View source for Bartonella bacilliformis

==Background==
===Epidemiology===
* Range is essentially restricted to the Andean mountains in Peru, Ecuador, and Colombia
* Transmitted by ''[[Has vector::Lutzomyia]]'' sand flies
* Humans are primary reservoir

==Clinical Manifestations==
* Traditionally presents as a biphasic illness with an acute phase ('''Oroya fever''') and a late phase ('''verruga peruana''')
* The acute phase starts after an incubation period of 3 to 12 weeks, and is characterized by fever, malaise, and a hemolytic anemia
** May only last a week and not present for medical care
** More severe disease can include high fever, chills, diaphoresis, anorexia, prostration, headache, and altered mental status
** The anemia can be profound in severe disease
** May be accompanied by severe myalgias and arthralgias, abdominal pain, emesis, jaundice, lymphadenopathy, thrombocytopenia, seizures, delirium, meningoencephalitis, obtundation, dyspnea, hepatic dysfunction, and angina, likely secondary to anemia and microvascular thrombosis
** Severe disease has high mortality if untreated, but decreases to 10% if treated
* The late phase occurs weeks to months after the acute phase, and is characterized by disseminated nodular skin lesions
** Crops of lesions proceed from miliary, to nodular, to mulaire lesions
** Mulaire lesions are superficial vascular bulbous lesions that can bleed and ulcerate
** Lesions can also be internal
** Lesions can come and go, with recurrences, over weeks to months

==Diagnosis==
* During acute phase, may see intraerythrocytic bacteria on blood film

==Management==

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