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Reports suggest that relapses or recurrences of Oroya fever are rare. According to experts, recurrence of fever after initial improvement of symptoms is considered suggestive of a secondary infection. Following resolution of the acute stage of infection (Oroya fever), untreated individuals typically develop distinctive skin lesions within weeks or months. As noted above, verruga peruana may develop in individuals who have or have not had previous symptoms of Oroya fever. Verruga peruana is typically

characterized

Affected individuals may develop sudden fever, chills, weakness, headache, dizziness, leg and back pain, and/or other abnormalities. Initial fever may last about four to five days and may recur one or several times, with each episode lasting about five days. Additional findings may include a temporary skin rash consisting of flat (macular) or raised (papular) lesions, and/or enlargement of the liver or spleen (hepatomegaly or splenomegaly).

Trench fever is usually a self-limiting disease, although relapses and chronic bacteremic states are well known. quintana infection has also been reported in immunocompromised individuals, such as in association with AIDS.

Bartonella bacteria invade red blood cells (erythrocytes) and the lining of the blood vessels (endothelial cells), where the organism proliferates.

Inside the erythrocytes, it is protected from the host’s primary and secondary immune response, thus explaining bacterial persistence that can occur in some cases.

Cat scratch disease: Cat scratch disease is caused by the B. Most cases follow a lick, scratch, or bite from a cat or kitten when the bacterium is present on the cat’s claws or oral cavity.

Some case reports have suggested transmission may occur from cat fleas directly to humans, but this has not yet been proven.

Cat-to-cat and person-to-person transmission has not been documented.

There have also been reports of the disease following the scratch or bite of dogs in 5% of cases.

henselae , which indicates that they have been previously exposed to these bacteria. henselae by fleas, preventing flea exposure will reduce B. henselae infection in cats and kittens and thereby prevent human infection.

Kittens under 12 months of age are much more likely to transmit the disease than adult cats. Outdoor cats and cats infested with fleas are also more likely to show antibodies (test seropositive) to B.

Animals that are carrying the disease are not ill, and will not exhibit any symptoms.

Not every person exposed to the carrier animal will develop cat scratch disease, and in most cases the symptoms are temporary (transient) and mild. bacilliformis is the etiologic agent of Carrion’s disease or Oroya fever (acute phase of infection) and verruga peruana or Peruvian warts (chronic phase of infection).

The bacterium is primarily carried and transmitted by the night-biting sand fly known as Lutzomyia (formerly Phlebotomus).

bacilliformis bacterium enters the bloodstream via the bite of the sand fly, enabling the bacterium to attach to the surface of erythrocytes.

Bacterial invasion and reproduction leads to abnormal fragility and premature destruction of many erythrocytes in the bloodstream (hemolysis). This results in abnormally decreased red blood cell levels and reduced concentrations of hemoglobin, the oxygen-carrying component of the blood (hemolytic anemia). In addition, the bacterium may invade cells lining small blood vessels (capillary endothelial cells), potentially leading to blockage of normal blood flow (vascular occlusion). Severe hemolytic anemia and the abnormal formation of blood clots within small blood vessels may potentially lead to life-threatening complications without prompt appropriate treatment. With developing immunity, levels of the bacterium markedly decrease in the blood. However, without appropriate antibiotic therapy, asymptomatic low-grade bacteremia may persist for months or years in some cases.

Following the symptom-free (latent) period, most untreated individuals develop the distinctive skin lesions characteristic of verruga peruana.

The nodular lesions consist of newly formed blood vessels (neovascular proliferation) infiltrated by certain white blood cells that play an important role in fighting and destroying invading microorganisms (e.g., lymphocytes, macrophages). Trench fever: Trench fever is caused by infection with B.

quintana most likely transmitted by the human body louse ( Pediculus humanus ) and is commonly found in homeless, alcoholic, and poverty-stricken populations where poor sanitation and poor hygiene often occurs.

Other diseases that have been identified to be caused by B. quintana include bacillary angiomatosis (angioproliferative lesions), bacteremia, and endocarditis.

Human endocarditis has now been associated with at least nine different Bartonella spp. berkhoffii has been isolated from immunocompetent patients with endocarditis, arthritis, neurological disease and vasoproliferative neoplasia.

Dogs and wild canines (foxes, coyotes, wolves), which are the primary reservoir hosts, are the suspected reservoir hosts for this bacterium, and ticks are the suspected vectors, but this has not been scientifically proven. Most infections in immunocompromised patients are caused by B. Unlike immunocompetent individuals who usually develop milder diseases such as cat scratch disease and trench fever, immunocompromised patients, including HIV/AIDS and posttransplant patients, are more likely to develop more severe, potentially life-threatening disease.

hensela e infection occurs in approximately 1 per 10,000 persons. Cat-scratch disease has been shown in some studies to occur more frequently in males than females with a ratio of 3:2. However, other studies have shown equal rates between males and females. One hypothesis to explain a greater incidence among males than females is the tendency toward rougher play with cats and consequently an increased risk of bites and scratches.

A database analysis in 2016 showed 33% of patients with CSD were 14 years of age or younger.

Cases of CSD occur throughout the United States and worldwide, with the incidence greater in regions with higher temperatures and humidity, which supports heavy flea populations.

In the United States, the majority of cases occur between the months of July and January. One study in 2016 concluded that incidence of CSD in the United States is higher in the South and lower in the West.