Bartonellosis is an
infectious disease
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
produced by
bacteria
Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...
of the
genus
Genus ( plural genera ) is a taxonomic rank used in the biological classification of extant taxon, living and fossil organisms as well as Virus classification#ICTV classification, viruses. In the hierarchy of biological classification, genus com ...
''
Bartonella
''Bartonella'' is a genus of Gram-negative bacteria. It is the only genus in the family Bartonellaceae. Facultative intracellular parasites, ''Bartonella'' species can infect healthy people, but are considered especially important as opportunis ...
''.
''
Bartonella
''Bartonella'' is a genus of Gram-negative bacteria. It is the only genus in the family Bartonellaceae. Facultative intracellular parasites, ''Bartonella'' species can infect healthy people, but are considered especially important as opportunis ...
'' species cause diseases such as
Carrión's disease,
trench fever
Trench fever (also known as "five-day fever", "quintan fever" ( la, febris quintana), and "urban trench fever") is a moderately serious disease transmitted by body lice. It infected armies in Flanders, France, Poland, Galicia, Italy, Salonika, Ma ...
,
cat-scratch disease
Cat-scratch disease (CSD) or felinosis is an infectious disease that most often results from a scratch or bite of a cat. Symptoms typically include a non-painful bump or blister at the site of injury and painful and swollen lymph nodes. People m ...
,
bacillary angiomatosis
Bacillary angiomatosis (BA) is a form of angiomatosis associated with bacteria of the genus '' Bartonella''.
Symptoms
Cutaneous BA is characterised by the presence of lesions on or under the skin. Appearing in numbers from one to hundreds, these l ...
,
peliosis hepatis
Peliosis hepatis is an uncommon vascular condition characterised by multiple, randomly distributed, blood-filled cavities throughout the liver. The size of the cavities usually ranges between a few millimetres and 3 cm in diameter. Chapter 80 ...
, chronic
bacteremia
Bloodstream infections (BSIs), which include bacteremias when the infections are bacterial and fungemias when the infections are fungal, are infections present in the blood. Blood is normally a sterile environment, so the detection of microb ...
,
endocarditis
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves. Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or the ...
, chronic
lymphadenopathy
Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type (the most common type) is lymphadenitis, producing swollen or enlarged lymph nodes. In cli ...
, and neurological disorders.
Presentation
Carrión's disease
Patients can develop two clinical phases: an
acute
Acute may refer to:
Science and technology
* Acute angle
** Acute triangle
** Acute, a leaf shape in the glossary of leaf morphology
* Acute (medicine), a disease that it is of short duration and of recent onset.
** Acute toxicity, the adverse eff ...
septic phase and a
chronic eruptive phase associated with
skin
Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation.
Other cuticle, animal coverings, such as the arthropod exoskeleton, have diffe ...
lesions. In the acute phase (also known as
Oroya fever
''Oroya'' is a genus of cacti (family Cactaceae), originating from Peru.
The name comes from the Peruvian town of la Oroya
La Oroya is a city on the River Mantaro in central Peru. It is situated on the Andes some 176 km east-north-e ...
or ''fiebre de la Oroya''), ''B. bacilliformis'' infection is a sudden, potentially life-threatening infection associated with high
fever
Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...
and decreased levels of circulating
red blood cell
Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek ''erythros'' for "red" and ''kytos'' for "holl ...
s (i.e.,
hemolytic anemia
Hemolytic anemia or haemolytic anaemia is a form of anemia due to hemolysis, the abnormal breakdown of red blood cells (RBCs), either in the blood vessels (intravascular hemolysis) or elsewhere in the human body (extravascular). This most commonly ...
) and transient immunosuppression. ''B. bacilliformis'' is considered the most deadly species to date, with a death rate of up to 90% during the acute phase, which typically lasts two to four weeks.
Peripheral blood smear
A blood smear, peripheral blood smear or blood film is a thin layer of blood smeared on a glass microscope slide and then stained in such a way as to allow the various blood cells to be examined microscopically. Blood smears are examined in the ...
s show anisomacrocytosis with many
bacilli
Bacilli is a taxonomic class of bacteria that includes two orders, Bacillales and Lactobacillales, which contain several well-known pathogens such as ''Bacillus anthracis'' (the cause of anthrax). ''Bacilli'' are almost exclusively gram-positive ...
adherent to
red blood cells
Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek language, Greek ''erythros'' for "red" and ''k ...
.
Thrombocytopenia
Thrombocytopenia is a condition characterized by abnormally low levels of platelets, also known as thrombocytes, in the blood. It is the most common coagulation disorder among intensive care patients and is seen in a fifth of medical patients an ...
is also seen and can be very severe. Neurologic manifestations (neurobartonellosis) are altered mental status, agitation, or even coma, ataxia, spinal
meningitis
Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or ...
, or
paralysis
Paralysis (also known as plegia) is a loss of motor function in one or more muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage. In the United States, roughly 1 in 50 ...
. It is seen in 20% of patients with acute infection, in which the
prognosis
Prognosis (Greek: πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the likely or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) or remain stabl ...
is very guarded with an about 50% mortality. The most feared complication is overwhelming infection mainly by Enterobacteriaceae, particularly ''
Salmonella
''Salmonella'' is a genus of rod-shaped (bacillus) Gram-negative bacteria of the family Enterobacteriaceae. The two species of ''Salmonella'' are ''Salmonella enterica'' and ''Salmonella bongori''. ''S. enterica'' is the type species and is fur ...
'' (both ''S. typhi'' and '' S. ''non-''typhi'', as well as reactivation of
toxoplasmosis
Toxoplasmosis is a parasitic disease caused by ''Toxoplasma gondii'', an apicomplexan. Infections with toxoplasmosis are associated with a variety of neuropsychiatric and behavioral conditions. Occasionally, people may have a few weeks or months ...
and other opportunistic infections .
The chronic manifestation consists of a
benign
Malignancy () is the tendency of a medical condition to become progressively worse.
Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malign ...
skin eruption with raised, reddish-purple
nodules (
angiomatous tumours). The bacterium can be seen microscopically, if a skin biopsy is
silver stain In pathology, silver staining is the use of silver to selectively alter the appearance of a target in microscopy of histological sections; in temperature gradient gel electrophoresis; and in polyacrylamide gels.
In traditional stained glass, silve ...
ed (the
Warthin–Starry method).
Cat-scratch disease
Cat-scratch disease is due to an infection by ''B. henselae'' and manifests as gradual regional
lymph nodes
A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...
enlargement (
axilla
The axilla (also, armpit, underarm or oxter) is the area on the human body directly under the shoulder joint. It includes the axillary space, an anatomical space within the shoulder girdle between the arm and the thoracic cage, bounded superior ...
,
groin
In human anatomy, the groin (the adjective is ''inguinal'', as in inguinal canal) is the junctional area (also known as the inguinal region) between the abdomen and the thigh on either side of the pubic bone. This is also known as the medial comp ...
,
neck
The neck is the part of the body on many vertebrates that connects the head with the torso. The neck supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In ...
) which may last 2–3 months or longer and a distal
scratch and/or red-brown skin
papule
A papule is a small, well-defined bump in the skin. It may have a rounded, pointed or flat top, and may have a dip. It can appear with a stalk, be thread-like or look warty. It can be soft or firm and its surface may be rough or smooth. Some h ...
(not always seen at the time of the disease). The enlarged lymph node is painful and tender. The lymph nodes may suppurate, some patients may remain afebrile or asymptomatic. Other presentations include fever (particularly in children), Parinaud's oculoglandular syndrome,
encephalopathy
Encephalopathy (; from grc, ἐνκέφαλος "brain" + πάθος "suffering") means any disorder or disease of the brain, especially chronic degenerative conditions. In modern usage, encephalopathy does not refer to a single disease, but r ...
, and neuroretinitis.
''B. henselae'' can be associated with bacteremia, bacillary angiomatosis, and peliosis hepatis in
HIV
The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
patients, and bacteremia and endocarditis in immunocompetent and immunocompromised patients. Symptoms may include fatigue, headaches, fever, memory loss, disorientation, insomnia, and loss of coordination. The bacteria block the normal immune response by suppressing the NF-κB apoptosis pathway. Disease progression may be accelerated if the host is subsequently infected by an immune-suppressing virus such as Epstein Barr virus.
Bacillary angiomatosis
''B. henselae'' and ''B. quintana'' can cause bacillary angiomatosis, a
vascular
The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away f ...
proliferative disease involving mainly the skin, and other organs. The disease was first described in human immunodeficiency virus (HIV) patients and
organ transplant
Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or organs may be transpo ...
recipients. Severe, progressive and disseminated disease may occur in HIV patients. Differential diagnoses include
Kaposi's sarcoma
Kaposi's sarcoma (KS) is a type of cancer that can form masses in the skin, in lymph nodes, in the mouth, or in other organs. The skin lesions are usually painless, purple and may be flat or raised. Lesions can occur singly, multiply in a limite ...
,
pyogenic
Pus is an exudate, typically white-yellow, yellow, or yellow-brown, formed at the site of inflammation during bacterial or fungal infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection ...
granuloma
A granuloma is an aggregation of macrophages that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such substances include infectious ...
,
hemangioma
A hemangioma or haemangioma is a usually benign vascular tumor derived from blood vessel cell types. The most common form, seen in infants, is an infantile hemangioma, known colloquially as a "strawberry mark", most commonly presenting on the ski ...
, ''verruga peruana'', and subcutaneous tumors. Lesions can affect
bone marrow
Bone marrow is a semi-solid tissue found within the spongy (also known as cancellous) portions of bones. In birds and mammals, bone marrow is the primary site of new blood cell production (or haematopoiesis). It is composed of hematopoietic ce ...
,
liver
The liver is a major Organ (anatomy), organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of proteins and biochemicals necessary for ...
,
spleen
The spleen is an organ found in almost all vertebrates. Similar in structure to a large lymph node, it acts primarily as a blood filter. The word spleen comes . , or
lymph nodes
A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...
.
Peliosis hepatis
''B. henselae'' is the etiologic agent for peliosis hepatis, which is defined as a vascular proliferation of
sinusoid
A sine wave, sinusoidal wave, or just sinusoid is a mathematical curve defined in terms of the ''sine'' trigonometric function, of which it is the graph. It is a type of continuous wave and also a smooth periodic function. It occurs often in ma ...
hepatic
capillaries
A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter. Capillaries are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the smallest blood vessels in the body: ...
resulting in blood-filled spaces in the liver in HIV patients and organ transplant recipients. Peliosis hepatis can be associated with peliosis of the spleen, as well as bacillary angiomatosis of the skin in HIV patients.
Trench fever
Trench fever, also known as five-day fever or quintan fever, is the initial manifestation of ''B. quintana'' infection. Clinical manifestations range from asymptomatic infection to severe illness. Classical presentations include a febrile illness of acute onset,
headache
Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches.
Headaches can occur as a result ...
,
dizziness
Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-specific feeling, such as giddiness or foolishness.
Dizziness is a common medical c ...
, and
shin
Shin may refer to:
Biology
* The front part of the human leg below the knee
* Shinbone, the tibia, the larger of the two bones in the leg below the knee in vertebrates
Names
* Shin (given name) (Katakana: シン, Hiragana: しん), a Japanese ...
pain. Chronic infection manifestations include attacks of fever and aching in some cases and persistent bacteremia in
soldiers
A soldier is a person who is a member of an army. A soldier can be a conscripted or volunteer enlisted person, a non-commissioned officer, or an officer.
Etymology
The word ''soldier'' derives from the Middle English word , from Old French ...
and
homeless
Homelessness or houselessness – also known as a state of being unhoused or unsheltered – is the condition of lacking stable, safe, and adequate housing. People can be categorized as homeless if they are:
* living on the streets, also kn ...
people.
Microbiology
Members of the genus ''
Bartonella
''Bartonella'' is a genus of Gram-negative bacteria. It is the only genus in the family Bartonellaceae. Facultative intracellular parasites, ''Bartonella'' species can infect healthy people, but are considered especially important as opportunis ...
'' are facultative intracellular bacteria, alpha 2 subgroup
Pseudomonadota
Pseudomonadota (synonym Proteobacteria) is a major phylum of Gram-negative bacteria. The renaming of phyla in 2021 remains controversial among microbiologists, many of whom continue to use the earlier names of long standing in the literature. The ...
. The genus comprises:
Pathophysiology
In mammals, each ''Bartonella'' species is highly adapted to its reservoir host as the result of intracellular parasitism and can persist in the bloodstream of the host. Intraerythrocytic parasitism is only observed in the acute phase of
Carrion's disease
Carrion's disease is an infectious disease produced by ''Bartonella bacilliformis'' infection.
It is named after Daniel Alcides Carrión.
Signs and symptoms
The clinical symptoms of bartonellosis are Pleomorphism (cytology), pleomorphic and so ...
. ''Bartonella'' species also have a tropism for endothelial cells, observed in the chronic phase of Carrion's disease (also known as ''verruga Peruana'') and
bacillary angiomatosis
Bacillary angiomatosis (BA) is a form of angiomatosis associated with bacteria of the genus '' Bartonella''.
Symptoms
Cutaneous BA is characterised by the presence of lesions on or under the skin. Appearing in numbers from one to hundreds, these l ...
.
Pathological response can vary with the immune status of the host. Infection with ''B. henselae'' can result in a focal suppurative reaction (CSD in immunocompetent patients), a multifocal angioproliferative response (
bacillary angiomatosis
Bacillary angiomatosis (BA) is a form of angiomatosis associated with bacteria of the genus '' Bartonella''.
Symptoms
Cutaneous BA is characterised by the presence of lesions on or under the skin. Appearing in numbers from one to hundreds, these l ...
in immunocompromised patients),
endocarditis
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves. Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or the ...
, or
meningitis
Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or ...
.
Diagnosis
There are several methods used for diagnosing ''Bartonella'' infection including
microscopy
Microscopy is the technical field of using microscopes to view objects and areas of objects that cannot be seen with the naked eye (objects that are not within the resolution range of the normal eye). There are three well-known branches of micr ...
,
serology
Serology is the scientific study of Serum (blood), serum and other body fluids. In practice, the term usually refers to the medical diagnosis, diagnostic identification of Antibody, antibodies in the serum. Such antibodies are typically formed in r ...
, and
PCR.
Microscopy
Microscopy is the technical field of using microscopes to view objects and areas of objects that cannot be seen with the naked eye (objects that are not within the resolution range of the normal eye). There are three well-known branches of micr ...
of blood smears is used to diagnose Carrión's disease (''B. bacilliformis''), however for other ''Bartonella'' species, microscopy and
silver stain In pathology, silver staining is the use of silver to selectively alter the appearance of a target in microscopy of histological sections; in temperature gradient gel electrophoresis; and in polyacrylamide gels.
In traditional stained glass, silve ...
ing are insensitive, not highly specific, and cannot differentiate species.
The CDC does not recommend lymph node aspiration for diagnostic purposes.
Serology and protein-based methods
IFA (
immunofluorescence
Immunofluorescence is a technique used for light microscopy with a fluorescence microscope and is used primarily on microbiological samples. This technique uses the specificity of antibodies to their antigen to target fluorescent dyes to specif ...
antibody
An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein used by the immune system to identify and neutralize foreign objects such as pathogenic bacteria and viruses. The antibody recognizes a unique molecule of the ...
assay) testing for the presence of antibodies in serum is used to diagnose ''B. henselae'' infection at the acute onset of Cat Scratch Disease symptoms, followed by PCR to confirm infecting species.
IFA can generally be used to confirm a diagnosis of ''Bartonella'' infection, but is limited by antibody cross-reactivity with other bacteria species
which can cause a false positive, and antigen variability which can result in false negatives.
''Bartonella'' spp. often evade an immune response, thus antibodies may not be detected even concurrent with an infection, resulting in an IFA false negative rate of up to 83% in chronically infected patients when other test results (e.g. organism isolation or PCR) are positive.
IFA sensitivity may range from 14 to 100%,
causing discrepancies between PCR and serology test results.
Positive IFA results do not distinguish between current infection and prior exposure.
ELISA (enzyme-linked immunosorbent assay) is another method that has been used to detect Bartonella, but it has a low sensitivity (17-35%).
Western blot
The western blot (sometimes called the protein immunoblot), or western blotting, is a widely used analytical technique in molecular biology and immunogenetics to detect specific proteins in a sample of tissue homogenate or extract. Besides detect ...
for protein detection of Bartonella-associated proteins has also been reported, but this method does not show clear immunoreactive profiles.
PCR
The CDC states that
PCR testing from a single blood draw is not sufficiently sensitive for ''B.'' ''henselae'' testing,
and can result in high false negative rates
due to a small sample volume and levels below the limit of molecular detection.
''Bartonella'' spp. are fastidious, slow-growing bacteria that are difficult to grow using traditional solid agar plate culture methods due to complex nutritional requirements and potentially a low number of circulating bacteria.
This conventional method of culturing ''Bartonella'' spp. from blood inoculates plated directly onto solid agar plates requires an extended incubation period of 21 days due to the slow growth rate.
Enrichment Culture
''Bartonella'' growth rates improve when cultured in an enrichment inoculation step in a liquid insect-based medium
such as ''Bartonella'' Alphaproteobacteria Growth Medium (BAPGM)
or Schneider's Drosophila-based insect powder medium.
Several studies have optimized the growing conditions of ''Bartonella'' spp. cultures in these liquid media, with no change in bacterial protein expressions or host interactions ''in vitro''.
Insect-based liquid media supports the growth and co-culturing of at least seven ''Bartonella'' species,
reduces bacterial culturing time and facilitates PCR detection and isolation of ''Bartonella'' spp. from animal and patient samples.
Research shows that DNA may be detected following direct extraction from blood samples and become negative following enrichment culture, thus PCR is recommended after direct sample extraction and also following incubation in enrichment culture.
Several studies have successfully optimized sensitivity and specificity by using PCR amplification (pre-enrichment PCR) and enrichment culturing of blood draw samples, followed by PCR (post-enrichment PCR) and DNA sequence identification.
Serial Testing
As ''Bartonella'' spp. infect at low levels and cycle between blood and tissues,
multiple blood draws over time may be necessary to detect infection.
Treatment
Treatment of infections caused by ''
Bartonella
''Bartonella'' is a genus of Gram-negative bacteria. It is the only genus in the family Bartonellaceae. Facultative intracellular parasites, ''Bartonella'' species can infect healthy people, but are considered especially important as opportunis ...
'' species include:
Some authorities recommend the use of
azithromycin
Azithromycin, sold under the brand names Zithromax (in oral form) and Azasite (as an eye drop), is an antibiotic medication used for the treatment of a number of bacterial infections. This includes middle ear infections, strep throat, pneumon ...
.
Epidemiology
Carrión's disease, or Oroya fever, or Peruvian wart is a rare
infectious disease
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
found only in
Peru
, image_flag = Flag of Peru.svg
, image_coat = Escudo nacional del Perú.svg
, other_symbol = Great Seal of the State
, other_symbol_type = Seal (emblem), National seal
, national_motto = "Fi ...
,
Ecuador
Ecuador ( ; ; Quechua: ''Ikwayur''; Shuar: ''Ecuador'' or ''Ekuatur''), officially the Republic of Ecuador ( es, República del Ecuador, which literally translates as "Republic of the Equator"; Quechua: ''Ikwadur Ripuwlika''; Shuar: ''Eku ...
, and
Colombia
Colombia (, ; ), officially the Republic of Colombia, is a country in South America with insular regions in North America—near Nicaragua's Caribbean coast—as well as in the Pacific Ocean. The Colombian mainland is bordered by the Car ...
. It is
endemic
Endemism is the state of a species being found in a single defined geographic location, such as an island, state, nation, country or other defined zone; organisms that are indigenous to a place are not endemic to it if they are also found elsew ...
in some areas of
Peru
, image_flag = Flag of Peru.svg
, image_coat = Escudo nacional del Perú.svg
, other_symbol = Great Seal of the State
, other_symbol_type = Seal (emblem), National seal
, national_motto = "Fi ...
, is caused by infection with the
bacterium
Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...
''
Bartonella bacilliformis
''Bartonella bacilliformis'' is a bacterium, Gram negative aerobic, pleomorphic, flagellated, motile, coccobacillary, 2–3 μm long, 0.2–0.5 μm wide, and a facultative intracellular bacterium.
History
The bacterium was discovered by Peru ...
'', and transmitted by
sandflies
Sandfly (or sand fly) is a colloquial name for any species or genus of flying, biting, blood-sucking dipteran (fly) encountered in sandy areas. In the United States, ''sandfly'' may refer to certain horse flies that are also known as "greenhea ...
of
genus
Genus ( plural genera ) is a taxonomic rank used in the biological classification of extant taxon, living and fossil organisms as well as Virus classification#ICTV classification, viruses. In the hierarchy of biological classification, genus com ...
''
Lutzomyia
''Lutzomyia'' is a genus of phlebotomine sand flies consisting of nearly 400 species, at least 33 of which have medical importance as vectors of human disease. Species of the genus ''Lutzomyia'' are found only in the New World, distributed in ...
''.
Cat scratch disease
Cat-scratch disease (CSD) or felinosis is an infectious disease that most often results from a scratch or bite of a cat. Symptoms typically include a non-painful bump or blister at the site of injury and painful and swollen lymph nodes. People m ...
occurs worldwide. Cats are the main reservoir of ''
Bartonella henselae
''Bartonella henselae'', formerly ''Rochalimæa henselae'', is a bacterium that is the causative agent of cat-scratch disease ( bartonellosis).
''Bartonella henselae'' is a member of the genus ''Bartonella'', one of the most common types of bacte ...
'', and the bacterium is transmitted to cats by the cat flea ''
Ctenocephalides felis
The cat flea (scientific name ''Ctenocephalides felis'') is an extremely common parasitic insect whose principal host is the domestic cat, although a high proportion of the fleas found on dogs also belong to this species. This is despite the wide ...
''. Infection in cats is very common with a prevalence estimated between 40 and 60%, younger cats being more commonly infective. Cats usually become immune to the infection, while dogs may be very symptomatic. Humans may also acquire it through flea or tick bites from infected dogs, cats, coyotes, and foxes.
Trench fever
Trench fever (also known as "five-day fever", "quintan fever" ( la, febris quintana), and "urban trench fever") is a moderately serious disease transmitted by body lice. It infected armies in Flanders, France, Poland, Galicia, Italy, Salonika, Ma ...
, produced by ''
Bartonella quintana
''Bartonella quintana'', originally known as ''Rochalimaea quintana'', and "''Rickettsia quintana''", is a bacterium transmitted by the human body louse that causes trench fever. This bacterial species caused outbreaks of trench fever affecting 1 ...
'' infection, is transmitted by the
human body louse
The body louse (''Pediculus humanus humanus'', also known as ''Pediculus humanus corporis'') is a hematophagic ectoparasite louse that infests humans. It is one of three lice which infest humans, the other two being the head louse, and the c ...
''Pediculus humanus corporis''. Humans are the only known reservoir. Thorough washing of clothing may help to interrupt the transmission of infection.
A possible role for ticks in transmission of ''Bartonella'' species remains to be elucidated; in November 2011, ''
Bartonella rochalimae'', ''
B. quintana'', and ''
B. elizabethae'' DNA was first reported in ''
Rhipicephalus sanguineus
''Rhipicephalus sanguineus'', commonly called the brown dog tick, kennel tick, or pantropical dog tick, is a species of tick found worldwide, but more commonly in warmer climates. This species is unusual among ticks in that its entire lifecycle c ...
'' and ''
Dermacentor nitens
''Dermacentor'' is a genus of ticks in the family Ixodidae, the hard ticks. The genus has a cosmopolitan distribution, with native species on all continents except Australia. Most occur in the Nearctic realm.
Hosts of ''Dermacentor'' ticks incl ...
'' ticks in Peru.
History
Carrión's disease
The disease was named after medical student
Daniel Alcides Carrión
Daniel Alcides Carrión García (August 12, 1857 – October 5, 1885) was a Peruvian medical student after whom Carrion's disease is named.
Fatal experiment
Carrión described the disease in the course of what proved to be a fatal experiment u ...
from
Cerro de Pasco
Cerro de Pasco is a city in central Peru, located at the top of the Andean mountains. It is the capital of the Pasco region, and an important mining center. At elevation, it is one of the highest cities in the world, and the highest or the sec ...
,
Peru
, image_flag = Flag of Peru.svg
, image_coat = Escudo nacional del Perú.svg
, other_symbol = Great Seal of the State
, other_symbol_type = Seal (emblem), National seal
, national_motto = "Fi ...
. Carrión described the disease after being inoculated at his request with the pus of a skin lesion from patient Carmen Paredes in 1885 by Doctor Evaristo M. Chávez, a close friend and coworker in Dos de Mayo National Hospital. Carrión developed the disease three weeks after the inoculation and kept a meticulous record of clinical symptoms and signs until the disease rendered him incapable of the task and he died at age 28 several weeks later—October 5, 1885. Carrión proved that Oroya fever and ''verruga peruana'' were two stages of the same disease, and not two different diseases as was thought at the time. His work did not result in a cure immediately, but his research started the process. Peru has named October 5 as "Peruvian Medicine Day" in his honor.
Peruvian microbiologist
Alberto Barton
Alberto Barton (1870-1950) was an Argentine-born Peruvian microbiologist who discovered the etiologic agent of Carrion´s disease or Oroya fever. The bacteria was named: '' Bartonella bacilliformis'', in his honor. It is the type species of t ...
discovered the causative bacterium in 1905, but his results were not published until 1909. Barton originally identified them as "endoglobular" structures, bacteria living inside red blood cells. Until 1993, the
genus
Genus ( plural genera ) is a taxonomic rank used in the biological classification of extant taxon, living and fossil organisms as well as Virus classification#ICTV classification, viruses. In the hierarchy of biological classification, genus com ...
''Bartonella'', within the family Bartonellaceae, contained only one species; 23 are now identified.
CSD
In 1988, English ''et al.'' isolated and cultured a bacterium that was named ''Afipia felis'' in 1992 after the team at the
Armed Forces Institute of Pathology
The Armed Forces Institute of Pathology (AFIP) (1862 – September 15, 2011) was a U.S. government institution concerned with diagnostic consultation, education, and research in the medical specialty of pathology.
Overview
It was founded in ...
that discovered it. This agent was considered the cause of cat-scratch Disease (CSD) but further studies failed to support this conclusion. Serologic studies associated CSD with ''
Bartonella henselae
''Bartonella henselae'', formerly ''Rochalimæa henselae'', is a bacterium that is the causative agent of cat-scratch disease ( bartonellosis).
''Bartonella henselae'' is a member of the genus ''Bartonella'', one of the most common types of bacte ...
'', reported in 1992. In 1993, Dolan isolated ''Rochalimae henselae'' (now called ''Bartonella henselae'') from lymph nodes of patients with CSD.
''Bartonella'' spp. are commonly treated with antibiotics including azithromycin, based on a single small randomized clinical trial. Treatment may take up to one year to eliminate the disease.
CSD often resolves spontaneously without treatment.
Trench fever
Detailed descriptions of the disease were reported in soldiers during the
First World War
World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...
. It is also known as five-day fever, quintan fever, Wolhinie fever, and urban trench fever, because it occurs in homeless people and alcoholics .
References
External links
{{Bacterial diseases
Bacterial diseases