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Carrion's disease

This article is a very small one, and could be improved on in content. I plan to add a little bit more to most of the existing sections, including a bit more to the lead section, any relevant modern history or epidemiology I can find, and more on symptoms and treatments. While it has all of these sections, most of them have very little information in them.

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Etiological Agent
Carrion's disease is one of several diseases caused by Bartonella bacteria.

There is little research on the disease's natural spread or impact in native animals, but the disease has been experimentally replicated in Rhesus monkeys.

Epidemiology
Sand flies serve as vectors for B. bacilliformis. Most cases are reported in Peru .Children have historically been among the most commonly affected by Carrion's disease. Mortality in the last fifty years of studies has ranged from 10-23%, and disproportionately affects children and pregnant women; however, mortality is often due to comorbid infections and indirect complications of the respiratory, cardiovascular, neurological, or gastrointestinal systems.

As of December 2015, there is no knowledge of any other vectors or nonhuman reservoirs of the disease.

It is believed that outbreaks of Carrion's disease are influenced to the El Nino Southern Oscillation climate phenomena.

There are few methods of preventing Carrion's disease, due to the prevalence of the sand flies that spread the disease in its range. Milder cases of Carrion's disease may present with fewer and less severe symptoms, and thus go undiagnosed and unrecognized. Infection by Bartonella is not always accompanied by physical symptoms of Carrion's disease.

General Signs and Symptoms
An individual can be affected by either or both phases.

Acute phase: (Carrion's Disease or Oroya Fever ): also called hematic phase
Other symptoms include headache, muscle aches, general abdominal pain ,and cardiac murmurs. In children, symptoms have also been found to include anorexia, nausea, and vomiting. Most of the mortality of Carrion's disease occurs during the acute phase. Mortality has been estimated as low as just 1% in studies of hospitalized patients, to as high as 88% in untreated, unhospitalized patients. Mortality is often due to subsequent infections due to the weakened immune symptoms and opportunistic pathogen invasion, or consequences of weight loss due to malnutrition in children.

In pregnant women with the acute phase, mortality rates are estimated at 40% and rates of spontaneous abortion in another 40%.

Chronic phase: also called tissue phase
The lesions often ulcerate and bleed. Joint pain is a common finding. Mortality during the chronic phase is very low. The chronic phase is the more common phase, and most common in children.

On microscopic examination, the chronic phase and its rash is produced by angioblastic hyperplasia, or the increased rates and volume of cell growth in the tissues that form blood vessels. This results in a loss of contact between cells and a loss of normal functioning.

Treatment
Because Carrion's disease is often comorbid with Salmonella infections, Chloramphenicol has historically been the treatment of choice. Chloramphenicol-resistant B. bacilliformis has been observed. Azithromycin, erythromycin, and ciprofloxacin have been used successfully for treatment during the eruptive phase, in which chloramphenicol is not useful.

Because of the high rates of comorbid infections and conditions, multiple treatments are often required. These often include the use of corticosteroids for respiratory distress, red blood cell tranfusions for anemia, pericardiectomies for pericardial tamponades, and other standard treatments.

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