DR HUGO LUMBRERAS : ULTIMO VIAJE A HUAYOPAMPA: Huaral, 1985 BARTONELLOSIS 2015 Introduction, History and epidemiology CIRO MAGUIÑA, M.D. Research Vice-Rector, UPCH Alexander von Humboldt Tropical Medicine Institute FORMER DEAN OF THE PERUVIAN COLLEGE OF PHYSICIANS Specialist in Infectious Diseases – Tropical Medicine - Dermatology BARTONELLOSIS 2015 . Bartonella spp. ARE FASTIDIOUS HAEMOTROPIC Gram- negative bacteria which are mainly transmitted by vectors. Since the last 23 years , the number of Bartonella species or subspecies identified from a wide range of mammals has considerably increased. BARTONELLOSIS . Among the 13 species or subspecies known or suspected to be pathogenic for humans, FOUR have been isolated from CATS . DOMESTIC CATS ARE THE MAIN RESERVOIR FOR Bartonella henselae, the main agent of CSD. Also, Bartonella clarridgeiae has been suspected in a few cases of CSD and Bartonella koehlerae has been reported as a causative agent of endocarditis in humans and dogs Bartonellosis Molecular Biology Christoph Dehio, Infection-associated type IV secretion systems of Bartonella and their diverse roles in host cell interaction, Cellular Microbiology (2008) 10 (8), 1591–1598 Bartonellosis: Chomel BB, Kasten RW. Journal of aplllied Microbiology, 109 (20) 743-750, 2010 . Recently, Bartonella quintana was isolated from a pet cat and its owner. Domestic dogs have been shown to be infected with a broad range of Bartonellla species, such as B. vinsonii berkhoffii, B. Henselae, B. clarridgeiae, B. rochalimae, B. quintana, B. koehlerae, B. washoensis, and Bartonella elizabethae. Int J. Syst Evol Microbiology 2009 . Bartonella rattaustraliani sp. nov., . Bartonella queenslandensis sp. nov. Bartonella coopersplainsensis sp. Nov. Have been identified in Australian rats. Bartonella 2010 . Bartonella japonica sp. nov. Bartonella silvatica sp. nov., isolated from Apodemus mice. Int J. Syst Evol Microbiology 2010 http://www.ncbi.nlm.nih.gov/pubmed/1965693 0# New Bartonellas:1993-2015 . Bartonella weiss, Bartonella washoensis . Bartonella schoenbuchii,Bartonella birtlessi . Bartonella bovis, Bartonella capreoli . Bartonella rochalimae (Cusco, 2007) BACTEREMIA, FEVER, AND SPLENOMEGALY CAUSED BY A NEWLY RECOGNIZED BARTONELLA SPECIES JUNE 2007 Marina E. Eremeeva, M.D., Ph.D., Helen L. Gerns, B.A., Shari L. Lydy, Ph.D., Jeanna S. Goo, B.S., Edward T. Ryan, M.D., Smitha S. Mathew, B.S., Mary Jane Ferraro, Ph.D., Judith M. Holden, M.P.H., William L. Nicholson, Ph.D., Gregory A. Dasch, Ph.D., and Jane E. Koehler, M.D. B. rochalimae: Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 15, No. 12, December 2009 . Recently, B. rochalimae DNA was detected in a dog from Greece . High (43%) prevalence of bacteremia observed in gray foxes in California suggests that they might act as a wildlife reservoir for this newly identified species. Furthermore, several B.clarridgeiae–like and B. rochalimae genes have been detected in fleas collected from humans , rodents ,red foxes (Vulpes vulpes) , and the environment in the Democratic Republic of Congo (12) during a plague outbreak. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 15, No. 12, December 2009 . Conclusions : We report the isolation or detection of B. rochalimae from red foxes, raccoons, and coyotes from North America, Europe, and the Middle East. Sequence analysis of 4 genes identified small variations in B. rochalimae isolates from these different geographic regions. A relatively high percentage (26%) of raccoons had B. rochalimae bacteremia compared with only 9.5% (2/21) coyotes. B. tamiae (Thailand) J Clin Microbiol. 2008 February; 46 (2): 772–775. Bartonella tamiae sp. nov., a newly recognized pathogen isolated from three human patients from Thailand. Kosov, et al. J Clin Microbiol. 2008 February; 46 (2): 772–775. Centers for Disease Control and Prevention, Division of Vector Borne Infectious Diseases, 3150 Rampart Road, Fort Collins, CO 80521, USA. [email protected] (10) Heller R, Kubina M, Mariet P, Riegel P,Delacour G, Dehio C, et al.Bartonella al-saticasp. nov., a new Bartonella species isolated from the blood of wild rabbits. Int J Syst Bacteriol. 1999;49:283–8 . Bartonella spp. are zoonotic agents that infect erythrocytes of mammals in which they cause chronic bacteremia . B. alsatica was first identified in 1999 in Alsace, France, as an agent of bacteremia in healthy wild rabbits (Heller 10). However, in 2006, interest in B. alsatica increased when it was considered to be a human pathogen because it caused blood- culture–negative endocarditis in a patient who had contacts with rabbits (5). The present case confirms that B. alsatica could be a human pathogen, especially in persons who live in contact with rabbits and should also be considered as a cause of lymphadenopathy Bartonella alsatica: Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 12, December 2008 .Human Case of Bartonella alsatica lymphadenitis New species: Bartonella ancashi, July 2013. Emergent Infectious Diseases . This strain was an unknown species . This CO20 strain underwent genotyping (using rrs, gltA, and rpoB sequences). It was compared with the genetic bank of Bartonella species. The sequence 1351-bp from the rrs fragment was very similar to 99.0% of rrs from B. bacilliformis. Fragments 312 and bp 589, as well as gltA and rpoB fragments , respectively, were similar to some parts of Bartonella bovis : 89.4% (gltA), and 85.9% (rpoB), Diseases caused by Bartonella species in humans . B. bacilliformis : Carrion’ s disease (acute Oroya fever) and Peruvian warts . B. quintana BA, endocarditis, trench fever chronic bacteremia B. henselae CSD, BA, peliosis hepatis endocarditis, bacteremia, neuroretinitis . B. clarridgeaie CSD ( serology) . B. elizabethae Endocarditis . B. grahammi Neuroretinis . B. vinsonii . B. rochalimae Bacteremia CUTANEOUS BARTONELLOSIS Bacillary Angiomatosis (B. henselae and B. quintana) CONTRIBUTION TO STUDIES ON CARRION’S DISEASE AND OTHER Bartonella spp. Pre-Columbian Phase Mochica pottery CARRION’S DISEASE: Chronic phase Krumdieck CF. La Enfermedad de Carrion o Verruga Peruana en el Niño. Anales de la Facultad de Medicina 1949; 32 (4): 227-306. History of Carrion’s Disease . Between 1870-1890, 7,000 Andean railroad workers died . They were building the highest railroad in the world (Oroya’s railroad 3,800 meters above sea level) Bartonellosis: History .Mortality rates for the acute febrile phase varied around 40-90% in the pre-antibiotic era. LIMA-LA OROYA RAILROAD: 3,800 m above sea level Verrugas bridge (Km 61) Henry MEIGGS (USA) highest railroad in the world (Oroya’s railroad 3,800 meters above sea level) (1870-1885) Carrion’s disease, 2015 ´` . A Peruvian medical student, Daniel A. Carrión, self-inoculated fluid obtained from a verruga lesion . Days later he developed the acute phase of the disease with severe anemia and eventually died (Oct 5, 1885) Chilean soldier with ‘mullar’ lesions. He Patient with ‘mullar’ lesions probably became infected in the Rimac valley during the South Pacific war Garcia, U. Historiografia de la Enfermedad de Carrion. Ideas e Imágenes en la enfermedad de Carrión. Análisis Historiográfico de la Iconografia de la Bartonellosis Humana. Parte II. Folia Dermatológica Peruana 1999; 10 (1): 57-63. In 1905, Dr. Alberto Barton discovered the agent of Oroya fever and named it ‘endoglobular body’. In 1913, Townsend discovered the vector of the disease (“Titira”-Phlebotomus) (Today, Lutzomyia) (sandfly) Colombia has reported in the last 60 years only two cases of Carrion’s disease It is not a public health issue in Colombia Ecuador has reported cases in the coast at 150 m above sea level Alexander B. A review of bartonellosis in Ecuador and Colombia Am J Trop Med Hyg 1995; 52: 354-359. Bartonellosis (Carrion`s disease): Epidemiology . In Peru, the disease is endemic at an altitude between 500-3,200 meters above sea level. Cases have been reported from Andean valleys and the high rain forest. Bartonelosis en el Perú 1945 – 2005*(SE08) Tasa de Incidencia - Curva Histórica 36.00 32.00 28.00 24.00 Año 2004: Casos : 8,883 (A+V+P) 20.00 T.I. : 32 x 100,000hab. 16.00 T.M. : 0.18 x 100,000 hab. Tasa x 100 000 hab. 000 Tasa100 x 12.00 8.00 4.00 0.00 1945 1947 1949 1951 1953 1955 1957 1959 1961 1963 1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 Fuente: Ministerio de Salud – ESN-Metaxenicas - DGSP Años Case distribution: January – June 2012 Deaths caused by Carrion’s disease according to Departments and Regional Health Directions, Peru (2002-2012 June) Año Departamento DISA 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012* Total % Ancash 2 8 8 9 2 1 1 1 0 0 1 33 13.5 Cajamarca 22 11 40 12 4 5 2 0 1 6 4 107 43.7 Cajamarca 2 0 0 0 1 0 0 0 0 0 0 3 Chota 0 0 1 1 0 0 0 0 0 0 0 2 Cutervo 3 1 9 3 1 2 0 0 0 1 1 21 Jaén 17 10 30 8 2 3 2 0 1 5 3 81 La Libertad 3 1 2 0 4 3 0 0 1 0 0 14 5.7 Amazonas 4 12 10 0 2 2 0 0 1 0 1 32 13.1 Piura Piura 2 12 3 2 1 2 5 2 0 1 1 31 12.7 Cusco 1 0 2 2 1 0 5 1 0 0 0 12 4.9 Lima Lima Norte 0 0 0 0 1 0 0 0 0 0 0 1 0.4 Huánuco 0 0 0 4 1 0 0 0 0 0 0 5 2.0 Ayacucho 0 0 0 0 3 0 0 0 0 0 0 3 1.2 Lambayeque 1 0 0 0 1 3 0 0 0 0 5 2.0 San Martín 0 1 0 0 0 0 0 0 0 0 0 1 0.4 Loreto 0 0 0 0 0 1 0 0 0 0 0 1 0.4 Total 35 45 65 29 20 14 16 4 3 7 7 245 100.0 Fuente: DGE-RENACE.