Introduction:
Carrion disease is caused by infection with Bartonella bacilliformis. It includes the Oroya fever, severe anemic stage of disease, verruga Peruana, and less severe eruptive stage. Oroya fever usually occurs after initial exposure, while verruga peruana is seen after recovery from primary infection. The clinical presentation of Carrion disease consists of an acute or systemic phase and a chronic or cutaneous phase. The signs of Carrion disease usually involve jaundice (yellowish coloration of skin, sclera, and mucous membrane), enlargement of the liver and spleen, swelling of lymph nodes, pallor, and heart murmur. The diagnosis of Carrion disease is usually done clinically and confirmed through blood culture in the case of Oroya fever during a biopsy for verruga peruana. The treatment for Carrion disease is usually antibiotics.
What Is Carrion Disease?
Carrion is a form of infectious vector-borne illness caused by Bartonella bacilliformis infections. It is an illness in which the bacterium is transmitted through bites of phlebotomine sand flies. It is further of two types, namely verruga Peruana (cutaneous Carrion disease) and Oroya fever (systemic Carrion disease). Carrion disease is also known as bartonellosis. Mostly, cases of Carrion disease are seen in endemic regions of South America due to the presence of sandflies that carry causative bacteria.
What Causes Carrion Disease?
Bartonella bacilliformis is a gram-negative bacterium that is usually transmitted to the human system through two vector species of sandflies, such as Lutzomyia verrucarum and Phlebotomus verrucarum. The other route of transmission includes contact with infected human blood, vertical transmission from mother to child, and blood transfusion.
What Is Bartonella Bacilliformis?
Bartonella bacilliform is gram-negative aerobic bacteria, motile, flagellated, and pleomorphic in nature. It is formerly known as South American bartonellosis, which is transmitted by the bite of infected sand flies. It was discovered by Peruvian microbiologist Alberto Barton in 1905. Most cases of Carrion disease are seen in Western South America, Colombia, Ecuador, and Peru. It is characterized by two distinct phases such as Oroya fever and verruga Peruana. The diagnosis of Bartonella bacilliformis is done by direct observation or blood culture using a peripheral blood smear.
What Are Clinical Presentations of Carrion Disease?
The two clinical presentations of Carrion disease are acute and chronic phases depending on two different host cell types invaded by a bacterium.
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Acute Phase: It is also known as the hematic phase, and the most common findings are fever, malaise, pale appearance, jaundice, and enlarged lymph nodes. This phase is characterized by transient immunosuppression and severe hemolytic anemia. Other associated symptoms include muscle pain, general abdominal pain, and headache.
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Chronic Phase: It is also known as the tissue phase or eruptive phase, in which a cutaneous rash is developed by the patient and is known as verruga peruana or Peruvian warts. The most common findings are fever, bleeding of verrugas, malaise, pallor, and anorexia (an eating disorder associated with low body weight, spleen, and liver enlargement. The chronic phase is considered to be the most common phase.
What Are the Symptoms of Carrion Disease?
The symptoms of Carrion disease are as follows :
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Fatigue.
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Headache.
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Low-grade fever.
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Jaundice (yellow discoloration of mucous membrane, skin, and sclera).
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Pallor.
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Myalgia (refers to muscle pain).
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Impaired digestive system.
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Lymphadenopathy (refers to swelling of the lymph nodes secondary to viral, bacterial, and fungal infection).
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Abdominal pain.
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An enlarged spleen and liver.
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Anorexia (an eating disorder associated with low body weight).
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Cardiac murmur (refers to heart murmur sounds such as swishing or whooshing).
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Tachycardia (refers to a rapid heart rate that can be regular or irregular).
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Memory loss or brain fog.
How to Diagnose Carrion Disease?
The diagnosis of Carrion disease depends upon whether the infected individual is present in the acute or chronic phase.
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Acute Phase: The diagnosis of Carrion in the acute or systemic phase includes non-specific symptoms and signs. It can be made with a Giemsa-stained peripheral blood smear. Other investigations involve polymerase chain reaction (PCR), indirect agglutination (soluble antigens are coupled to large particles such as latex or erythrocytes sphere ), and indirect haemagglutination (refers to serological test used to detect antibodies)
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Chronic Phase: This phase of Carrion disease involves characteristic skin lesions. The histological evaluation of skin biopsy with Giemsa and Warthin-Starry silver stain may reveal bacteria.
What Is a Differential Diagnosis of Carrion Disease?
The differential diagnosis of Carrion disease are :
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Malaria (refers to a disease caused by the transmission of a female anopheles mosquito bite).
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Yellow fever (refers to a viral disease caused by a mosquito).
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Typhoid fever (refers to fever caused by contaminated water and food).
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Viral hepatitis (viral fever that causes inflammation and damage to the liver).
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Brucellosis (an infection spread from animals to people through dairy products).
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Hemolytic anemia (disorder in which red blood cells are destroyed faster than normal).
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Pyogenic granuloma (refers to benign, common, acquired, and vascular tumor that arises in tissues such as mucous membrane and skin.
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Cherry angioma (benign skin growth made of blood vessels).
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Kaposi sarcoma (refers to the type of cancer that causes lesions in soft tissue).
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Mollascum contagious (refers to the spot that appears on the skin).
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Herpes zoster (refers to a viral infection that causes skin rash).
What Is Treatment For Carrion Disease?
Treatment options for Carrion disease are as follows:
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Antibiotics are used in the acute phase of Carrion diseases, such as Ciprofloxacin, Chloramphenicol, Amoxicillin, and Clavulanic acid.
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In the case of chronic Carrion disease, Azithromycin is the first treatment, and Rifampicin is the second-line treatment.
What Are Major Complications of Carrion Disease?
The major complication of Carrion disease is associated with pregnancy; it can lead to premature birth or an increased risk of miscarriages.
Conclusion:
Carrion disease or bartonellosis is a bacterial infection with the causative organism Bartonella bacciliformis, which is usually transmitted by sandflies. It is restricted to certain geographic zones, increasing tourism to endemic regions (refers to disease localized to a particular area).
It is often a neglected tropical disease. If left untreated, it can be fatal to human beings. Carrion disease is sometimes associated with Salmonella (refers to bacterial infection that affects the small intestine) and is treated with Chloramphenicol. The mortality rate of Carrion disease in the acute phase ranges from 40 % to 85 % in untreated patients.
