RESUMO
BACKGROUND Carrion's disease (CD) is a neglected biphasic illness caused by Bartonella bacilliformis, a Gram-negative bacteria found in the Andean valleys. The spread of resistant strains underlines the need for novel antimicrobials against B. bacilliformis and related bacterial pathogens. OBJECTIVE The main aim of this study was to integrate genomic-scale data to shortlist a set of proteins that could serve as attractive targets for new antimicrobial discovery to combat B. bacilliformis. METHODS We performed a multidimensional genomic scale analysis of potential and relevant targets which includes structural druggability, metabolic analysis and essentiality criteria to select proteins with attractive features for drug discovery. FINDINGS We shortlisted seventeen relevant proteins to develop new drugs against the causative agent of Carrion's disease. Particularly, the protein products of fabI, folA, aroA, trmFO, uppP and murE genes, meet an important number of desirable features that make them attractive targets for new drug development. This data compendium is freely available as a web server (http://target.sbg.qb.fcen.uba.ar/). MAIN CONCLUSION This work represents an effort to reduce the costs in the first phases of B. bacilliformis drug discovery.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Bartonella/tratamento farmacológico , Bartonella bacilliformis/efeitos dos fármacos , Bartonella bacilliformis/genética , Bartonella bacilliformis/isolamento & purificação , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Genômica , Humanos , Reação em Cadeia da PolimeraseRESUMO
BACKGROUND Carrion's disease (CD) is a neglected biphasic illness caused by Bartonella bacilliformis, a Gram-negative bacteria found in the Andean valleys. The spread of resistant strains underlines the need for novel antimicrobials against B. bacilliformis and related bacterial pathogens. OBJECTIVE The main aim of this study was to integrate genomic-scale data to shortlist a set of proteins that could serve as attractive targets for new antimicrobial discovery to combat B. bacilliformis. METHODS We performed a multidimensional genomic scale analysis of potential and relevant targets which includes structural druggability, metabolic analysis and essentiality criteria to select proteins with attractive features for drug discovery. FINDINGS We shortlisted seventeen relevant proteins to develop new drugs against the causative agent of Carrion's disease. Particularly, the protein products of fabI, folA, aroA, trmFO, uppP and murE genes, meet an important number of desirable features that make them attractive targets for new drug development. This data compendium is freely available as a web server (http://target.sbg.qb.fcen.uba.ar/). MAIN CONCLUSION This work represents an effort to reduce the costs in the first phases of B. bacilliformis drug discovery.
Assuntos
Humanos , Infecções por Bartonella/tratamento farmacológico , Bartonella bacilliformis/efeitos dos fármacos , Antibacterianos/uso terapêutico , DNA Bacteriano/isolamento & purificação , DNA Bacteriano/genética , Reação em Cadeia da Polimerase , Genômica , Bartonella bacilliformis/isolamento & purificação , Bartonella bacilliformis/genéticaRESUMO
We report a fatal case of Bartonella henselae bacteremic patient. He had negative serology and PCRs from whole blood and liquid culture; only ftsZ nested PCR was positive from the blood liquid culture. The isolate had positive PCRs. When considered, bartonellosis diagnosis can be still challenging because of technical limitations.
Assuntos
Infecções por Bartonella/diagnóstico , Reações Falso-Negativas , Antibacterianos/uso terapêutico , Infecções por Bartonella/tratamento farmacológico , Infecções por Bartonella/microbiologia , Infecções por Bartonella/patologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Choque Séptico/tratamento farmacológico , Choque Séptico/microbiologia , Choque Séptico/patologiaRESUMO
BACKGROUND: Bartonellosis affects small Andean communities in Peru, Colombia and Ecuador. Research in this area has been limited. METHODS: Retrospective review of 191 cases of bartonellosis managed in Caraz District Hospital, Peru, during the last outbreak (2003). RESULTS: The majority of cases (65%) were 14 years old and younger. There was a peak in acute cases after the rainy season; chronic cases presented more constantly throughout the year. The sensitivity of blood smear against blood culture in acute disease was 25%. The most commonly used treatment for chronic disease was rifampicin; chloramphenicol was used to treat most acute cases. Complications arose in 6.8% and there were no deaths. CONCLUSIONS: Diagnostic and treatment algorithms for acute and chronic bartonellosis have been developed without a strong evidence base. Preparation of ready-to-go operational research protocols for future outbreaks would strengthen the evidence base for diagnostic and treatment strategies and enhance opportunities for control.
Assuntos
Algoritmos , Bartonella bacilliformis , Cloranfenicol/administração & dosagem , Surtos de Doenças , Rifampina/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Bartonella/diagnóstico , Infecções por Bartonella/tratamento farmacológico , Infecções por Bartonella/epidemiologia , Infecções por Bartonella/patologia , Criança , Pré-Escolar , Doença Crônica , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Peru/epidemiologiaRESUMO
OBJECTIVES: To evaluate in vitro antimicrobial susceptibility to chloramphenicol (CHL) and ciprofloxacin (CIP) in strains of Bartonella bacilliformis from areas that are endemic to Bartonellosis in Peru, through three laboratory methods. MATERIALS AND METHODS: Antimicrobial susceptibility to CHL and CIP from 100 strains of Bartonella bacilliformis isolated in patients from the regions of Ancash, Cusco, Cajamarca, Lima and La Libertad were evaluated. Strains were evaluated by: disk diffusion, E-test and agar dilution. RESULTS: 26% of the strains of Bartonella bacilliformis evaluated were resistant to CIP and 1% to CHL. Similar patterns of antimicrobial sensitivity / resistance were obtained in all three methods. CONCLUSIONS: Bartonella bacilliformis strains circulating in Peru have high levels of in vitro resistance to CIP, so it is advisable to expand research on the use of drug treatment regimens of the Bartonellosis. The methods of E-test and disk diffusion were the most suitable for assessment in vitro of antimicrobial susceptibility of the microorganism.
Assuntos
Antibacterianos/farmacologia , Bartonella bacilliformis , Farmacorresistência Bacteriana , Infecções por Bartonella/tratamento farmacológico , Infecções por Bartonella/epidemiologia , Humanos , Peru/epidemiologiaRESUMO
BACKGROUND: Carrion's disease affects small Andean communities in Peru, Colombia and Ecuador and is characterized by two distinct disease manifestations: an abrupt acute bacteraemic illness (Oroya fever) and an indolent cutaneous eruptive condition (verruga Peruana). Case fatality rates of untreated acute disease can exceed 80% during outbreaks. Despite being an ancient disease that has affected populations since pre-Inca times, research in this area has been limited and diagnostic and treatment guidelines are based on very low evidence reports. The apparently limited geographical distribution and ecology of Bartonella bacilliformis may present an opportunity for disease elimination if a clear understanding of the epidemiology and optimal case and outbreak management can be gained. METHODS: All available databases were searched for English and Spanish language articles on Carrion's disease. In addition, experts in the field were consulted for recent un-published work and conference papers. The highest level evidence studies in the fields of diagnostics, treatment, vector control and epidemiology were critically reviewed and allocated a level of evidence, using the Oxford Centre for Evidence-Based Medicine (CEBM) guidelines. RESULTS: A total of 44 studies were considered to be of sufficient quality to be included in the analysis. The majority of these were level 4 or 5 (low quality) evidence and based on small sample sizes. Few studies had been carried out in endemic areas. CONCLUSIONS: Current approaches to the diagnosis and management of Carrion's disease are based on small retrospective or observational studies and expert opinion. Few studies take a public health perspective or examine vector control and prevention. High quality studies performed in endemic areas are required to define optimal diagnostic and treatment strategies.
Assuntos
Infecções por Bartonella/epidemiologia , Infecções por Bartonella/prevenção & controle , Bartonella bacilliformis/isolamento & purificação , Bartonella bacilliformis/patogenicidade , Erradicação de Doenças , Infecções por Bartonella/diagnóstico , Infecções por Bartonella/tratamento farmacológico , Colômbia/epidemiologia , Equador/epidemiologia , Humanos , Controle de Insetos/métodos , Peru/epidemiologiaAssuntos
Infecções por Bartonella/tratamento farmacológico , Bartonella bacilliformis/patogenicidade , Febre/tratamento farmacológico , Hemólise , Anemia/tratamento farmacológico , Anemia/etiologia , Infecções por Bartonella/complicações , Infecções por Bartonella/diagnóstico , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Ciprofloxacina/administração & dosagem , Ciprofloxacina/uso terapêutico , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Resultado do TratamentoRESUMO
A large number of travelers visit the African continent annually for studying, tourism or business reasons. The authors report a case of cervical adenomegaly, hepatomegaly and splenomegaly associated with a two-week history of fever and seropositivity for Bartonella sp in a 22-year-old female patient who returned from South Africa after field work with primates in a wild area.
Assuntos
Tonsila Faríngea/patologia , Anticorpos Antibacterianos/sangue , Infecções por Bartonella/diagnóstico , Bartonella/imunologia , Viagem , Infecções por Bartonella/tratamento farmacológico , Brasil , Feminino , Febre/microbiologia , Humanos , África do Sul , Adulto JovemRESUMO
Um grande número de viajantes visita anualmente, por estudo, turismo ou trabalho o continente africano. Um caso de adenomegalia cervical e hepatoesplenomegalia associado à febre de duas semanas de duração com teste sorológico positivo para Bartonella sp em uma paciente de 22 anos do sexo feminino que retornou da África do Sul após realização de trabalho de campo com primatas em área silvestre é apresentado.
A large number of travelers visit the African continent annually for studying, tourism or business reasons. The authors report a case of cervical adenomegaly, hepatomegaly and splenomegaly associated with a two-week history of fever and seropositivity for Bartonella sp in a 22-year-old female patient who returned from South Africa after field work with primates in a wild area.
Assuntos
Feminino , Humanos , Adulto Jovem , Tonsila Faríngea/patologia , Anticorpos Antibacterianos/sangue , Infecções por Bartonella/diagnóstico , Bartonella/imunologia , Viagem , Brasil , Infecções por Bartonella/tratamento farmacológico , Febre/microbiologia , África do Sul , Adulto JovemRESUMO
The number of known Bartonella species is rapidly growing. Some of them are responsible for distinct infectious diseases and show different prevalence and antibiotic susceptibility profiles. Not only have some vectors of Bartonella not been fully characterized, but also intermediate hosts are actually much more numerous and diverse than previously thought. Among these, dogs differ from cats because they tend to suffer an overt disease similar to humans, thus providing the base for a useful animal indicator and research model. Among the debilitating conditions with an unclear impact on the course of these infections, specific conditions (e.g., homelessness, alcoholism) have been linked to a much higher prevalence and to high risk of unfavorable outcome. Due to the limited arsenal of antibiotics effective in vivo on this peculiar intracellular pathogen, the risk/benefit balance of antibiotic therapy is sometimes difficult to draw. In this evolving picture, the recent discoveries of new species highlights the importance of basic molecular biology resources that would bring major public health benefits if available in endemic areas, and specifically in many areas of Peru and Bolivia.
Assuntos
Infecções por Bartonella/epidemiologia , Bartonella/classificação , Bartonella/patogenicidade , Doenças Transmissíveis Emergentes/epidemiologia , Animais , Bartonella/genética , Bartonella/isolamento & purificação , Infecções por Bartonella/diagnóstico , Infecções por Bartonella/tratamento farmacológico , Infecções por Bartonella/microbiologia , Bolívia/epidemiologia , Doença da Arranhadura de Gato/diagnóstico , Doença da Arranhadura de Gato/tratamento farmacológico , Doença da Arranhadura de Gato/epidemiologia , Doença da Arranhadura de Gato/microbiologia , Gatos , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/tratamento farmacológico , Doenças Transmissíveis Emergentes/microbiologia , Cães , Doenças Endêmicas , Humanos , Peru/epidemiologia , Especificidade da EspécieRESUMO
Cat-scratch disease warrants extensive investigation, from an epidemiological, a diagnostic, but especially a therapeutic point of view. Two suggestive episodes of Bartonella henselae-caused cat-scratch disease are reported, and discussed in the light of the most recent literature evidence. The first case occurred in a 60-year-old man, thus suggesting that it is important to maintain an elevated level of suspicion for this disease in adults as well. Both episodes were characterized by a very prolonged and complicated disease course (with the involvement of three lymph node sets in the first case), a need for lymph-node drainage, and apparently negligible activity of many antimicrobial courses, with a very slow local cure. While specific culture and molecular biology techniques proved negative (probably due to late availability of appropriate clinical specimens), indirect immunofluorescence antibody assay was positive since the first weeks of disease, and elevated levels were also fond many months after disease onset. When clinicians face patients with prominent swelling of lymph nodes draining from the upper limbs, cat-scratch disease may be suspected on the grounds of epidemiological and clinical features, with a limited systemic involvement contrasting with a prominent local disease. The significance of specific antibody temporal kinetics in the subacute disease course is still unknown. Although biomolecular assays are now available, the time elapsed from disease onset to clinical diagnosis usually hampers diagnosis, while the roles of surgical debridement and of the unpredictable activity of antimicrobial chemotherapy warrant careful investigation.
Assuntos
Animais , Gatos , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Bartonella/diagnóstico , Bartonella henselae/imunologia , Doença da Arranhadura de Gato/diagnóstico , Antibacterianos/uso terapêutico , Infecções por Bartonella/tratamento farmacológico , Doença da Arranhadura de Gato/tratamento farmacológico , Doença da Arranhadura de Gato/microbiologia , Técnica Indireta de Fluorescência para Anticorpo , Resultado do TratamentoRESUMO
Cat-scratch disease warrants extensive investigation, from an epidemiological, a diagnostic, but especially a therapeutic point of view. Two suggestive episodes of Bartonella henselae-caused cat-scratch disease are reported, and discussed in the light of the most recent literature evidence. The first case occurred in a 60-year-old man, thus suggesting that it is important to maintain an elevated level of suspicion for this disease in adults as well. Both episodes were characterized by a very prolonged and complicated disease course (with the involvement of three lymph node sets in the first case), a need for lymph-node drainage, and apparently negligible activity of many antimicrobial courses, with a very slow local cure. While specific culture and molecular biology techniques proved negative (probably due to late availability of appropriate clinical specimens), indirect immunofluorescence antibody assay was positive since the first weeks of disease, and elevated levels were also fond many months after disease onset. When clinicians face patients with prominent swelling of lymph nodes draining from the upper limbs, cat-scratch disease may be suspected on the grounds of epidemiological and clinical features, with a limited systemic involvement contrasting with a prominent local disease. The significance of specific antibody temporal kinetics in the subacute disease course is still unknown. Although biomolecular assays are now available, the time elapsed from disease onset to clinical diagnosis usually hampers diagnosis, while the roles of surgical debridement and of the unpredictable activity of antimicrobial chemotherapy warrant careful investigation.
Assuntos
Infecções por Bartonella/diagnóstico , Bartonella henselae/imunologia , Doença da Arranhadura de Gato/diagnóstico , Animais , Antibacterianos/uso terapêutico , Infecções por Bartonella/tratamento farmacológico , Doença da Arranhadura de Gato/tratamento farmacológico , Doença da Arranhadura de Gato/microbiologia , Gatos , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Bartonellosis, or Carrion's Disease, is an endemic and reemerging disease in Peru and Ecuador. Carrion's Disease constitutes a health problem in Peru because its epidemiology has been changing, and it is affecting new areas between the highland and the jungle. During the latest outbreaks, and previously in endemic areas, the pediatric population has been the most commonly affected. In the pediatric population, the acute phase symptoms are fever, anorexia, malaise, nausea and/or vomiting. The main signs are pallor, hepatomegaly, lymphadenopathies, cardiac murmur, and jaundice. Arthralgias and weight loss have also commonly been described. The morbidity and mortality of the acute phase is variable, and it is due mainly to superimposed infections or associated respiratory, cardiovascular, neurological or gastrointestinal complications. The eruptive phase, also known as Peruvian Wart, is characterized by eruptive nodes (which commonly bleed) and arthralgias. The mortality of the eruptive phase is currently extremely low. The diagnosis is still based on blood culture and direct observation of the bacilli in a blood smear. In the chronic phase, the diagnosis is based on biopsy or serologic assays. There are nationally standardized treatments for the acute phase, which consist of ciprofloxacin, and alternatively chloramphenicol plus penicillin G. However, most of the treatments are based on evidence from reported cases. During the eruptive phase the recommended treatment is rifampin, and alternatively, azithromycin or erythromycin.
Assuntos
Humanos , Masculino , Feminino , Criança , Infecções por Bartonella , Infecções por Bartonella/diagnóstico , Infecções por Bartonella/tratamento farmacológico , Infecções por Bartonella/epidemiologia , Doenças Endêmicas , Peru/epidemiologiaRESUMO
Bartonellosis or Carrion's disease is endemic in some regions of Peru, classically found in the inter-Andean valleys located between 500 and 3200 meters above sea level. We report the case of a 43 year-old male patient, farmer, who was born in the Pichanaki district (Chanchamayo, Junin), located in the High Forest of Peru. He presented with disseminated, raised, erythematous cutaneous lesions, some of which bled. The distribution of these lesions included the nasal mucosa and penile region. Additionally subcutaneous nodules were distributed over the trunk and extremities. Hematologic exams showed a moderate anemia. Serologic studies for HIV and Treponema pallidum were negative. The histopathologic results of two biopsies were compatible with Peruvian wart. Oral treatment with ciprofloxacin (500 mg BID) was begun. Over 10 days, the patient showed clinical improvement. This is the first report of a confirmed case of bartonellosis in the eruptive phase originating from the Peruvian High Forest, showing the geographical expansion of the Carrion's disease.
Assuntos
Infecções por Bartonella/patologia , Adulto , Anti-Infecciosos/uso terapêutico , Infecções por Bartonella/tratamento farmacológico , Ciprofloxacina/uso terapêutico , Humanos , Masculino , Peru , ÁrvoresRESUMO
Bartonellosis, or Carrion's Disease, is an endemic and reemerging disease in Peru and Ecuador. Carrion's Disease constitutes a health problem in Peru because its epidemiology has been changing, and it is affecting new areas between the highland and the jungle. During the latest outbreaks, and previously in endemic areas, the pediatric population has been the most commonly affected. In the pediatric population, the acute phase symptoms are fever, anorexia, malaise, nausea and/or vomiting. The main signs are pallor, hepatomegaly, lymphadenopathies, cardiac murmur, and jaundice. Arthralgias and weight loss have also commonly been described. The morbidity and mortality of the acute phase is variable, and it is due mainly to superimposed infections or associated respiratory, cardiovascular, neurological or gastrointestinal complications. The eruptive phase, also known as Peruvian Wart, is characterized by eruptive nodes (which commonly bleed) and arthralgias. The mortality of the eruptive phase is currently extremely low. The diagnosis is still based on blood culture and direct observation of the bacilli in a blood smear. In the chronic phase, the diagnosis is based on biopsy or serologic assays. There are nationally standardized treatments for the acute phase, which consist of ciprofloxacin, and alternatively chloramphenicol plus penicillin G. However, most of the treatments are based on evidence from reported cases. During the eruptive phase the recommended treatment is rifampin, and alternatively, azithromycin or erythromycin.
Assuntos
Infecções por Bartonella , Doenças Endêmicas , Infecções por Bartonella/diagnóstico , Infecções por Bartonella/tratamento farmacológico , Infecções por Bartonella/epidemiologia , Criança , Feminino , Humanos , Masculino , Peru/epidemiologiaRESUMO
Se denomina bartonelosis a todas las infecciones provocadas en el ser humano por las distintas especies del género Bartonella, pudiendo manifestarse como bacteriemias o como lesiones localizadas de aspecto vascular: angiomatosis bacilar (AB) y peliosis bacilar (PB), predominando éstas en el paciente HIV +. La enfermedad por arañazo de gato (EAG) está causada por Bartonella henselae (Bh), siendo considerado raro el síndrome oculoglandular de Parinaud, pues sólo es observable en el 6 por ciento de los casos. El diagnóstico de la EAG está basado en la clínica, el antecedente de contacto con gatos, el fracaso en la identificación de otras etiologías y los exámenes complementarios. El exámen histopatológico de biopsias ganglionares sigue siendo útil y como la Bh es un bacilo gram negativo deben hacerse coloraciones especiales como la preparación de plata Warthin-Starry. La detección de anticuerpos por inmunofluorescencia indirecta (IFI) es un método muy confiable pues tiene una sensibilidad del 93 por ciento y una especificidad del 98 por ciento, con el que se demuestran Ac. antiBh, IgG y Ac. anti-Bh, IgM. El título suele reflejar el grado de infección. El compromiso sistémico: hígado, bazo, osteomielitis y más raro (1 por ciento) del SNC (encefalitis y epilepsias), es posible en pacientes inmunocomprometidos. La EAG y la AB deben ser consideradas formas clínicas polares de la infección por Bh, expresión del estado inmunitario del paciente y reflejo del fenómeno primario denominado inflamación, el cual también expica la fisiopatogenia de los signos dermatológicos (histogénesis) (AU)
Assuntos
Humanos , Animais , Masculino , Adolescente , Feminino , Doença da Arranhadura de Gato/diagnóstico , Infecções por Bartonella/diagnóstico , Angiomatose Bacilar/diagnóstico , Eritromicina/uso terapêutico , Linfadenite/etiologia , Doença da Arranhadura de Gato/tratamento farmacológico , Doença da Arranhadura de Gato/epidemiologia , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/prevenção & controle , Infecções por Bartonella/tratamento farmacológico , Infecções por Bartonella/epidemiologia , Infecções por Bartonella/complicações , Infecções por Bartonella/prevenção & controle , Infecções Oportunistas , Doenças do Gato , Gatos/microbiologia , Angiomatose Bacilar/classificação , Angiomatose Bacilar/complicações , Infecções Oportunistas Relacionadas com a AIDS , Reações Cruzadas , Estudos Soroepidemiológicos , Síndrome da Imunodeficiência Adquirida/complicações , Bartonella henselae/isolamento & purificação , Bartonella quintana/isolamento & purificação , Técnica Indireta de Fluorescência para Anticorpo , Ensaio de Imunoadsorção Enzimática , Sensibilidade e EspecificidadeRESUMO
Se presenta un caso típico de verruga peruana atendido en el Servicio de Dermatología del Hospital Alberto Sabogal Sologuren, y a raíz de ello revisamos esta interesante enfermedad emergente mundial. La bartonelosis humana al principio fue asociada básicamente a la especie Bartonella bacilliformis, pero hoy en día se han descubierto hasta 18 Bartonellas que afectan al humano y a varios animales domésticos. La Bartonella bacilliformis es una parásito bacteriano intracelular facultativo de los eritrocitos humanos y de las células endoteliales. La enfermedad de Carrión, fiebre de la Oroya y verruga peruana son todos términos que describen las consecuencias patológicas de la infección humana por Bartonella bacilliformis. Aunque las infecciones que involucran especies de Bartonella, tales como Bartonella henselae quintan, ocurren en todo el mundo, la enfermedad de Carrión es endémica únicamente en Sudamérica. Las infecciones por B. bacilliformis son un problema de salud en numerosas áreas rurales de Sudamérica y para los viajeros que visitan estas regiones montañosas de Perú, Ecuador y Colombia. La Lutzomya verrucarum es el principal vector para la transmisión de la bacteria al ser humano; la hembra del mosquito transmite el patógeno durante su alimentación nocturna de sangre humana. Presumiblemente el insecto se alimenta de la sangre de un individuo infectado y disemina el patógeno por medio de su saliva durante la siguiente ingesta de sangre. La bacteria no es contagiosa entre humanos.
Assuntos
Humanos , Feminino , Criança , Infecções por Bartonella/diagnóstico , Infecções por Bartonella/tratamento farmacológico , Rifampina/uso terapêutico , Resultado do TratamentoRESUMO
Bartonellosis remains a major problem in Peru, but many contemporary aspects of this disease have not been adequately described. We examined the cases of 145 symptomatic patients in Lima, Peru, in whom bartonellosis was diagnosed from 1969 through 1992, including 68 patients in the acute (hematic) phase and 77 patients in the eruptive (verruga) phase. In modern Peru, symptomatic patients who have acute-phase bartonellosis typically present with a febrile illness and systemic symptoms caused by profound anemia; most patients respond successfully to treatment with chloramphenicol. Patients who have eruptive-phase bartonellosis most often present with cutaneous verrugas but may have less specific symptoms, such as fever and arthralgias; diagnosis can be confirmed in such patients by Western immunoblotting, and most patients appear to respond to treatment with rifampin.
Assuntos
Infecções por Bartonella , Doença Aguda , Adolescente , Adulto , Antibacterianos/uso terapêutico , Infecções por Bartonella/complicações , Infecções por Bartonella/diagnóstico , Infecções por Bartonella/tratamento farmacológico , Infecções por Bartonella/epidemiologia , Criança , Pré-Escolar , Cloranfenicol/uso terapêutico , Doença Crônica , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez , Rifampina/uso terapêuticoAssuntos
Humanos , Masculino , Criança , Adolescente , Infecções por Bartonella/diagnóstico , Doença da Arranhadura de Gato/complicações , Abscesso/etiologia , Esplenopatias/diagnóstico , Esplenopatias/etiologia , Infecções por Bartonella/tratamento farmacológico , Reservatórios de Doenças , Abscesso/patologia , Abscesso/tratamento farmacológico , Linfadenite/etiologia , Antibacterianos/uso terapêuticoRESUMO
We report an outbreak of human bartonellosis in Zamora Chinchipe Province in Ecuador, which occurred in 1995-1996. Nineteen cases were seen, of which 18 presented with classical oroya fever (fever and profound anaemia) and one with verruga peruana; 11 of the cases (58%) had positive blood films containing Bartonella bacilliformis. The houses of cases and neighbouring controls were visited; blood samples for thin films and cultures were collected from members of each house and a questionnaire was administered to investigate possible risk factors for disease transmission. In none of those sampled was B. bacilliformis bacteriologically demonstrable. All case houses were located in isolated areas at the margin of forest and the presence of dead rodents was reported only in case houses (P < 0.05). We suggest that human bartonellosis is a zoonosis with a natural rodent reservoir and that migrant humans infected in this way may become a temporary reservoir host in populated areas.