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SASTM Newsflash - Bartonellosis - Peru (Amazonas)


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SASTM Newsflash




Since 12 Jan 2013, 40 cases of bartonellosis have been reported in Rodriguez de Mendoza province [Amazonas region].


Authorities from the Amazonas Regional Health Directorate and some district mayors agreed to immediately start a fumigation campaign aiming to combat the insect vector [sandfly, locally know as 'uta'] for Carrion's disease [bartonellosis] and cutaneous leishmaniasis. This campaign will focus more intensively in Omia district, where there is a greater presence of the sandfly vector.


The local epidemiologist, Dr Pershing Bustamante-Chauca, indicated that (samples from the) reported cases have already been sent to the laboratories from the Regional Health Directorate, in order to identify the type of disease affecting persons from the districts of Mariscal Benavides, Omia, San Nicolas, and other nearby areas in Mendoza Province.


Communicated by: ProMED-mail


[Bartonellosis comprises infections caused by newly emerging pathogens. In 1909, Alberto Barton described organisms that adhered to red blood cells (RBCs). The name _Bartonia_, later _Bartonella bacilliformis_, was used for the only member of the group identified before 1993. _Rochalimaea_ (named for Rocha-Lima), a similar group, were recently combined with _Bartonella_. Although these organisms were originally thought to be rickettsiae, _Bartonella_ bacteria can be grown on artificial media, unlike rickettsiae.


At least a dozen species belong to the genus _Bartonella_. 3 species are considered important causes of human disease, but other significant human pathogens in this genus will undoubtedly be found in the future. _B. bacilliformis_ causes Oroya fever and 'verruga peruana' (Peruvian wart, also known as Carrion's disease). _B.

henselae_ causes cat scratch disease (CSD). _B. quintana_ causes trench fever. Either _B. henselae_ or _B. quintana_ may cause peliosis of the liver (often called bacillary peliosis; characterized by cystic, blood-filled spaces in the liver), infections in homeless populations, and infections in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). New species that may cause human disease include _B. vinsonii_, _B. clarridgeiae_, and _B. elizabethae_. Several of these other species are found in animals.


_Bartonella bacilliformis_ is endemic in the Andean Mountain regions of Peru, Ecuador, and Colombia and usually substantially above sea level but seems to have expanded its range to lower altitudes between the highlands and jungles. The vector is the sandfly, _Lutzomyia verrucarum. The acute form of the disease caused by _B. bacilliformis_ gets its name from an outbreak that occurred in 1871 near La Oroya, Peru. More than 7000 people perished. Some survivors later developed a skin disease called verruga peruana (Peruvian wart). These skin lesions were observed prior to the 1871 outbreak -- perhaps as far back as the pre-Columbian era -- but a connection to Oroya fever was unknown. In 1885, a young medical researcher, Daniel Carrion, inoculated himself with blood from a lesion to study the course of the skin disease. When he became ill with Oroya fever, the connection became apparent. Oroya fever is often called Carrion's disease in honor of his fatal experiment.


Although the bacterium, _B. bacilliformis_, was isolated by Alberto Barton in 1909, it was not identified as the cause of the fever until 1940. The disease is limited to a small area of the Andes Mountains in western South America; nearly all cases have been in Peru, Colombia, and Ecuador. A large outbreak involving thousands of people occurred in 1940-41, but bartonellosis has since occurred sporadically. Control of sandflies, the only known disease vector, has been credited with managing the disease.


Once in the bloodstream, the bacteria attach to red blood cells (erythrocytes). Bacilli can also enter the red blood cells.


In the process, up to 90 percent of the host's erythrocytes are destroyed, causing severe hemolytic anemia. The anemia is accompanied by high fever, muscle and joint pain, delirium, and sometimes coma.


An infected individual may develop verruga peruana 2-8 weeks after the acute phase. However, individuals may exhibit the characteristic lesions without ever experiencing the acute phase or they can even precede the bacteremic phase. Left untreated, the lesions may last months or years. These lesions resemble blood-filled blisters, up to 4 cm (1.6 in) in diameter, and appear primarily on the head and limbs. They can be painful to the touch and may bleed or ulcerate.


Bartonellosis is identified by symptoms and the patient's history, such as recent travel in areas where bartonellosis occurs. Isolation of _B. bacilliformis_ from the bloodstream or lesions can confirm the diagnosis. Antimicrobial agents are the mainstay of bartonellosis treatment. The bacteria are susceptible to several antibiotics, including chloramphenicol, penicillins, and aminoglycosides. Blood transfusions may be necessary to treat the anemia caused by bartonellosis.


Antibiotics have dramatically decreased the fatality associated with bartonellosis. Prior to the development of antibiotics, the fever was fatal in 40 percent of cases. With antibiotic treatment, that rate has dropped to 8 percent. Fatalities can result from complications associated with severe anemia and secondary infections. Once the infection is treated, an individual can recover fully.




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The information provided in SASTM Newsflashes is collected from various news sources, health agencies and government agencies. Although the information is believed to be accurate, any express or implied warranty as to its suitability for any purpose is categorically disclaimed. In particular, this information should not be construed to serve as medical advice for any individual. The health information provided is general in nature, and may not be appropriate for all persons. Medical advice may vary because of individual differences in such factors as health risks, current medical conditions and treatment, allergies, pregnancy and breast feeding, etc. In addition, global health risks are constantly evolving and changing. International travelers should consult a qualified physician for medical advice prior to departure.

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