Oroya fever

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Classification according to ICD-10
A44.0 Systemic bartonellosis, including Oroya fever
ICD-10 online (WHO version 2019)

The Oroya fever ( Carrión's disease ) is a caused by the bacterium Bartonella bacilliformis caused disease. The sand flies of the New World genus Lutzomyia transmit the bacterium from person to person as a vector . The disease occurs in the habitat of the vector in South America on the western slopes of the Andes above 800 m altitude in Peru, Ecuador and Colombia. The bacterium lives primarily in erythrocytes , secondarily colonizing the spleen and other organs. The only known reservoir is humans. Oroya fever belongs to the group of bartonellos .

Course of disease

  • 16 to 22 days for the hemolytic form of bartonellosis: Oroya fever with high fever, lymph node swelling, hepatosplenomegaly , severe hemolysis due to destruction of the erythrocytes. This is followed by a phase of pronounced immunosuppression, which earlier, without antibiotics, was mostly fatal, mainly because of secondary infections.
  • Without treatment with antibiotics ( ciprofloxacin , levofloxacin , doxycycline or rifampicin ) the main stage of this bartonellosis, the so-called verruga peruana ( Peruvian wart ), develops two to four months later . This condition usually lasts a few months before it heals spontaneously (if antibiotic treatment with rifampicin and ciprofloxacin or levofloxacin is not recommended).
A Chilean soldier with large warts as a symptom of Oroya fever, which he contracted while fighting in the ravines of the Río Rímac during the Saltpeter War (1881)

Historical

In the second half of the 19th century, the American entrepreneur Henry Meiggs financed the construction of the highest railway in the world: across the Peruvian Andes from Lima to Oroya at up to 5,000 m above sea level. It was hoped that huge amounts of mineral resources would be excavated there. Workers were recruited across Peru and Chile to help build railroads. In 1869 the route left the lowlands and reached heights of over 1000 m along the Rimac River. The Verrugas Bridge also belonged to the route . Thousands of railway workers lived in the worst hygienic conditions. A completely new disease occurred in the mass accommodation. The workers first had a high fever before thousands of them died of severe anemia (anemia) and secondary infections such as miliary tuberculosis , shigellosis and salmonellosis . However, the disease was far from new in this region.

As early as 1540, Valdizan, Francisco Pizarro's military reporter, reported an outbreak of an illness among the soldiers that began with a high fever and after a while left the survivors with blood-filled warts. That was the oldest written tradition in connection between the febrile illness (Oroya fever) and the Peruvian warts (Verruga peruana). This connection was proven by the fatal self-experiment of the Peruvian medical student Daniel Alcides Carrión (1857–1885), after whom the disease was later named.

However, the warts not only adorned pictorial representations of people on pottery and steles, but even pre-Columbian mummies.

This knowledge was forgotten, so that the disease was re-described in 1915 by Richard Pearson Strong on a scientific expedition at Harvard University under the name of Oroya fever. Alberto Barton discovered the pathogen as early as 1905 .

literature

Individual evidence

  1. ^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 186.
  2. ↑ Top 10 Researchers who Experimented on Themselves