae or Bartonella quintana....
.
Peliosis hepatis
Peliosis hepatis is defined as a vascular proliferation of sinusoid hepatic capillaries resulting in blood-filled spaces in the liver. Bartonella henselaeBartonella henselae
Bartonella henselae, formerly Rochalimæa, is a proteobacterium that can cause bacteremia, endocarditis, bacillary angiomatosis, and peliosis hepatis. It is also the causative agent of cat-scratch disease which, as the name suggests, occurs after a cat bite or scratch...
is recognized as the etiologic agent in HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
patients and organ transplant recipients. Peliosis hepatis can be associated by peliosis of the spleen, as well as bacillary angiomatosis
Bacillary angiomatosis
Bacillary angiomatosis is a form of angiomatosis associated with bacteria of the Bartonella genus.-Causes:It is caused by either Bartonella henselae or Bartonella quintana....
of the skin in HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
patients.
Treatment
Treatment of infections caused by BartonellaBartonella
Bartonella is a genus of Gram-negative bacteria. Facultative intracellular parasites, Bartonella species can infect healthy people but are considered especially important as opportunistic pathogens. Bartonella are transmitted by insect vectors such as ticks, fleas, sand flies and mosquitoes...
species.
| Disease | Adults | Children |
|---|---|---|
| Cat scratch disease Cat scratch disease Cat scratch disease is a usually benign infectious disease caused by the intracellular bacterium Bartonella. It is most commonly found in children following a scratch or bite from a cat by about one to two weeks... |
no recommendation | no recommendation |
| Retinitis | Doxycycline + Rifampin | unknown |
| Trench fever Trench fever Trench fever is a moderately serious disease transmitted by body lice. It infected armies in Flanders, France, Poland, Galicia, Italy, Salonika, Macedonia, Mesopotamia, and Egypt in World War I Trench fever (also known as "Five day fever", "Quintan fever" (febris Quintana in Latin), "Urban trench... or chronic bacteremia by B.quintana |
Doxycycline + Gentamicin | unknown |
| Bacillary angiomatosis Bacillary angiomatosis Bacillary angiomatosis is a form of angiomatosis associated with bacteria of the Bartonella genus.-Causes:It is caused by either Bartonella henselae or Bartonella quintana.... |
Erythromycin or Doxycycline | Erythromycin |
| Peliosis hepatis Peliosis hepatis Peliosis Hepatis is an uncommon vascular condition characterised by randomly distributed multiple blood-filled cavities throughout the liver. The size of the cavities usually ranges between a few millimetres to 3 cm in diameter... |
Erythromycin or Doxycycline | Erythromycin |
| Endocarditis Endocarditis Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices... |
Doxycycline + Gentamicin + Rifampin or Ceftriaxone + Gentamicin | |
| Carrión´s disease Carrion's disease Oroya fever or Carrion's Disease is an infectious disease produced by Bartonella bacilliformis infection.It is named for Daniel Alcides Carrión.-History:... (acute phase) |
Ciprofloxacin or Chloramphenicol | Chloramphenicol + beta-lactam |
| Carrión´s disease Carrion's disease Oroya fever or Carrion's Disease is an infectious disease produced by Bartonella bacilliformis infection.It is named for Daniel Alcides Carrión.-History:... (chronic phase: Verruga peruana Verruga peruana Verruga peruana is the chronic delayed stage of infection by Bartonella bacilliformis.... ) |
Rifampin or macrolides | Rifampin or macrolides |
While some authorities recommend the use of azithromycin
Azithromycin
Azithromycin is an azalide, a subclass of macrolide antibiotics. Azithromycin is one of the world's best-selling antibiotics...
, it's difficult to gauge what, if any significant benefit, is afforded given the often self-limiting course in patients with intact immune function.