NATURE 119 EPIDEMIOLOGY of BARTONELLOSIS Bartonella to Infestations with the Cestode Hymfmo• Lepis Nana Var
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No. 3926, JANUARY 27, 1945 NATURE 119 EPIDEMIOLOGY OF BARTONELLOSIS Bartonella to infestations with the cestode Hymfmo lepis nana var. fraterna, when the whole spleen (that F any biologist requires a problem which will is, a large part of the reticulo-endothelial system) I exercise to the full his patience and experimental is removed. skill, he could get it from the monograph "In Historically the cutaneous form of human barton fectious Anffimias due to Bartonella and Related ellosis, Verruga peruviana (Verruga peruana), was Red Cell Parasites", by David Weimnan (Trans. known to the pre-Inca inhabitants of Peru. Among Amer. Phil. Soc., Philadelphia, New Series, 33, Part 3, the illustrations of operations and diseases found on 1944). Weimnan was parasitologist to ancient pottery ('huacos') "pertaining to the Chimu the Harvard Expedition to Peru in 1937, which finally civilization", Verruga peruviana has been identified. established the fact that Bartonella bacilliformis is the When the Spaniards arrived, they found that Verruga cause of both Oroya fever and Verruga peruviana peruviana was already distinguished in the Keshua (Verruca peruviana, Verruga peruana), both of which language from the common wart and other diseases, are sometimes called Carri6n's disease. Carri6n, one and the very first group of conquering Spaniards of the pioneers of the study of these South American suffered from it. Less appears to be known about the diseases, died of Oroya fever after inoculating him history of the anffimic form of human bartonellosis self with verruga material. (Oroya fever). A serious epidemic of it in 1870 in As Prof. Tyzzer says in his preface to this mono workers building a railway from Lima to Oroya graph, the symptoms of these two diseases are so caused 7,000 deaths, and this and later epidemics different that it is not surprising that they were, led to the popular saying that "every crosstie in the until comparatively recently, considered to be due railroad represented a human life". The nature of to different organisms. The main symptoms of Oroya fever was not clearly known until Carri6n. Oroya fever are fever, marked pain in the head, joints who was dissatisfied with the existing knowledge of and bones and a rapidly developing alll£mia. If the Verruga peruviana, decided to inoculate himself with patient does not die in a few weeks, a verrucous verruga material. He developed Oroya fever and stage may follow. The mortality is 40 per cent or died of it on October 5, 1885. It was not until 1905 Jrigher. Verruga peruviana is a milder infectious that Barton described bodies in the blood which were, disease in which superficial and deep nodules appear. he claimed, living organisms and the cause of Oroya The superficial ones resemble warts and are about fever. His claims were not accepted until the 1913 the size and colour of cranberries when they are Harvard Expedition to Peru confirmed Barton's mature; the subcutaneous ones are larger, less findings and gave the name Bartonella bacillifarmis 'numerous and often erode the skin surface. These to the bodies which he had described. This Expedition eruptions last from one to twelve months and then made great contributions to our knowledge of the disappear. Mortality is low. Latent infections with disease. But its etiology remained obscure until Barronella bacillifarmis may occur without symptoms. Noguchi and Battistini cultivated B. bacillifarmis. It is now known that both diseases are due to the The 1937 Harvard Expedition to Peru finally estab single species of Bartonella-Bartonella bacilliformis- lished the fact that B. bacillifarmis causes both Oroya which was formerly classed among the Protozoa, but fever and Verruga peruviana. is now classified by Tyzzer, Weimnan and others as a B. bacillifarmis is extremely polymorphous, and its flagellated bacillus. taxonomy, microscopical appearance, cultivation and The two diseases caused by this organism are both behaviour in experimental animals are fully described confined, at present, to a restricted area of South by Weimnan. The symptoms of the various forms America, namely, to a narrow strip of the Andes in of the two diseases which it causes are also described Peru to foci in the south-west of Ecuador and to the in detail. The section on epidemiology and trans neighbourhood of the city of Pasto in Colombia. mission by sandflies is valuable. Phlebotom1t8 verru Central American foci in Honduras and Guatemala carum seems to be the most important vector of the have been suspected, but have not been proved. three species of Phlebotomus occurring in those areas Weinman points out, however, that human bar of Peru in which bartonellosis is endemic (P. verru tonellosis appears to be spreading in its epidemic carum, P. noguchii, P. peruensis). The four other form. In animals the related genera H mmobartonella Peruvian species of Phlebotomus have not yet been and Eperythrozoon, which have been, for reasons dis incriminated; and no other blood-sucking arthropod cussed by Weinman in this monograph, removed from has been shown to be naturally infected with Barton the genus Bartonella, are widely distributed and may ella. Infection by contact does not occur in ordinary be present in laboratory animals used for studies of circumstances. The disease has, however, been re the blood or reticulo-endothelial system or for nutri ported as a new one in Colombia since 1935, and tional and other problems; they may profoundly none of the Peruvian sandfiies has yet been collected affect the results of these studies. The comparative in Colombia. This suggests that B. bacilliformis was study of animal bartonellosis may, Weinman thinks, introduced into Colombia and then became estab illuminate the etiology, pathogenesis and treatment lished in the Colombian sandfiies, rather than that of blood diseases. This study has already revealed Peruvian infected sandfiies became acclimatized in that the spleen has an important immunological Colombia (as, for example, African Anopheles gambim function in animals infected with Bartonella. It became established in Brazil in 1939 and caused maintains an equilibrium between certain of these there one of the most devastating epidemics of parasites and their hosts, which is so perfect that malaria known to history (see Nature, 153, 765; infection may never be apparent unless splenectomy May 20, 1944)). If this is so, the question arises is performed; and the study of this function of the whether other species of Phlebotomus could become spleen may give us new information about the relation vectors of B. bacilliformis. This question has not of the spleen to immunity. We are here reminded of been studied experimentally. It is important, because 'the work of E. Larsh, jun. (Amer. J. Hyg., 39, 133 ; sandflies which bite man are widely distributed 1944; and Trop. Dis. Bull., 41, 765; 1944) on the throughout the world in tropical and temperate increased susceptibility of mice not infected with countries (cf. the part they play in transmitting to © 1945 Nature Publishing Group 120 NATURE JANUARY 27, 1945, VOL. 155 man the cause of human cutaneous leishmaniasis a very small region, some 7,000 people died; and (Leishmania tropica) in the Gerbils and Sousliks of in Colombia more recently 4,000 deaths have been the deserts of middle Asia, described in a review of attributed to bartonellosis in one year (1938). The Russian work on this question by C. A. Hoare (Trop. disease is, so far as we know, restricted to Peru, Dis. Bull., 41, 331; 1944)). Modern rapid methods Colombia and Ecuador, and is irregularly distributed of transport could either carry the sandilies which in a long, narrow area of the Andes, 1,000 miles transmit Bartonella or infected human beings to an long by about 100 miles wide, in which it occurs area inhabited by uninfected sandfiies. at moderate altitudes, near water and most often Two alleged cases of congenital transmission of in narrow valleys; but it is probable that its distribu Baf'tonella in man are reported by Weinman, and tion is incompletely known. the factors affecting susceptibility and resistance to Man is both the victim and reservoir of Bartonella the infection are discussed. Man is the only important bacilliformis and no other animal naturally infected known source of B. bacilliformis, and Phlebotomus with this species is known, except the sandily vector. the only other animal known to be naturally infected. Weinman discusses fully the epidemiological evidence There is, however, some evidence that dogs may be for this. Further knowledge of the insect vector is naturally infected sometimes. The suggestion that required, because most of our knowledge about it domestic animals, lizards, rats and some plants may has been worked out in Peru only. The nocturnal be reservoirs of the infection has not been confirmed. biting activity of the sandily explains why the Weinman discusses at length the immunology, treat disease is chiefly contracted at night, and this bio ment and control of the infection, but these complex logical fact has been used for control. Workmen questions cannot be discussed here. Treatment of repairing a railway bridge over the Rimac River Oroya fever is the most important, because of its were, for example, removed by train from the bridge high mortality, but the study of it is handicapped in time to be outside the endemic zone before night by our inability to produce the syndrome at will in fall. Phlebotomus-proof buildings would be equally experimental animals. effective, and when Shannon lived for months in one In Chapter 2 Weinman discusses the genus of these in an endemic area, he did not become Hwmobartonella, created by Tyzzer and Weinman in infected; but the expense of providing them for 1939, to include Bartonella-like organisms which do everyone would be great. Repellents applied to the not multiply outside the blood and do not produce body and insecticides are said to help protection.