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| Carrion's disease | |
|---|---|
| Other names | Oroya fever |
 | |
| Carrion's disease chronic phase—verruga peruana (Peruvian warts) | |
| Specialty | Infectious diseases  |
Carrion's disease is aninfectious disease produced byBartonella bacilliformis infection.
It is named afterDaniel Alcides Carrión.[1]
The clinical symptoms of bartonellosis arepleomorphic and some patients from endemic areas may be asymptomatic. The two classical clinical presentations are the acute phase and the chronic phase, corresponding to the two different host cell types invaded by the bacterium (red blood cells andendothelial cells). An individual can be affected by either or both phases.[2][3]
The acute phase is also called the hematic phase or Oroya fever.[2] The most common findings are fever (usually sustained, but with temperature no greater than 102 °F or 39 °C), pale appearance, malaise, painlessliver enlargement,jaundice,enlarged lymph nodes, andenlarged spleen. This phase is characterized by severehemolytic anemia and transient immunosuppression. The case fatality ratios of untreated patients exceeded 40% but reach around 90% whenopportunistic infection withSalmonella spp. occurs. In a recent study, the attack rate was 13.8% (123 cases) and the case-fatality rate was 0.7%.[citation needed]
Other symptoms include aheadache,muscle aches, and general abdominal pain.[4] Some studies have suggested a link between Carrion's disease and heart murmurs due to the disease's impact on the circulatory system. In children, symptoms of anorexia, nausea, and vomiting have been investigated as possible symptoms of the disease.[2]
Most of the mortality of Carrion's disease occurs during the acute phase. Studies vary in their estimates of mortality. In one study, mortality has been estimated as low as just 1% in studies of hospitalized patients, to as high as 88% in untreated, unhospitalized patients.[2] In developed countries, where the disease rarely occurs, it is recommended to seek the advice of a specialist in infectious disease when diagnosed.[5] Mortality is often thought to be due to subsequent infections due to the weakened immune system and opportunistic pathogen invasion, or consequences of malnutrition due to weight loss in children.[2][6] In a study focusing on pediatric and gestational effects of the disease, mortality rates for pregnant women with the acute phase were estimated at 40% and rates of spontaneous abortion in another 40%.[2]
The chronic phase is also called the eruptive phase or tissue phase, in which the patients develop a cutaneous rash produced by a proliferation of endothelial cells, known as "Peruvian warts" or "verruga peruana". Depending on the size and characteristics of the lesions, there are three types: miliary (1–4 mm), nodular or subdermic, and mular (>5mm). Miliary lesions are the most common. The lesions often ulcerate and bleed.[4]
The most common findings are bleeding of verrugas, fever, malaise, arthralgias (joint pain), anorexia, myalgias, pallor, lymphadenopathy, and liver and spleen enlargement.[citation needed]
On microscopic examination, the chronic phase and its rash are produced by angioblastic hyperplasia, or the increased rates and volume of cell growth in the tissues that form blood vessels. This results in a loss of contact between cells and a loss of normal functioning.[2][7]
The chronic phase is the more common phase. Mortality during the chronic phase is very low.[2][4]
Carrion's disease is caused byBartonella bacilliformis.[4][7] Recent investigations show thatBartonella ancashensis may cause verruga peruana,[8][9][10] although it may not meet all ofKoch's postulates.[11] There has been no experimental reproduction of the Peruvian wart in animals apart fromMacaca mulatta, and there is little research on the disease's natural spread or impact in native animals.[12]
Diagnosis during the acute phase can be made by obtaining a peripheral blood smear withGiemsa stain, Columbia blood agar cultures,immunoblot, indirectimmunofluorescence, andPCR. Diagnosis during the chronic phase can be made using aWarthin–Starry stain of wart biopsy, PCR, and immunoblot.
Because Carrion's disease is often comorbid withSalmonella infections,chloramphenicol has historically been the treatment of choice.[5]
Fluoroquinolones (such asciprofloxacin) or chloramphenicol in adults and chloramphenicol plusbeta-lactams in children are theantibiotic regimens of choice during the acute phase of Carrion's disease.[5] Chloramphenicol-resistantB. bacilliformis has been observed.[2][5]
During the eruptive phase, in which chloramphenicol is not useful,azithromycin,erythromycin, and ciprofloxacin have been used successfully for treatment.Rifampin ormacrolides are also used to treat both adults and children.[2][5]
Because of the high rates of comorbid infections and conditions, multiple treatments are often required. These have included the use of corticosteroids for respiratory distress, red blood cell transfusions foranemia,pericardiectomies forpericardial tamponades, and other standard treatments.[2][13]
The disease was featured in an episode ofThe WB supernatural dramaCharmed that aired on February 3, 2000. In the episodePiper Halliwell becomes infected when asandfly bites her while she is importing a crate ofKiwano for her club, P3. Piper slowly begins to die of the condition as her sistersPrue andPhoebe rush to find a magical way to save her.