Bartonellosis

• Odriozola 1895
• Barton 1909

• Verruga peruana
• Carrión fever
• Oroya fever

Infectious disease which, in addition to cutaneous manifestation, also leads to sepsis.

• occurrence only in the high mountain valleys (600-3000m) of Peru, Ecuador and southwest Colombia
• Approximately 5% of the population of the endemic area is expected to be asymptomatic carriers

• Pathogen: Bartonella bacilliformis
• Transmission: sand flies of Lutzomyia spp., especially Lutzomia verrucarum
• Transmission occurs during the act of sucking and after blood transfusions
• Incubation period: weeks - months

• Bartonella bacilliformis causes both dermal nodules (verruga peruana) and sepsis (Oroya fever)
• The cutaneous manifestation includes pedunculated, verruciform, grouped and eroded papules and nodules. In particular, the face, extremities, but also mucous membranes are affected. Petechial exanthema
• Sepsis, reduced general condition, fever, anaemia, hepatosplenomegaly, lymphadenopathy
• A secondary infection with salmonella may occur

• Travel history
• Clinical
• Detection of pathogens by blood culture or biopsy

• Similar to bacillary angiomatosis
• Bacterial detection is achieved by Warthin-Starry staining

• Letality: 10-90%
• Survivors experience spontaneous recovery, often after years

• Transfer to an intensive care unit if there are signs of sepsis
• Blood count, liver and kidney values, coagulation
• Blood culture
• Vital parameter monitoring
• Chloramphenicol i.v. 25-30 mg/kg bw (max. 2g), in course 50-60 mg/kg bw (max. 4g daily) in 4 single doses
• Alternatively: Doxycycline p.o. 100 mg 2x tgl.
• Alternatively: Erythromycin p.o. 500 mg 3x tgl., max. dose: 4 g/d (adults)

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3. Bai Y, Malania L, Alvarez Castillo D, Moran D, Boonmar S, Chanlun A et al. Global distribution of Bartonella infections in domestic bovine and characterization of Bartonella bovis strains using multi-locus sequence typing. PLoS One 2013;8:e80894.
4. Prutsky G, Domecq JP, Mori L, Bebko S, Matzumura M, Sabouni A et al. Treatment outcomes of human bartonellosis: a systematic review and meta-analysis. Int J Infect Dis 2013;17:e811-9.
5. Edouard S, Nabet C, Lepidi H, Fournier PE , Raoult D. Bartonella, a common cause of endocarditis: a report on 106 cases and review. J Clin Microbiol 2015;53:824-9.
6. Fleischman DA, Chomel BB, Kasten RW, Andre MR, Goncalves LR , Machado RZ. Bartonella clarridgeiae and Bartonella vinsonii subsp. berkhoffii exposure in captive wild canids in Brazil. Epidemiol Infect 2015;143:573-7.