Population Genetic Analysis ofBartonella bacilliformisIsolates from Areas of Peru Where Carrion's Disease Is Endemic and Epidemic

Abstract

Carrion's disease is caused by infection with the ␣-proteobacterium Bartonella bacilliformis. Distribution of the disease is considered coincident with the distribution of its known vector, the sand fly Lutzomyia verrucarum. Recent epidemics of B. bacilliformis infections associated with atypical symptomatology in nonendemic regions have raised questions regarding the historic and present distribution of this bacterium and the scope of disease that infection causes. Phylogenetic relationships and genomic diversity of 18 B. bacilliformis isolates (10 isolates from a region where Carrion's disease is epidemic, Cuzco, Peru, and 8 isolates from a region where Carrion's disease is endemic, Caraz, Peru) were assessed using genomic data generated by infrequent restriction site PCR and gene sequence analysis of the flagellin gltA and ialB genes. A population genetic analysis of the genomic diversity suggests that what was once considered an epidemic region of Peru did not result from the recent introduction of B. bacilliformis.Bartonella bacilliformis, the causative agent of Carrion's disease (also referred to as bartonellosis, Oroya fever, and verruga peruana), has one of the highest reported human casefatality rates among bacterial diseases (e.g., 40 to 88% [12,24]). The classic disease is considered biphasic: the first phase involves a hemolytic anemia and fever, which occurs soon after infection, and this is followed by a cutaneous or verruga phase, which involves skin eruptions and can occur months after infection. Another distinctive feature of Carrion's disease is that the distribution of reported human disease has historically been considered to be restricted to a relatively well-defined altitudinal zone (600 to 3,200 m) of the Andean mountain valleys of South America (3, 17). It has been widely presumed that the limited geographic distribution was a function of the limited range of the sand fly vector, Lutzomyia verrucarum (3, 18). However, recent reports have documented human B. bacilliformis infections over a much larger area than previously reported, including the Andean highlands and the Amazona region east of the Andes mountains, as well as in historically recognized areas where B. bacilliformis is endemic (1, 9, 16, 17). These studies have indicated that in addition to B. bacilliformis occurring over a broader geographical range than previously recognized, the spectrum of symptoms associated with B. bacilliformis infection is highly variable.This extended range for human B. bacilliformis-associated disease suggests one or more possible scenarios of significant public health importance, including the following: (i) B. bacilliformis-associated disease has existed for many years over a much wider range than previously recognized; (ii) in addition to its endemic distribution, B. bacilliformis has a large but less stable distribution that results from multiple, overlapping introductions of the bacterium via frequent migration between endemic regions and regions that are only marginally capable of maintaining t...

First Report of Bartonella SP. In Sand Flies (Diptera: Psychodidae: Phlebotominae) From Southern Mexico

“…In particular, B. bacilliformis, which causes an endemic anthropozoonosis in Peru, has also been reported in outbreaks in southeastern Ecuador and southern Colombia. Additionally, some unconfirmed cases have been reported in Thailand, Bolivia, Chile, and Guatemala (Patiño-Camargo 1939, Hambuch et al 2004, Sanchez Clemente et al 2012, Maroli et al 2013). This pathogen is transmitted by sand fly species such as Pintomyia verrucarum (Townsend), Lutzomyia noguchii (Shannon), and Lu.…”

Bartonella Infection: Treatment And Drug Resistance

“…The second stage of infection (verruga peruana) leads to the eruption of nodular angioproliferative cutaneous lesions weeks to months after infection [57]. The disease has a very limited geographical distribution, with most cases reported in arid areas that are 500-3000 m above sea level in the Peruvian Andes between southwestern Colombia and central Peru [4,54,58].…”

Isolation and Characterization of Bartonella bacilliformis from an Expatriate Ecuadorian

“…It is speculated that in these areas, the incidence of bartonellosis is highly underreported due to its mild clinical presentation and may be associated with circulation of less virulent isolates of B. bacilliformis (26). Genetic diversity among B. bacilliformis strains has also been suggested as a factor responsible for differences in the clinical progression of human bartonellosis reported from areas of endemicity and newly recognized foci in Peru (21,26). We report here the isolation of B. bacilliformis from a persistently infected patient who had traveled from the United States to Ecuador 3 years previously and describe preliminary characteristics of this new isolate compared with B. bacilliformis isolates from Peru.…”

“…In Peru, the highest incidence of bartonellosis has occurred in Ancash, followed by Cajamarca, Amazonas, the Lima highlands, and Cusco (reviewed in 24). Epidemiological studies also suggest that the spectrum of clinical manifestations associated with B. bacilliformis in Peruvian patients is highly variable, ranging from occurrence of either one or both phases to asymptomatic infections characterized by chronic bacteremia (9,10,19,21,24). In areas of endemicity in Peru, the cutaneous phase is the most common clinical presentation and mainly affects children, while in regions where the disease is both epidemic and endemic, a majority of acute-phase infections are also found in children (reviewed in reference 24).…”