Isolation and Characterization of Bartonella bacilliformis from an Expatriate Ecuadorian

Abstract

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.

Oroya Fever and Verruga Peruana: Bartonelloses Unique to South America

“…In short, Carrión's disease is a reemerging public health threat in several South American nations and to travelers who visit these countries [10], [30].…”

“…BA caused by B. henselae has been observed primarily on skin, although the bacteria can disseminate and affect other organs such as eyes, liver, and heart [102], [106]. In contrast, VP lesions are rarely observed in organs other than skin and subcutaneous tissue [10]. As in tumor angiogenesis, Bartonella -triggered neovascularization follows a series of steps that involve disruption of the normal pattern of the extracellular matrix and basal membrane, endothelial cell migration and proliferation at the site of angiogenic stimuli [107].…”

Intruders below the Radar: Molecular Pathogenesis of Bartonella spp

“…It is crucial to note that the nodules observed over the course of this phase are "clinically and histologically indistinguishable" from the tumors arising during bacillary angiomatosis with the modern Bartonella species (67,254). Like these, the pathological angiogenesis during the verruga peruana phase usually occurs in the skin, but atypical cases involving other organs such as the spleen (266) have been reported. In striking contrast to the acute phase of Carrion's disease, verruga peruana is associated with only negligible mortality (325).…”

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.…”