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Carrion’s disease

Carrion’s disease. Nicholas Seeliger, MD. Epidemiology. Endemic in Andes mountains Peru, Columbia, and Ecuador “ verruga zone” Dependant on environmental requirements Vector is L verrucarum Risk factors for infection Tourist Transient workers Children less than 5.

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Carrion’s disease

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  1. Carrion’s disease Nicholas Seeliger, MD

  2. Epidemiology • Endemic in Andes mountains • Peru, Columbia, and Ecuador • “verruga zone” • Dependant on environmental requirements • Vector is L verrucarum • Risk factors for infection • Tourist • Transient workers • Children less than 5

  3. Clinical Manifestations • Biphasic Illness • Acute febrile illness (Oroya fever) • 40 percent mortality if untreated • 3 weeks after inoculation • Onset of mild fever, HA, anorexia, and malaise • Anemia leading to • infectious and noninfectious complications • Chronic cutaneous phase (verrugaperuana) • Lesions appear 2-8 weeks after fever • Miliary, nodular, or mular lesions • 2 months

  4. Disease Diagnosis • Blood cultures • Can be delayed 2 weeks • Positive 10-15 % after acute phase • ID on Giemsa-stain • blood smears • skin biopsy • Serology • Antibody testing • Immunoblot • IFA

  5. Disease Treatment • Prompt initiation of antimicrobial therapy • Oroya fever • Chloramphenicol + B-lactam agent • Cipro • Verrugaperuana • Rifampin • Streptomycin (best alternative)

  6. Disease Transmission • Bartonellabacilliformis • Transmitted by sandflies of genus • Phlebotomus

  7. Worldwide Distribution • Andean Mountains • Peru • Ecuador • Columbia

  8. Prevention • Prevent transmission by blocking inoculation • Skin protection • Repellant • Protective clothing • Bed netting

  9. Disease Control No vaccine available Prevention focused on blocking inoculation Correct identification of infection crucial Accurate reporting of infection required

  10. Outbreaks • Cajamarca – 2002 • 80 % under age 18 • Cusco – 1998 • 38.5 % age 6-14 • Mortality = 23% • Aguaruna – 1992

  11. References Alexander B., A review of bartonellosis in Ecuador and Colombia. American J Tropical Medicine and Hygeine 1995; 52:354-9. Chamberlin J, Laughlin LW, Romero S, et al. Epidemiology of endemic Bartonellabacilliformis: a prospective cohort study in a Peruvian mountain valley community. J Infect Dis 2002; 186:983. EremeevaME, Gerns HL, Lydy SL, et al. Bacteremia, fever, and splenomegaly caused by a newly recognized bartonella species. N Engl J Med 2007; 356:2381. Montoya M., Maguiña C., Vigo B., et al. Bartonellosis en el valle sagrado de los Incas (Cusco). Bol Soc Per Med Interna 1998;11:170-6. Maguiña C. Bartonellosis o Enfermedad de Carrión, nuevos aspectos de una vieja enfermedad. A.F.A Editores Importadores SA, Lima-Peru, 1998. Pachas P. La Bartonelosis en el Perú. Módulos Técnicos, Oficina General de Epidemiología – Instituto Nacional de Salud. Lima, 2000.

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