These infections are caused by gram-negative, small and pleomorphic. Until recently only considered the pathology related to Bartonella baciliformis , but recently have included the microorganisms for Rochalimaea that Bartonella quintana comeprenden agent of trench fever, Bartonella henselae (agent of cat scratch disease and bacillary angiomatosis) and Bartonella elisabethae. Other components of the genre have not been demonstrated, for the time being pathogenic to humans.
B. INFECTION bacilliformis ETIOLOGY
B. bacilliformis is a gram small, pleomorphic, aerobic gram-negative and stained pinkish-purple with Giemsa and grows well in rich media.
EPIDEMIOLOGY
is endemic to the Andes, especially Peru, Ecuador and Colombia, which clearly relates to the habitat of the mosquito vector (Phlebotomus verrucarum ).
The only reservoir for the disease is the human being. CLINICAL - Oroya fever (or disease Carrion) is the acute form of infection. After an incubation period of 2 to 4 weeks, appears remittent fever, musculoskeletal pain, headache, painful lymphadenopathy and hemolytic anemia ( Bartonella adheres to the surface favoring erythrocyte deformation). There may be hepatomegaly and splenomegaly. In severe froma may have delirium, drowsiness and coma. It is frequently associated with other infections, especially Salmonella .
- Peruvian wart is the chronic form of infection that occurs in individuals who had acquired immunity.
is characterized by nodules in the face and extremities in the form of outbreaks, may be accompanied by fever and joint pain. DIAGNOSIS
In Oroya fever, the diagnosis is made by observation of the germ in the red cells stained with Giemsa or Wright. In the Peruvian wart, the seed can be grown from injuries and occasionally blood.
TREATMENT AND PREVENTION
The treatment of choice in acute froma is chloramphenicol (2 g / day for 7 days). response to treatment is rapid, whereas without treatment the mortality ranges from 10-40%. penicillin and tetracycline are also effective. the warts respond slowly to treatment and required ocaasiones excised. Prophylaxis is aimed at combating vector.
FEVER OR THE TRENCHES QUINTANA
quintana fever, fever of five days Wolhynia disease, Meuse feverThe Trench Fever disease is transmitted by the human louse. This disease was described extensively during WWI and WWII. At present, the disease is reported in destitute and homeless. [ 1 ] outbreaks have been reported United States and France.
Other names that are known Wolhynia fever, trench fever, five days of fever, Meuse fever, Werner-His disease. ETIOLOGY
The causative agent is the bacterium Bartonella quintana and the vector is the human louse Pediculus humanus corporis .
PATHOLOGY AND TRANSMISSION
Bartonella quintana is transmitted by contamination of a wound in the skin of the human louse feces or by the bite of the louse Pediculus humanus corporis . SYMPTOMS
The disease has been classically described by a fever of five days, rarely recurrent and continuous. The incubation period is about 2 weeks. The onset of symptoms is sudden with high fever, headache, painful eye movement, leg and back muscle pain and hyperesthesia in the front legs. The initial fever is followed within days by a fever peak short-term or relapsing asymptomatic periods between peaks. The most commonly reported symptom is pain in the legs. Fatal cases are exceptional. DIAGNOSIS
Serological tests ( Weil-Felix test ) is useful for diagnosis. The differential diagnosis includes typhus, ehrlichiosis , leptospirosis, Lyme disease and rashes caused by viruses ( measles, rubella , etc).
TREATMENT
Tetracyclines (doxycycline ) are effective. Chloramphenicol is an alternative treatment (in cases of liver disease, kidney failure, pregnancy). treatment duration is for 7 to 10 days.
Angiomatosis, Bacillary
INTRODUCTION
Sincedescribed Inmunodeficiencla Syndrome (AIDS) became evident that a prominent feature of their pathology was the frequent occurrence of Kaposi's Sarcoma, a form of vascular neoplasia, which appeared especially aggressive in the final stages (1,2,3) .
LeBoit et al in 1988. describe seven AIDS patients with papular and nodular lesions of the skin, clinically similar to Kaposi's sarcoma, but histologically morphology showed epitelloide hemangioma (histiocytoid). Electron microscopy showed bacillary colonies and stains for organisms revealed that they took the Warthin Starry, appearing similar to the microorganisms found in cat scratch disease. Using an antiserum to bacilli of cat scratch disease, prepared in rabbits, and the immunoperoxidase staining technique, were able to show in the five cases investigated, the bacteria gave a positive reaction. Finally, the authors note the similarity of the lesions with those described in the Peruvian wart (7) . Numerous
Subsequent investigations confirmed the occurrence in AIDS patients, vascular lesions other than Kaposi-with the characteristics listed above, and was so recognized this entity as "bacillary angiomatosis" or "bacillary angiomatosis epiteliolde" (8.9) .
Although the finding of a positive reaction with antibodies to Afipia felis (10) - the bacillus that causes cat scratch disease, in cases of bacillary angiomatosis, suggested the identity of pathogens (11) , subsequent investigations led to the recognition that bacillary angiomatosis and parenchymal bacillary peliosis, and persistent bacteremia were produced by a new pathogen: a rickettsia, initially named as Rochalimae henselae (12, 13) .
Subsequently biochemical and molecular genetics Rochalimae crops have established the difference with Afipia felis (14,15,16) and final reclassification in the genus of Bartonella (17 ) : Bartonella henselae. At present it is accepted that bacillary angiomatosis is caused by Bartonella henselae and by Bartonella quintana and the cat scratch disease can be caused both by the Afipia felis as the Bartonella henselae (18,19,20,21) .
ETIOLOGY
bacillary angiomatosis is one of the most interesting developments in the pathology of late. Unlike Kaposi's disease, a neoplastic process that spreads evil characters, bacillary angiomatosis, which is also a vascular proliferation, is a unique reactive process in response to infection with Bartonella henselae , and responds favorably to antibiotic treatment, as we had the opportunity to verify in this case report.
Injuries angiomatous similar to those described in the skin have been reported in the respiratory and gastrointestinal mucosal (24) . In the liver and spleen, the reaction takes the form of the so-called peliosis ", which form large spaces filled with blood sinusoldales (25,26) . Ocular injury in our case is of particular interest because such a finding reported the occurrence of this disease in the bulbar conjunctiva.
The pathogenesis of the process deserves special attention. We have already stressed that Bartonella henselae is the causative agent of anglomatosis and most cases of cat scratch disease. Hence it is logical to think that the relationship with cats can be a contributing factor to the occurrence of the disease also in bacillary angiomatosis. When serological surveys have been conducted in healthy domestic cats in the United States, the prevalence of seropositivity for Bartonella henselae has been as high as 50% (27) . When specifically investigated the pets of patients with cat scratch disease, 89% were bacteremic with Bartonella henselae , compared with 28% of cats in the control group (28) . In our patient, we found a history of contact with cats for ten years, which could indicate a long period of latent infection.
Some questions, no definite answer today is: why Bartonella henselae injury occurs in some cases as those of cat scratch disease and in other cases of bacillary angiomatosis?. or, on the other hand, why Bartonella quintana occurs in some cases of trench fever and in other cases the lesions of bacillary angiomatosis?. LeBoit has been speculated, given the angiogenic factor described by Garcia et al. (29) in cultures of Bartonella baciliformis, that the addition of a plasmid of Bartonella henselae or quintana could encode a protein with the same Anglo-stimulating effect than that produced the Bartonella baciliformis (24) . The similarity between the histological reaction of the Peruvian wart (30) and bacillary angiomatosis is certainly remarkable.
Both processes are, as a basic alteration of endothelial cell proliferation that can be made good or bad hair and take on cases, a pseudo-tumoral aspect epitelloide (31) . The fact that the two processes are produced by bacteria of the same gender adds interest to the comparison and opens the door to a field of research in the pathogenesis each of them. While in the Peruvian wart warty button appears in the final phase of the infection and is supported so far, is the expression of specific immunity in the lymph angiomatosis occurring in an immunocompromised patient. Without doubt, much learned from the study of companion cells to the endothelial reaction. Today it is possible the characterization of lymphocyte cells, with new techniques inmunohitoquímicas, imposes its investigation in the two processes.
Finally, in our environment we must pay attention to the occurrence of bacillary angiomatosis, not only because it is a strange disease that occurs in patients with AIDS, but also because it has been described in immunocompetent individuals (32,33) and in these cases confusion with Peruvian wart will be more feasible.
REFERENCES
- Milonakis, Eleftherios, and Michael A. Forgione. "Trench Fever." EMedicine. 26 June 2006. 11 June 2007
- Farreras. Treaty of Internal Medicine. 14 th edition. Barcelona: Harcourt, 2000. WIKIPEDIA
- http://es.wikipedia.org/wiki/Fiebre_de_las_Trincheras 2008
- Arias-Stella, J. Dermatology Folia Peruvian-vol. 7 n º 2. June 1996.
2008
