Micro - Carrión’S Disease

Front 1

Bartonella quintana – causes __

Back 1

Bartonella quintana – causes Trench fever

Front 2

B. quintana & B. henselae – cause __ & ____

Back 2

B. quintana & B. henselae – cause Bacillary angiomatosis & Culture-negative endocarditis

Front 3

B. henselae – causes

Back 3

B. henselae – causes Cat Scratch Disease

Front 4

B. bacilliformis - causes

Back 4

B. bacilliformis - causes Oroya fever and verruga peruana

Front 5

Case reports of other Bartonella spp. causing

Back 5

Case reports of other Bartonella spp. causing culture-negaitve endocarditis

Front 6

Carrión’s Disease - what are the acute and chronic phases?

Back 6

Oroya Fever--> acute phase

Verruga Peruana--> chronic phase

Front 7

Where do you find Bartonellosis ?

Back 7

Bartonellosis in South America
Distribution:
Latitude between 5° N and 15° S
Altitude 500 to 3400 m. above sea level (Andes)

Front 8

What is the importance of Carrion's Disease?

Back 8

IMPORTANCE :
Economic >700,000 tourists to Cusco annually; also to other areas.
Case Fatality rate for untreated acute bartonellosis is 40 – 90%

Front 9

What is the significance of 1868, Oroya Railroad
(Puente de Verrugas)?

Back 9

Built between Callao to Oroya in the mid-1800s; In 1875 an outbreak, characterized by fever and anemia occurred in the region of construction of the railroad line between Lima and Oroya.
7000 workers died; workers from Columbia etc. had not been exposed previously; doctor caring for the patients said “it turns the blacks into whites” - profound anemia!

Front 10

What department of Peru had the highest incidence of Carrion's disease in 1999?

Back 10

Ancash

Front 11

What departments of Peru had the largest incidence of Carrion's between 2004-2006?

Back 11

Cajamarca and Ancash

Front 12

Who discovered Carrion's disease?

Back 12

Daniel Alcides Carrión(1858-1885)

Medical student; experimental inoculation
Died October 5, 1885 at age 28
Oct 5 now celebrated as Peruvian Medicine Day
Declared a “National Hero” in 1991 by govt.
National University and stadium now named after him

Front 13

What did Alberto Barton discover?

Back 13

Alberto Barton, 1905 – identified Bartnoella bacilliformis within erythrocytes

Front 14

In the 1990s, what several important facts emerged:

Back 14

In the 1990s, several important facts emerged:
B. henselae causes Cat Scratch disease (40% cats carry the organism; transmitted by fleas between cats; human infection by bite or scratch from a claw containing bits of flea dirt)
B. quintana (Rochalimea quintana) – trench fever; louse-borne
B. henselae or B. quintana – Bacillary angiomatosis in AIDS
Bartonella spp. - Culture-negative Endocarditis

Front 15

Describe what kind of bacteria B. bacilliformis
is

Back 15

Bartonella bacilliformis is a proteobacterium, Gram negative aerobic, pleomorphic, flagellated, motile, coccobacillary, 2–3 μm large and 0.2–0.5 μm wide and facultative intracellular bacterium.

Front 16

Where do you find Carrion's Disease?

Back 16

Bartonella bacilliformis is found only in Peru, Ecuador, and Colombia.[2] It is endemic in some areas of Peru,occurring outbreaks of the disease in new epidemic areas.[

Front 17

How is Carrion's Disease transmitted?

Back 17

The bacterium is transmitted by sandflies of genus Lutzomyia

Front 18

What is the incubation period of Carrion's?

Back 18

Incubation period:
3 w (2-14 w)
endothelial cells, RES

Front 19

How long do you have Oroya fever, what are the main symptoms?

Back 19

Oroya fever:
2-4 w
fever, anemia

Front 20

What is the intercalar period of Carrion's?

Back 20

Intercalar period:
2 m
asymptomatic

Front 21

How long do you have Verruga peruana, what are the main symptoms?

Back 21

Verruga peruana:
months-1 year
red cutaneous nodules

Front 22

Carruion's Infectious Complications:

Back 22

Infectious Complications:
Salmonellosis**
Shigellosis
Enterobacterias
Staphylococci
Toxoplasmosis
Histoplasmosis
Pneumocystosis
Tuberculosis

Front 23

What are miliary lesions of bartonellosis?

Back 23

Miliary lesions (eruptive-phase bartonellosis). <5-mm erythematous, round papules

Front 24

What are Nodular lesions of bartonellosis?

Back 24

Nodular lesions.

irregularly shaped, subdermal nodular lesions on a lower extremity. The overlying skin appears normal

Front 25

Which ones are the eruptive phases of bartonellosis?

Back 25

Miliary lesions - numerous <5-mm erythematous, round papules

Mular lesions - erythematous, round lesion , = >5mm, usu. bleeding

Front 26

What are Rocha-Lima
inclusions?

Back 26

Bartonella bacilliformis, a gram-negative, flagellated, motile bacterium, is the etiologic agent of verruca peruana. It is found within the verruca, where it can form large cytoplasmic (Rocha-Lima) inclusions in endothelial cells

Front 27

How do you diagnose bartonellosis via histopathologically?

Back 27

Rocha-Lima inclusions

Vascular tumor-like proliferation

Silver stain

Front 28

How do you diagnose Carrion's Disease?

Back 28

Diagnosis:
Epidemiology
Clinical picture
Blood smear
Serologic tests
PCR
Histology
Culture

Front 29

Diagnosis Carrión’s Disease - what is the sensitivity of a blood smear vs. immunoblot vs PCR?

Back 29

Blood smear:
Sens - 0.36-0.73
Spec - 0.91-0.96

Immunblot:
Sens - 0.70
Spec - 0.94

PCR (16S, 23S) :
Sens - 0.47
Spec - 0.98

Front 30

Carrión’s Disease
Treatment:
Acute Phase:

Back 30

Acute Phase:
(7-10 days)chloramphenicol, ciprofloxacin, cephalosporins, penicillin, streptomycin

Front 31

Carrión’s Disease
Treatment:
Verrucous Phase:

Back 31

Verrucous phase:
(10-14 days)rifampin, azithromycin, streptomycin, surgery

Front 32

Carrión’s Disease - Prevention

Back 32

Prevention:
No chemo or immunoprophylaxis
Avoid contact with vectors:stay indoors at high risk hoursrepellents (DDT, permethrin)bed-netting

Front 33

Differential Diagnosis of Fever and Anemia?

Back 33

Malaria
Bartonellosis

Front 34

Who gets Carrions?

Back 34

Rare disease overall; travelers and non-residents

Front 35

Where is it endemic?

Back 35

Rare disease overall; travelers and non-residents
Endemic in Peru, Colombia and Ecuador

Front 36

What is the agent?

Back 36

Agent - Bartonella bacilliformis

Front 37

What is the vector?

Back 37

Vector – Sandfly (Lutzomyia verrucarum)

Front 38

What is the latitude?

Back 38

Latitude between 5° N and 15° S

Front 39

What is the altitude?

Back 39

Altitude 500 to 3400 m. above sea level (Andes)

Front 40

Incubation period of carrions?

Back 40

Average incubation period – 3 weeks

Front 41

acute phase

Back 41

Acute phase – Oroya fever

Front 42

Chronic phase?

Back 42

Chronic phase – Verruga peruana (Peruvian warts)

Front 43

important complication?

Back 43

Important complication – Salmonellosis

Front 44

lab tests?

Back 44

Lab : Blood smear (Giemsa), serology, culture

Front 45

treatment?

Back 45

Treatment: Quinolones, cephalosporins