Carrion's disease
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{{Infobox_Disease
| Name = Carrion's disease
| ICD10 = {{ICD10|A|44|0}}
| ICD9 = {{ICD9|088|0}}
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| DiseasesDB = 1249
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| eMedicineSubj = med
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'''Oroya fever''' or '''Carrion's Disease''' is an [[infectious disease]] produced by ''[[Bartonella bacilliformis]]'' infection.
==History==
[[image:Huaco2.jpg|right|thumb|100px|Huaco from Ancash]] Carrion's disease has been known since Pre-Inca times. Numerous artistic representations in clay (called "huacos")of the chronic phase have been found in endemic areas. The Spanish chronist, Garcilazo De La Vega described a disease with warts in Spanish troops during the conquest of Inca Empire, in Coaque-Ecuador. During a long time was thought that the disease was endemic only in Peru and that it had only one phase, the "peruvian wart" or "verruga peruana"<ref>Maguiña, C., 1998. Bartonellosis o Enfermedad de Carrión. A.F.A. Editores Importadores S.A., Lima.</ref>
In 1875 an outbreak, characterized by fever and anemia ("oroya fever") occurred in the region of construction of the railroad line between [[Lima]] and [[Oroya]]
In August 1885, [[Daniel Alcides Carrión]], a Peruvian medical student, inoculated with the help of Evaristo Chavez the material taken from a verruga lesion of a patient in chroic phase (Carmen Paredes) and after 3 weeks developed classic symptoms of the acute phase of the disease, thus establishing a common source for these 2 diseases. He died from bartonellosis the October 5th, 1885 and was recognized like a martyr of Peruvian medicine and the term Carrion's disease was used until our times (Peruvian medicine day is October 5th in honor to him).
Alberto [[Barton]], a Peruvian microbiologist, identified ''Bartonella bacilliformis'' within erythrocytes in 1905, an announced the discovery of the etiologic agent (Barton bacillus) in 1909, which was called ''Bartonella bacilliformis''.
==Etiologic agent==
See ''[[Bartonella bacilliformis]]''
==Epidemiology==
[[image:lutzomya.jpg|right|thumb|100px|sandfly]]Carrion's disease is found only in [[Peru]], [[Ecuador]], and [[Colombia]].<ref>{{cite journal |author=Maguina C, Garcia PJ, Gotuzzo E, Cordero L, Spach DH |title=Bartonellosis (Carrión's disease) in the modern era |journal=Clin. Infect. Dis. |volume=33 |issue=6 |pages=772–9 |year=2001 |month=September |pmid=11512081 |doi= |url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID001355}}</ref> It is [[endemic (epidemiology)|endemic]] in some areas of [[Peru]] and is caused by infection with the [[bacterium]] ''[[Bartonella bacilliformis]]'' and transmitted by [[sandfly|sandflies]] of [[genus]] ''[[Lutzomyia]]''.<ref>{{cite book| last =Herrer| first = Arístides| title = Epidemiología de la verruga peruana| publisher =L. Gonzales-Mugaburu| date = 1990| location =Lima | pages = | url = | doi = | id = | isbn = }}</ref>
==Clinical signs and symptoms==
<!-- Deleted image removed: [[image:verruga.jpg|right|thumb|100px|Verruga peruana]] -->The clinical symptoms of bartonellosis are pleomorphic and some patients from endemic areas may be asymptomatics. 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 and endothelial cells).
'''Acute phase:''' ('''Carrion's disease''') the most common findings are fever (usually sustained, but with temperature no greater that 39ºC), pallor, malaise, nonpainful hepatomegaly, jaundice, lymphadenopathy, splenomegaly.
This phase is characterized by severe hemolytic anemia and transient immunosuppression.
The case fatality ratios of untreated patients exceeded 40% but reach around 90% when opportunistic infection with Salmonella spp occurs.
In a recent study the attack rate was 13.8% (123 cases) and the case-fatality rate was 0.7%.
[[image:verruga.jpg|right|thumb|100px|chronic phase]]'''Chronic phase:'''('''Verruga Peruana or Peruvian Wart''') it is characterized by an eruptive phase, in which the patients develop a cutaneus rash produced by a proliferation of endothelial cells and is known as "peruvian warts" or "verruga peruana". Depending of 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 most common findings are bleeding of verrugas, fever, malaise, arthralgias, anorexia, myalgias, pallor, lymphadeopathy, and hepato-splenomegaly.
==Diagnosis==
[[image:smear.jpg|right|thumb|100px|thin blood film]]For the diagnosis during the acute phase is used the thin blood film with Giemsa stain, Columbia-blood agar cultures, immunoblot, IFI, and PCR.
For the chronic phase is used blood culture, Warthin-Starry stain of wart biopsy, PCR, and immunoblot.
==Treatment==
The drug of choice during the acute phase is Quinolones or Chloramphenicol in adults and Chloramphenicol plus beta lactams in children.
For the chronic phase Rifampin or macrolides are the drug of choice for adults and children
==References==
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==External links==
* [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11512081&dopt=Abstract Bartonellosis (Carrion's disease) in the modern era]
* [http://www.biology-online.org/dictionary/carrions_disease Oroya fever]
* [http://www.pitt.edu/~super1/lecture/lec8711/index.htm Human Bartonellosis caused by ''Bartonella bacilliformis'']
[[de:Oroya-Fieber]]
[[es:Enfermedad de Carrión]]
[[Category:Bacterial diseases]]
[[Category:Insect-borne diseases]]
[[Category:Tropical diseases]]
[[Category:Neglected diseases]]