Bartonelosis (Carrion's Disease) in the pediatric population of Peru: an overview and update

Abstract

DISA Jaen, Ministry of Health 3 , PeruBartonellosis, or Carrion's Disease, is an endemic and reemerging disease in Peru and Ecuador. Carrion's Disease constitutes a health problem in Peru because its epidemiology has been changing, and it is affecting new areas between the highland and the jungle. During the latest outbreaks, and previously in endemic areas, the pediatric population has been the most commonly affected. In the pediatric population, the acute phase symptoms are fever, anorexia, malaise, nausea and/or vomiting. The main signs are pallor, hepatomegaly, lymphadenopathies, cardiac murmur, and jaundice. Arthralgias and weight loss have also commonly been described. The morbidity and mortality of the acute phase is variable, and it is due mainly to superimposed infections or associated respiratory, cardiovascular, neurological or gastrointestinal complications. The eruptive phase, also known as Peruvian Wart, is characterized by eruptive nodes (which commonly bleed) and arthralgias. The mortality of the eruptive phase is currently extremely low. The diagnosis is still based on blood culture and direct observation of the bacilli in a blood smear. In the chronic phase, the diagnosis is based on biopsy or serologic assays. There are nationally standardized treatments for the acute phase, which consist of ciprofloxacin, and alternatively chloramphenicol plus penicillin G. However, most of the treatments are based on evidence from reported cases. During the eruptive phase the recommended treatment is rifampin, and alternatively, azithromycin or erythromycin.

An Evaluation Study of Enzyme-Linked Immunosorbent Assay (ELISA) Using Recombinant Protein Pap31 for Detection of Antibody against Bartonella bacilliformis Infection among the Peruvian Population

“…However, the disease has recently expanded over a broader geographical range including lower elevations, high forest regions, and valleys located in the eastern portions of the Andes. [2][3][4] The bacteria is known to invade and replicate inside human erythrocytes and endothelial cells causing the disease, which is classically manifested in one of two distinct ways, either as acute onset of fever with hemolytic anemia (Oroya fever) or with angiogenic skin lesions called verruga peruana. 1 Although the first manifestation is life-threatening with case fatality rates that can reach as high as 88% in untreated patients, verruga peruana is benign and self-limiting.…”

An unidentified cluster of infection in the Peruvian Amazon region

“…Additionally, several symptoms and signs, including headache and jaundice, have also been described [1,5]. Regardless of its being considered the most lethal bacterial infection in the pre-antibiotic era, this illness may be successfully treated with a series of antimicrobial agents, including quinolones and macrolides, among others.…”

“…Although some molecular diagnostic tools have been proposed [1,2,5], the diagnosis of Carrion's disease in rural endemic areas is mostly restricted to clinical criteria or optical microscopy and it is frequently misdiagnosed by both [1,2].…”

Possible Vertical Transmission of Bartonella bacilliformis in Peru

“…3 Thus, young children are especially affected by this illness. 3,4 In the second phase of the illness, which may occur weeks to months after the acute phase (but may be present in the absence of previously described acute phase symptoms), the bacteria cause an abnormal proliferation of endothelial cells, producing the so-called Peruvian wart. 3,5 Additionally, the presence of healthy carriers, which may act as a natural bacterial reservoir, has also been described.…”