Carrion's disease
| Carrion's disease | |
|---|---|
| Other names: Oroya fever[1] | |
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| Carrion's disease chronic phase—verruga peruana (Peruvian warts) | |
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| Specialty | Infectious disease |
| Symptoms | Fever, malaise, anorexia, vomiting, hepatomegaly, lymphadenopathy and systolic murmur.[2] |
| Complications | Salmonella species(most common)[3] |
| Causes | Bartonella bacilliformis[4] |
| Diagnostic method | PCR, blood test[3] |
| Differential diagnosis | Malaria,Yellow fever,Brucellosis,viral hepatitis,Haemolytic anaemia [3] |
| Treatment | Ciprofloxacin and chloramphenicol(systemic phase)[3] |
| Frequency | 3.02 cases per 100,000 people-South American Andes( Peru, Ecuador, and Colombia)[5][6] |
Carrion's disease is an infectious disease produced by Bartonella bacilliformis infection.It is named after Daniel Alcides Carrión who demonstrate definitively the cause of the illness.[3][5]
In terms of fatality rates we find that untreated individuals have 88 percent fatality in contrast to 10 percent of individuals who are treated. Treatment is done via a combination of antibiotics and the phase of the infection.[5]
Signs and symptoms
The clinical symptoms of bartonellosis are pleomorphic 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 . An individual can be affected by either or both phases.[7][8]
Acute phase
The most common findings are fever usually sustained, pale appearance, malaise, painless liver enlargement, jaundice, enlarged lymph nodes, and enlarged spleen. This phase is characterized by severe hemolytic anemia and transient immunosuppression. The case fatality ratios of untreated individual exceeded a moderate percentage but reach around 90% when opportunistic infection with Salmonella spp. occurs.[3][8][5]
Other symptoms include a headache, muscle aches, and general abdominal pain.[9] 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.[7]
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.[7] In developed countries, where the disease rarely occurs, it is recommended to seek the advice of a specialist in infectious disease when diagnosed.[10] Mortality is often thought to be due to subsequent infections due to the weakened immune symptoms and opportunistic pathogen invasion, or consequences of malnutrition due to weight loss in children.[7][8] 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%.[7]
Chronic phase
It is also called the eruptive phase or tissue phase, in which the patients develop a cutaneous rash produced by a proliferation of endothelial cells and is 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.[9]
The most common findings are bleeding of verrugas, fever, malaise, anorexia, myalgias, pallor, lymphadenopathy, and liver enlargement.[2]
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.[7][11]
The chronic phase is the more common phase. Mortality during the chronic phase is very low.[7][9]
Cause
Carrion's disease is caused by Bartonella bacilliformis. Recent investigations show that Candidatus Bartonella ancashi may cause verruga peruana, although it may not meet all of Koch's postulates.[5][9][11]
Transmission
In terms of the transmission we find that Carrion's disease which is caused by bacterium Bartonella bacilliformis enters the bloodstream via the bite of a female sandfly. [3]
Diagnosis
Diagnosis during the acute phase can be made by obtaining a peripheral blood smear with Giemsa stain, immunoblot, indirect immunofluorescence, and PCR. Diagnosis during the chronic phase can be made using a Warthin-Starry stain of wart biopsy, PCR, and immunoblot.[3][12]
Differential diagnosis
The DDx for Carrion's disease in an affected individual is as follows:[3]
- Malaria
- Yellow fever
- Brucellosis
- Viral hepatitis
- Haemolytic anaemia
Treatment
Because Carrion's disease is often comorbid with Salmonella infections, chloramphenicol has historically been the treatment of choice.[10]
Fluoroquinolones (such as ciprofloxacin) or chloramphenicol in adults and chloramphenicol plus beta-lactams in children are the antibiotic regimens of choice during the acute phase of Carrion's disease.[10] Chloramphenicol-resistant B. bacilliformis has been observed.[7][10]
During the eruptive phase, in which chloramphenicol is not useful, azithromycin, erythromycin, and ciprofloxacin have been used successfully for treatment. Rifampin or macrolides are also used to treat both adults and children.[7][10]
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 for anemia, pericardiectomies for pericardial tamponades, and other standard treatments.[7][13]
Epidemiology
In terms of epidemiology we find that Carrion's disease, is primarily endemic to the Andean valleys of Peru, Ecuador, and Colombia[5][14].Peru in particular went into the thousands of cases prior to 2010 when it began to decrease[15]
History
Carrión, a medical student, described the disease in the course of what proved to be a fatal experiment upon himself in 1885, in order to demonstrate definitively the cause of the illness. [16]
He was inoculated with blood which had been taken from a wart of a 14-year-old individual.[16]
In terms of history it was Alberto Barton in 1909, that announced the discovery of the causal agent of Carrion's disease.[17]
See also
References
- ↑ "Oroya fever - National Organization for Rare Disorders". rarediseases.org. Retrieved 8 October 2024.
- ↑ 2.0 2.1 Angelakis, Emmanouil; Raoult, Didier (1 January 2017). "Rickettsia and Rickettsia-Like Organisms". Infectious Diseases (Fourth ed.). Elsevier. pp. 1666–1675.e1. ISBN 978-0-7020-6285-8.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 "Carrion disease". DermNet®. 26 October 2023. Archived from the original on 2 March 2024. Retrieved 24 September 2024.
- ↑ Pons, Maria J.; Gomes, Cláudia; del Valle-Mendoza, Juana; Ruiz, Joaquim (13 October 2016). "Carrion's Disease: More Than a Sand Fly–Vectored Illness". PLOS Pathogens. 12 (10): e1005863. doi:10.1371/journal.ppat.1005863. ISSN 1553-7366. PMC 5063350. PMID 27736978.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Garcia-Quintanilla, Meritxell; Dichter, Alexander A.; Guerra, Humberto; Kempf, Volkhard A. J. (December 2019). "Carrion's disease: more than a neglected disease". Parasites & Vectors. 12 (1): 141. doi:10.1186/s13071-019-3390-2. ISSN 1756-3305. PMC 6434794. PMID 30909982.
- ↑ Urrutia, Liceth Carolina; Patiño-Barbosa, Andrés Mauricio; Arroyave-Valencia, Felipe; Sabogal-Roman, Juan Alejandro; Cardona-Ospina, Jaime A; Rodriguez-Morales, Alfonso J. (2018). "Oroya Fever, Verruga Peruana, and Other Bartonelloses Incidence Rates in Colombia (2009-2013)". Cureus. 10 (10): e3528. doi:10.7759/cureus.3528. ISSN 2168-8184. PMC 6318093. PMID 30648063.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 Huarcaya, Erick; Maguiña, Ciro; Torres, Rita; Rupay, Joan; Fuentes, Luis (2004-10-01). "Bartonelosis (Carrion's Disease) in the pediatric population of Peru: an overview and update". Brazilian Journal of Infectious Diseases. 8 (5): 331–339. doi:10.1590/S1413-86702004000500001. ISSN 1413-8670. PMID 15798808.
- ↑ 8.0 8.1 8.2 Maguina C, Garcia PJ, Gotuzzo E, Cordero L, Spach DH (September 2001). "Bartonellosis (Carrión's disease) in the modern era". Clin. Infect. Dis. 33 (6): 772–779. doi:10.1086/322614. PMID 11512081.
- ↑ 9.0 9.1 9.2 9.3 "Bartonella Infection (Cat Scratch Disease, Trench Fever, and Carrión's Disease)". www.cdc.gov. Archived from the original on 2019-05-07. Retrieved 2016-10-17.
- ↑ 10.0 10.1 10.2 10.3 10.4 "Bartonellosis - NORD (National Organization for Rare Disorders)". NORD (National Organization for Rare Disorders). Archived from the original on 2018-10-01. Retrieved 2016-10-17.
- ↑ 11.0 11.1 Maco V, Maguiña C, Tirado A, Maco V, Vidal JE (2004). "Carrion's disease (Bartonellosis bacilliformis) confirmed by histopathology in the High Forest of Peru". Rev. Inst. Med. Trop. Sao Paulo. 46 (3): 171–174. doi:10.1590/S0036-46652004000300010. PMID 15286824.
- ↑ Sanchez Clemente, Nuria; Ugarte-Gil, Cesar A.; Solórzano, Nelson; Maguiña, Ciro; Pachas, Paul; Blazes, David; Bailey, Robin; Mabey, David; Moore, David (25 October 2012). "Bartonella bacilliformis: A Systematic Review of the Literature to Guide the Research Agenda for Elimination". PLOS Neglected Tropical Diseases. 6 (10): e1819. doi:10.1371/journal.pntd.0001819. ISSN 1935-2727. PMC 3493376. PMID 23145188.
- ↑ Camacho, Cesar Henriquez (7 December 2002). "Human Bartonellosis Cause By Bartonella Bacilliformis". University of Pittsburgh. Archived from the original on 10 August 2018. Retrieved 2 November 2016.
- ↑ Stechenberg, Barbara W. (1 January 2009). "CHAPTER 138 - BARTONELLOSIS". Feigin and Cherry's Textbook of Pediatric Infectious Diseases (Sixth ed.). W.B. Saunders. pp. 1675–1678. ISBN 978-1-4160-4044-6.
- ↑ Franco-Paredes, Carlos; Santos-Preciado, José Ignacio (8 May 2015). Neglected Tropical Diseases - Latin America and the Caribbean. Springer. p. 189. ISBN 978-3-7091-1422-3. Archived from the original on 5 October 2024. Retrieved 4 October 2024.
- ↑ 16.0 16.1 Chatterjee, Pranab; Chandra, Shivika; Biswas, Tamoghna (November 2015). "Daniel Alcides Carrion (1857-1885) and a history of medical martyrdom". Journal of Medical Biography. 23 (4): 224–227. doi:10.1177/0967772013479532. ISSN 1758-1087. PMID 24585618. Archived from the original on 2020-11-18. Retrieved 2024-09-28.
- ↑ Gomes, Cláudia; Ruiz, Joaquim (29 November 2017). "Carrion's Disease: the Sound of Silence". Clinical Microbiology Reviews. 31 (1): e00056–17. doi:10.1128/CMR.00056-17. ISSN 0893-8512. PMC 5740975. PMID 29187394.
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