Oroya Fever and Verruga Peruana: Bartonelloses Unique to South America

Abstract

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.

Infective endocarditis due to Bartonella bacilliformis associated with systemic vasculitis: a case report

“…This biphasic disease consists of an acute form, known as Oroya fever, and a chronic phase, denominated Peruvian wart 5 . Infectious and noninfectious complications occur in 70% of patients in the acute phase, such as neurological, hematologic, and cardiovascular alterations, including cardiac failure, pericarditis, and myocarditis 6 . To our knowledge, only one case of endocarditis caused by this bacterium was reported in a pediatric patient with underlying cardiac disease 2 .…”

Paleomicrobiology of Bartonella infections

“…The disease is transmitted to humans by the sand fly, Lutzomia verrucarum, in the Andes from Chile to Colombia [35].…”

“…Oroya fever was also probably recognized by pre-Columbian Indians as suggested by the word "sirki" (anemia) in Quechua language [35]. However, it was not before the early 20th century that its causative agent was observed by Alberto Barton in red blood cells from patients suffering from Carri on's disease [24].…”

Molecular identification of Bartonella bacilliformis in ticks collected from two species of wild mammals in Madre de Dios: Peru

“…The infection causes an initially life-threatening phase, known as “Oroya fever”, and the second phase with chronic cutaneous manifestations called “Verruga Peruana” [3, 7]. Oroya fever is characterized by acute fever and hemolytic anemia with case fatality rates up to 88% in untreated patients.…”

“…Oroya fever is characterized by acute fever and hemolytic anemia with case fatality rates up to 88% in untreated patients. In contrast, the verruga peruana presents as angiogenic benign skin lesions which are self-limiting and can persist for 6 months [7–9]. However, most patients with Verruga Peruana do not have a clear previous history of febrile illness [7, 10].…”