An outbreak of bartonellosis in Zamora Chinchipe Province in Ecuador

Cooper, Philip J.; Guderian, Ronald H.; Orellana, Paulina; Sandoval, Carlos; Olalla, Hector; Valdez, Macias; Calvopiña, Manuel; Guevara, Angel; Griffin, George E.

doi:10.1016/s0035-9203(97)90019-5

Cited by 15 publications

(13 citation statements)

References 5 publications

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“…Cooper et al carried out two case-control studies [51], [52] in Zamora Chinchipe province, Ecuador, using questionnaires to determine whether there was an excess of dead or dying animals in case households compared to controls. Case households reported seeing significantly more dead or dying rodents [51] and chickens [52] than controls.…”

Section: Resultsmentioning

confidence: 99%

“…Case households reported seeing significantly more dead or dying rodents [51] and chickens [52] than controls.…”

Section: Resultsmentioning

confidence: 99%

“…Studies looking at alternative reservoirs are mostly inconclusive, with euphorb plants [48] and intra-domicilliary animals [49]–[51] failing to contain B. bacilliformis in a number of experiments. Cooper's studies in Ecuador, which found that households with cases reported more dead or dying rodents and chickens, are also unreliable (evidence level 4) as none of the animals were tested for B. bacilliformis and the questionnaire methodology is potentially subject to bias including responder bias if questions were asked in a leading way by the interviewers who were not blind to whether households were case or control.…”

Section: Discussionmentioning

confidence: 99%

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Bartonella bacilliformis: A Systematic Review of the Literature to Guide the Research Agenda for Elimination

Clemente

Ugarte-Gil

Solórzano³

et al. 2012

PLoS Negl Trop Dis

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BackgroundCarrion's disease affects small Andean communities in Peru, Colombia and Ecuador and is characterized by two distinct disease manifestations: an abrupt acute bacteraemic illness (Oroya fever) and an indolent cutaneous eruptive condition (verruga Peruana). Case fatality rates of untreated acute disease can exceed 80% during outbreaks. Despite being an ancient disease that has affected populations since pre-Inca times, research in this area has been limited and diagnostic and treatment guidelines are based on very low evidence reports. The apparently limited geographical distribution and ecology of Bartonella bacilliformis may present an opportunity for disease elimination if a clear understanding of the epidemiology and optimal case and outbreak management can be gained.MethodsAll available databases were searched for English and Spanish language articles on Carrion's disease. In addition, experts in the field were consulted for recent un-published work and conference papers. The highest level evidence studies in the fields of diagnostics, treatment, vector control and epidemiology were critically reviewed and allocated a level of evidence, using the Oxford Centre for Evidence-Based Medicine (CEBM) guidelines.ResultsA total of 44 studies were considered to be of sufficient quality to be included in the analysis. The majority of these were level 4 or 5 (low quality) evidence and based on small sample sizes. Few studies had been carried out in endemic areas.ConclusionsCurrent approaches to the diagnosis and management of Carrion's disease are based on small retrospective or observational studies and expert opinion. Few studies take a public health perspective or examine vector control and prevention. High quality studies performed in endemic areas are required to define optimal diagnostic and treatment strategies.

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Section: Resultsmentioning

confidence: 99%

“…Case households reported seeing significantly more dead or dying rodents [51] and chickens [52] than controls.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Bartonella bacilliformis: A Systematic Review of the Literature to Guide the Research Agenda for Elimination

Clemente

Ugarte-Gil

Solórzano³

et al. 2012

PLoS Negl Trop Dis

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“…During the last two decades, several outbreaks have occurred at abnormal altitudes and in historically nonendemic regions of Ecuador, Colombia, and Peru (e.g., near sea level in Huaral and Ica, Peru [13], [15]; the Utcubamba River Valley in Amazonas [16]; Urubamba Valley and Sacred Valley of the Incas near Cuzco [17], [18]; and the high Amazonas jungle [19]). In addition, multiple outbreaks have occurred concurrently in endemic regions (e.g., Ancash Region, Peru; Zamora-Chinchipe Province, Ecuador) [5]–[8], [20], [21]. Children have been hardest hit by these outbreaks, with fatality rates of approximately 10% [13], [15], [22].…”

Section: Janus: the Two Faces Of Carrión's Diseasementioning

confidence: 99%

Oroya Fever and Verruga Peruana: Bartonelloses Unique to South America

et al. 2014

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Bartonella bacilliformis is the bacterial agent of Carrión's disease and is presumed to be transmitted between humans by phlebotomine sand flies. Carrión's disease is endemic to high-altitude valleys of the South American Andes, and the first reported outbreak (1871) resulted in over 4,000 casualties. Since then, numerous outbreaks have been documented in endemic regions, and over the last two decades, outbreaks have occurred at atypical elevations, strongly suggesting that the area of endemicity is expanding. Approximately 1.7 million South Americans are estimated to be at risk in an area covering roughly 145,000 km2 of Ecuador, Colombia, and Peru. Although disease manifestations vary, two disparate syndromes can occur independently or sequentially. The first, Oroya fever, occurs approximately 60 days following the bite of an infected sand fly, in which infection of nearly all erythrocytes results in an acute hemolytic anemia with attendant symptoms of fever, jaundice, and myalgia. This phase of Carrión's disease often includes secondary infections and is fatal in up to 88% of patients without antimicrobial intervention. The second syndrome, referred to as verruga peruana, describes the endothelialcell-derived, blood-filled tumors that develop on the surface of the skin. Verrugae are rarely fatal, but can bleed and scar the patient. Moreover, these persistently infected humans provide a reservoir for infecting sand flies and thus maintaining B. bacilliformis in nature. Here, we discuss the current state of knowledge regarding this life-threatening, neglected bacterial pathogen and review its host-cell parasitism, molecular pathogenesis, phylogeny, sand fly vectors, diagnostics, and prospects for control.

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“…In Ecuador, typically severe febrile hemolytic diseases have been reported for years from the highland province of Zamora-Chinchipe bordering Peru (11,12). In contrast, growing numbers of atypical illnesses associated with only chronic verrucous skin lesions have been reported from the coastal lowland provinces of Manabí and Guayas (2).…”

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Isolation and Characterization of Bartonella bacilliformis from an Expatriate Ecuadorian

Lydy¹,

Eremeeva²,

Asnis

et al. 2008

J Clin Microbiol

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Carrion's disease is typically biphasic with acute febrile illness characterized by bacteremia and severe hemolytic anemia (Oroya fever), followed by benign, chronic cutaneous lesions (verruga peruana). The causative agent, Bartonella bacilliformis, is endemic in specific regions of Peru and Ecuador. We describe atypical infection in an expatriate patient who presented with acute splenomegaly and anemia 3 years after visiting Ecuador. Initial serology and PCR of the patient's blood and serum were negative for Bartonella henselae, Bartonella quintana, and B. bacilliformis. Histology of splenic biopsy was suggestive of bacillary angiomatosis, but immunohistochemistry ruled out B. henselae and B. quintana. Bacilli (isolate EC-01) were subsequently cultured from the patient's blood and analyzed using multilocus sequence typing, protein gel electrophoresis with Western blotting, and an immunofluorescence assay (IFA) against a panel of sera from patients with Oroya fever in Peru. The EC-01 nucleotide sequences (gltA and internal transcribed spacer) and protein band banding pattern were most similar to a subset of B. bacilliformis isolates from the region of Caraz, Ancash, in Peru, where B. bacilliformis is endemic. By IFA, the patient's serum reacted strongly to two out of the three Peruvian B. bacilliformis isolates tested, and EC-01 antigen reacted with 13/20 Oroya fever sera. Bacilliary angiomatosis-like lesions were also detected in the spleen of the patient, who was inapparently infected with B. bacilliformis and who presumably acquired infection in a region of Ecuador where B. bacilliformis was not thought to be endemic. This study suggests that the range of B. bacilliformis may be expanding from areas of endemicity in Ecuador and that infection may present as atypical clinical disease.

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An outbreak of bartonellosis in Zamora Chinchipe Province in Ecuador

Cited by 15 publications

References 5 publications

Bartonella bacilliformis: A Systematic Review of the Literature to Guide the Research Agenda for Elimination

Bartonella bacilliformis: A Systematic Review of the Literature to Guide the Research Agenda for Elimination

Oroya Fever and Verruga Peruana: Bartonelloses Unique to South America

Isolation and Characterization of Bartonella bacilliformis from an Expatriate Ecuadorian

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