This document discusses bartonellosis, caused by Bartonella bacilliformis infection transmitted by sandflies in Peru, Ecuador, and Colombia. It describes the acute and chronic phases of the disease. The acute phase causes fever, anemia, and potentially fatal complications without treatment. The chronic phase causes skin eruptions known as "Peruvian wart." The document also provides details on diagnosis, treatment with antibiotics, and presents a case report of a patient with acute bartonellosis presenting with fever, jaundice, and complications who was treated with antibiotics and blood transfusions.

1. UNIVERSIDAD NACIONAL PEDRO
F A C U L T A D D E MGALLO U M A N A
RUÍZ E D I C I N A H
BARTONELOSIS
2011
ARBOLEDA DÍAZ OSCAR
BECERRA SILVA FRANK
CARRASCO HERRERA DENIS
MENDOZA HERNÁNDEZ ALEX
PISCOYA TENORIO JORGE
TINEO TINEO DENNY
Dra. ROSA GONZÁLES LLONTOP

2. BATONELOSIS
SIGNS AND SYMPTOMS
Clinical symptoms of bartonellosis are pleomorphic and
some endemic areaspatients may be asymptomatic. The two classic
presentations are acute and the chronic phase, corresponding to the
two cells invaded by bacteria (red blood cells and endothelial cells).
ACUTE PHASE
The most common findings are:
 Fever (usually notsustained but with temperatures no higher
than 39 ° C)
 Pallor
 Malaise
 Hepatomegaly
 Jaundice
 Lymphadenopathy
 Splenomegaly
This phase is characterized by severe hemolytic anemia and
immunosuppression. The mortality rate of patients not receiving
treatment is over 40% and can reach 90% if associated with opportunistic
infections by enterobacteria such as Salmonella spp.

3. CHRONIC PHASE
It is characterized byaneruptive phasein whichpatients developa skin
reactioncausedby a proliferation ofendothelialcellsand is knownas
"Peruvian wart." Depending on thesize and characteristicsof injuries,
there are 3 types:
 Miliary(1-4mm)
 Nodular orsubdermal
 Bottlenose(> 5mm)
Themiliary lesionsare mostfrequent.The most common symptomsare:
 Bleeding of the wart
 Fever
 Discomfort
 Arthralgia
 Anorexia
 Myalgia
 Pallor
 Lymphadenopathy
 Hepato-splenomegaly.

4. EPIDEMIOLOGY
Carrion's disease is found only in Peru, Ecuador, and Colombia. It is
endemic in some areas of Peru and is caused by infection with the
bacterium Bartonella bacilliformis and transmitted by sandflies of genus
Lutzomyia.
Various investigations in Ancash, Cuzco, Amazonas, Cajamarca, etc.
have demonstrated for the first time the existence of the disease in new
altitudes (> 3,000-m), the onset of Oroya fever and Peruvian wart in new
areas of the High Forest of Cajamarca, demonstrated the existence of
native disorder in the severe forms.
DIAGNOSTIC
Asan intracellular parasiteBartonellain the firststage of infectionit can
beobserved withinthe red blood cellsaffectedbyslidesand special
stainsasRomanosky, GiemsaorWright inthe early days ofbacillaryformand
then thecocidea. The patientsshow a markedseveremacrocyticanemia,
and a remarkablehypocromica hematócrito 16decreased.

5. Asuspected case ofbartonellosiseverythingyoutake ablood sample
tosmear andthickat the first visitand second andthird sampleat 12 and24
hoursrespectively, ifnecessary.
Theroutinediagnostic procedurefor confirmation
ofbartonellosiscasesitisthe examination ofbloodsmearsandthickand
canbe complemented byserology, bloodand/or mielocultivo.
SerologicalproceduresIFI,ELISA and WesternBlotare very specificand
sensitive inthe testphasehistopathologicalverrucosais essential, its
reactionpatternis quitesuggestive ofthe disease,endothelialcell
proliferationandnew formation ofblood vesselsat the level
ofpapillarydermis(a whitehead)lattice (a papule)and even
thesubcutaneous(nodular) are highly reliablediagnostic referenceinthese
tissuesstained withWarthin-Starry stain also can observe the
intracelularmente.
Bothperipheral blood(more easily) in the first phaseas thewarty lesionson
the secondBartonellacan be isolatedby meansof special
cropscharacterized bysemisolid agarwithrabbit bloodat temperatures
of25 to 28 degreesCelsius.

6. TREATMENT
Bartonella bacilliformis is a bacteria sensitive to many antibiotics. As the
majority of β-lactam antibiotics, aminoglycosides, macrolides,
doxycycline and rifampin; its high susceptibility to penicillin G and
relative resistance to cephalothin is shared with other species of
bartonelia.
IN THE ACUTE PHASE: It has been used with success penicillin G,
chloramphenicol, tetracyclines various and erythromycin.
Chloramphenicol, which is used in the acute stage by the frequent
complication salmonelosica, is dosed at a rate of 50 mg/kg/day until
fever referred and continues with half the dose until completing 10 to 14
days
IN THE ERUPTIVE PHASE: Comes using rifampin oral, 10 mg/kg/day for 14
to 21 days, as well as the ciprofloxacin. In cases with poor response has
been used successfully erythromycin, azithromycin and ciprofloxacin in
the severe injuries, combinations of ciprofloxacin or rifampicin with
azithromycin, with good results. In addition, it is reported the use of
sultamicillin 25 mg/kg/day by mouth for 10 days.

7. CASE REPORT
Male 26 years old, born in Lima where you live5 Carhuaz years, lowered.
30 days ago musculoskeletal pain referred to the lower back and legs,
pale progressive dyspnea, abdominal pain, headache, prostration,
fever, jaundice and dark urine.
Read at the Hospital of Yungay with ciprofloxacin for three days and
then transferred to Huaraz for myeloproliferative 12/03/98. He noted
drowsiness, pale skin, fever, jaundice and mucous membranes,
petechiae on the arms, chest, the soft palate and
hepatosplenomegalysubcrépitoslungand painful.
The evolution makes severe epistaxis, edema of lower limbs and the
sacrum, right pleuroparenquimal syndrome, hepatosplenomegaly, and
ascites (ultrasound), serum albumin, systolic posterior pericardial effusion
in the lower limit of normal (echocardiography).
HIV, direct Coombs negative LE cells. The study was conducted3/14/98
peripheral blood hematological shows a mild anemia, bartonellosis
coccobacillary 28% of myeloid reaction and severe thrombocytopenia,
bone marrow cell hyper, erythroidand megakaryocytic hyperplasia,
normal maturation (citofagocitosis reactive histiocytosis of red blood
cells , normoblasts, leukocytes and platelets ending in acute hemolytic
anemia and thrombocytopenia, peripheral bartonellosis was treated
with blood transfusions (three units), ceftriaxone, chloramphenicol and
dexamethasone. The top and left 10 days later 03/27/98 came to control
the clinic:.
This case was asymptomatic diagnosis of acute bartonellosis
complicated by severe thrombocytopenia, anasarca and jaundice
syndrome.