Bartonellosis

Bartonellosis General Information

Bartonellosis is an extremely rare infectious disease common in certain areas of South Africa, especially in Andes Mountains. It can be endemic is regions of Peru. The cause of Bartonellosis is represented by a bacterium, called bartonella bacilliformis, being transmitted by sandflies belonging to the genus Lutzomyia. There are more synonyms for this disease and some of them are: oroya fever, cat scratch disease (CSD), (urban) trench fever, peliosis hepatis, verruga peruana, bacillary peliosis, bartonella bacilliformis, Carrion's disease, pediculus humanus, bacillary angiomatosis, bartonella clarridgeiae/ elizabethae/ quintana/ henselae/ vinsonii.

This disease was first named after a doctor from Peru, Alcides Carrión of Cerro de Pasco who described it after he requested to a very close friend along whom he worked in Dos de Mayo National Hospital, Doctor Evaristo M. Chávez. He tried to kept historical medical information as much time as he could, until the high fever caused by the infection put him down. After this experiment, which succeeded to demonstrate that "Verruga Peruana" and "Fiebre de la Oroya" are two different stages of this disease and not different infectious as other doctors tended to affirm at that time. The real bacterium that causes Bartonellosis was discovered in 1903 by Alberto Barton who did not publish this information until 1908. He first thought them to be as endoglobular structures that were actually the bacteria that live inside the hematite (the red cells of the blood). Until the year of 1995, the Bartonella genus was believed to contain only one species. Nowadays, 23 species have been identified.

Bartonellosis Symptoms

The main characteristic of this disease may be an acute stage (“Fiebre de la Oroya” or Oroya fever) that has vascular effects and a chronic one that is related with skin symptoms. The bacilliformis that causes Bartonellosis is using to move a polar flagellum. After this organism enters into the human body, it replicates in vacuoles. These bacteria can cause proliferation of both blood vessels and endothelial cells because they make an endothelial cell–stimulating factor. The bacteria form a protein binder that will adhere to mammals RBC membranes, penetrating after the endothelial cells. Usually, Bartonellosis is transmitted by the nocturnal sandfly that is infected with B. bacilliformis and dines on human blood where it can inject the bacteria directly in the bloodstream. Here, the organisms latch onto erythrocytes (the red cells of the blood) and reproduces itself. During this process, more than 85% of the erythrocytes of the host are destroyed. This usually leads to an acute hemolytic anemia. Along anemia, the affected person could complain of joint and muscle pain and high fever. Sometimes, these symptoms are accompanied by delirium or worse, coma. Only after three to nine weeks from the acute phase, the patient could develop verruga peruana. But there are individuals who exhibit the characteristic lesions even they have not experienced the acute phase. These lesions, if are not treated on time, they could last for moths or worse, years. The lesions usually have somewhere around 5 cm in diameter and look like blood-filled blisters, appearing first on the limbs and head. Sometimes, when you touch them, they could be really painful or may ulcerate and bleed.

Bartonellosis Treatment

If you live in an area where the risk of getting Bartonellosis is really high and you present the symptoms listed above, seek as soon as possible medical care so that you prevent the development of some severe complications that could put your life in danger. The specialist you need to consult may be an infectious diseases doctor or a surgeon for drainage or biopsy. He or she will try to identify Bartonellosis by the history of the medical situation of the patient and symptoms. It is very important to tell the specialists if you were in regions where Bartonellosis is more common. Isolating B. bacilliformis from the lesions or bloodstream can help detecting the right diagnosis. In a clinic, you will do several tests to determine exactly your disease and after the doctor will proceed with the proper treatment. You may do a CT scanning or ultrasonography of the abdomen and chest, to observe if there are any lymph node enlargements. The valvular lesions are discovered with an echocardiography. A skin test may also be helpful although it is possible that this test transmits other infectious agents. After an exact determination of the right disease, the doctor may proceed with the treatment against Bartonellosis. An early treatment usually reduces the risk of developing possible complications. But you should try not to get infected in the first place. For example, avoid to be eaten by sandflies because this is the primary cause of getting Bartonellosis. There are programs for sandfly eradication in the areas where they are very common. Once the population of sandflies is decreased, the risks are not that big.

The main treatment against this infectious disease is the antibiotics because the bacteria responsible of developing it are susceptible to some drugs, such as penicillin, chloramphenicol, or aminoglycosides. Scientists tried to develop the industry of antibiotics to treat the fever caused by this disease because it was fatal in more that 30% of the cases. After using these kinds of drugs, this percentage has dropped to 10%. Some patients may need transfusions of blood to treat the anemia provoked by B. bacilliformis. The fatality associated with this infection is the result of secondary infections and several complications and has been significantly decreased by the antibiotics used. The full recovery of a patient is assured once the infection is halted. Some other effective pharmaceutical choices are doxycycline, erythromycin, or azithromycin. Some unsuccessful results may appear after two to three weeks of the initial start of the therapy. Also, the patients experience later relapses. Then, the doctor will switch the patient to gentamicin, co-trimoxazole, rifampin combined with another drug quinolone. A therapy usually lasts from one to seven weeks or at least four weeks for the patients who are bacteremic. A more prolonged therapy may be needed in the patients with HIV. During their treatments, the patients must be monitored to have an evidence of drug toxicity and several responses. The suppurative nodes must be drained if they become painful and tense.