Bartonella bacilliformis: Difference between revisions

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Bartonella bacilliformis
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===Epidemiology===
 
===Epidemiology===
 
* Range is essentially restricted to the Andean mountains in Peru, Ecuador, and Colombia
 
* Range is essentially restricted to the Andean mountains in Peru, Ecuador, and Colombia
* Transmitted by ''[[Has vector::Lutzomyia]]'' sand flies
+
* Transmitted by ''[[Vector::Lutzomyia]]'' sand flies
 
* Humans are primary reservoir
 
* Humans are primary reservoir
   
==Clinical Presentation==
+
==Clinical Manifestations==
 
* Traditionally presents as a biphasic illness with an acute phase ('''Oroya fever''') and a late phase ('''verruga peruana''')
 
* Traditionally presents as a biphasic illness with an acute phase ('''Oroya fever''') and a late phase ('''verruga peruana''')
* The acute phase is characterized by fever, malaise, and a hemolytic anemia
+
* The acute phase starts after an incubation period of [[Usual incubation period::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
* The late phase is characterized by nodular skin lesions
 
  +
** 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==
 
==Diagnosis==

Latest revision as of 09:47, 5 August 2020

Background

Epidemiology

  • Range is essentially restricted to the Andean mountains in Peru, Ecuador, and Colombia
  • Transmitted by 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