Carrion's disease (Bartonellosis bacilliformis) confirmed by histopathology in the High Forest of Peru

Abstract

SUMMARYBartonellosis or Carrion´s disease is endemic in some regions of Peru, classically found in the inter-Andean valleys located between 500 and 3200 meters above sea level. We report the case of a 43 year-old male patient, farmer, who was born in the Pichanaki district (Chanchamayo, Junin), located in the High Forest of Peru. He presented with disseminated, raised, erythematous cutaneous lesions, some of which bled. The distribution of these lesions included the nasal mucosa and penile region. Additionally subcutaneous nodules were distributed over the trunk and extremities. Hematologic exams showed a moderate anemia. Serologic studies for HIV and Treponema pallidum were negative. The histopathologic results of two biopsies were compatible with Peruvian wart. Oral treatment with ciprofloxacin (500 mg BID) was begun. Over 10 days, the patient showed clinical improvement. This is the first report of a confirmed case of bartonellosis in the eruptive phase originating from the Peruvian High Forest, showing the geographical expansion of the Carrion´s disease.

Clinical and dermoscopic characteristics of a patient with cutaneous and mucosal manifestations of Peruvian wart

“…The eruptive phase is rarely fatal; lesions tend to be painful and tend to bleed. Mucosal involvement is rare, however, compromise of oral, nasal and ocular conjunctiva has been previously described …”

“…Carrion's disease is an illness native to Peru, found more commonly in the inter‐Andean valleys between 500 and 3200 m above sea level . These conditions make it a perfect environment for Lutzomyia verrucarum , the main vector involved in its transmission . The etiologic agent is Bartonella bacilliformis , an aerobic, pleomorphic, flagellated Gram‐negative bacteria .…”

“…The illness presents with two different phases, an acute or hemolytic phase and an eruptive phase also known as Peruvian wart . Usually, after weeks or months of the acute phase, 10% of the patients will progress to the eruptive phase . During this phase, it is characteristic to find different skin lesions classified in three types: miliary, mulaire, and nodular .…”

Prevalencia y esquemas de tratamiento de la enfermedad de Carrión (bartonelosis humana), en un distrito de Amazonas

“…En el Perú, las zonas endémicas tradicionalmente reconocidas son los departamentos de Ancash, Lima, Cajamarca, Piura, Amazonas, La Libertad, Junín y Huancavelica, siendo Ancash el departamento con el más alto índice de bartonelosis. Desde 1997, se ha informado sobre nuevas zonas endémicas en algunos lugares de la selva alta de Cajamarca (San Ignacio), Amazonas (Provincias Luya, Utcubamba y Rodrí-guez de Mendoza), Huánuco (Valle del Monzón) y Cusco (Valle Sagrado de los Incas) (9,(13)(14)(15)(16) .…”

Isolation and Characterization of Bartonella bacilliformis from an Expatriate Ecuadorian

“…These mountainous areas of endemicity include Ancash, Lima, Cajamarca, Piura, La Libertad, Huancavelica, Huánuco, Ayacucho, Junín, and Ina (reviewed in reference 31). However, during the last 2 decades, emergent disease outbreaks have occurred at lower elevations between the highlands and jungle (Amazonas, Cajamarca, and Huánuco), high forest regions (Chanchamayo and Junín), and in valley regions east of the Andes such as Cuzco (19,24,26,29,31). In Peru, the highest incidence of bartonellosis has occurred in Ancash, followed by Cajamarca, Amazonas, the Lima highlands, and Cusco (reviewed in 24).…”