Overview.
Bartonellosis is an infection caused by bacillus-like Bartonella and is commonly referred to as human Bartonellosis. It is also known as Carrion’s disease because the signs and symptoms were first reported by Daniel Carrion in Peru in 1855. The whitefly is its vector, and there are two distinctly different phases of clinical manifestations, namely, Oroya fever, which is characterized by acute fever with hemolytic anemia, and Peruvian warts, which are characterized by skin lesions.
Etiology
Baltons are a group of gram-stain-negative, nutritionally demanding parasitic bacilli. Humans can become infected or sickened by Bartonella through closer contact with animals such as dogs and cats that harbor Bartonella, or through incidental contact with wildlife such as rodents in their natural environment. Bartonella infection can cause inflammation and various complications.
Symptoms
The incubation period is about 3 weeks or longer. There are often prodromal symptoms such as low-grade fever, bone, joint and muscle aches and pains before the onset of the disease, after which the disease may develop into one of the two types of the disease.
1. Oroya Fever
It is an acute blood disease stage with progressive hemolytic anemia. The patient suddenly develops chills, high fever, profuse sweating, extreme fatigue, pallor, and severe muscle and joint pain and headache, and in severe cases, delirium, coma and peripheral circulatory failure. In this stage can become the main cause of death, this type of untreated mortality rate is often more than 50%, mostly in the first 10 days to 4 weeks, after antibacterial drug treatment, fever subsides, the blood bacteria to reduce or even eliminate, physical strength is gradually recovered, some of the less serious cases can also be recovered on their own, but it is relatively slow, often months to half a year.
2. Peruvian warts
This type is the stage of skin damage, characterized by anemia or no antecedent symptoms, the skin appeared many wart-like rash, can be corn-like, nodular or large pieces of rotting flesh, the size of the 2 ~ 10 mm to 3 ~ 4 cm, the above three kinds of wart-like lesions can be seen in the same patient, to the sides of the limbs and the face is more, followed by the genitals, the scalp and the mucous membranes of the mouth and pharynx, the wart-like rash of different color, from red to purple, can persist for a month, and can be used for a long period of time. The wart-like rash varies in color from red to purple and may persist for 1 month to 2 years, and pathogens may be detected from the lesions.
The pathogen can be detected in the lesions.
1. Blood tests
Blood tests show a rapid drop in red blood cells, often from normal to 1.0×1012/L in 4-5 days, normal pigment macrocytic anemia, nucleated erythrocytes, Howell-Jolly bodies, Cabot rings and basophilic dots, and a mild increase in white blood cell counts with leftward shifting of the nucleus, which is associated with the presence of a large number of pathogens in the blood. Smear staining may show that 90% of the red blood cells have been invaded.
2. Pathogen culture
The blood culture should be done for the carrier to be clear. For Peruvian warts, tissue specimens can be stained with Giemsa’s stain, and the pathogen can be diagnosed.
3. Other tests
Recently, serum immunological tests, such as fluorescent antibody, indirect hemagglutination and enzyme immunoassay, have been used to help in epidemiological investigation and diagnosis.
Diagnosis
The disease should be suspected when patients in endemic areas have a history of lacewing bite and typical clinical manifestations, such as fever, progressive hemolytic anemia, enlarged lymph nodes, and warty rash. The diagnosis can be confirmed by finding the pathogen in a blood smear or a positive culture.
Treatment
1. Drug treatment
A variety of antibiotics such as chloramphenicol, tetracycline, penicillin and streptomycin have antibacterial effects on Mycobacterium avium. Chloramphenicol is the drug of choice for acute Mycobacterium avium infection, as it is also effective against the common complication of Salmonella infection. The fever usually subsides after 2 days of medication and the condition improves rapidly with it.
Although Bartonella in vitro is sensitive or hypersensitive to many antimicrobial drugs, such as doxycycline, erythromycin and its derivatives, aminoglycosides, rifampicin, and ciprofloxacin, there is no indication for the application of antimicrobial drugs in general cases.
For severe cases such as those with high fever, those with encephalitis and those with immunodeficiency, doxycycline, ciprofloxacin, rifampicin, or the combination of erythromycin and aminoglycosides for a period of 7 days or longer is appropriate.
2. Surgical therapy
Surgical removal of enlarged lymph nodes can be considered if the lymph nodes have not been reduced in size for more than 1 year. If the lymph node is purulent, puncture and aspiration of pus can be done to reduce the symptoms, and repeat the procedure after 2-3 days if necessary, and incision and drainage is not recommended.
3.Other therapies
The treatment of the disease is based on symptomatic therapy. Bartonella is highly sensitive to antibiotics in vitro, but only aminoglycosides have killing effect on Bartonella. Severe anemia can be transfused.