Lydy Shari L, Eremeeva Marina E, Asnis Deborah, Paddock Christopher D, Nicholson William L, Silverman David J, Dasch Gregory A
Rickettsial Zoonoses Branch, Mail Stop G-13, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
J Clin Microbiol. 2008 Feb;46(2):627-37. doi: 10.1128/JCM.01207-07. Epub 2007 Dec 19.
Carrion's disease is typically biphasic with acute febrile illness characterized by bacteremia and severe hemolytic anemia (Oroya fever), followed by benign, chronic cutaneous lesions (verruga peruana). The causative agent, Bartonella bacilliformis, is endemic in specific regions of Peru and Ecuador. We describe atypical infection in an expatriate patient who presented with acute splenomegaly and anemia 3 years after visiting Ecuador. Initial serology and PCR of the patient's blood and serum were negative for Bartonella henselae, Bartonella quintana, and B. bacilliformis. Histology of splenic biopsy was suggestive of bacillary angiomatosis, but immunohistochemistry ruled out B. henselae and B. quintana. Bacilli (isolate EC-01) were subsequently cultured from the patient's blood and analyzed using multilocus sequence typing, protein gel electrophoresis with Western blotting, and an immunofluorescence assay (IFA) against a panel of sera from patients with Oroya fever in Peru. The EC-01 nucleotide sequences (gltA and internal transcribed spacer) and protein band banding pattern were most similar to a subset of B. bacilliformis isolates from the region of Caraz, Ancash, in Peru, where B. bacilliformis is endemic. By IFA, the patient's serum reacted strongly to two out of the three Peruvian B. bacilliformis isolates tested, and EC-01 antigen reacted with 13/20 Oroya fever sera. Bacilliary angiomatosis-like lesions were also detected in the spleen of the patient, who was inapparently infected with B. bacilliformis and who presumably acquired infection in a region of Ecuador where B. bacilliformis was not thought to be endemic. This study suggests that the range of B. bacilliformis may be expanding from areas of endemicity in Ecuador and that infection may present as atypical clinical disease.
卡里翁病通常分为两个阶段，急性发热期以菌血症和严重溶血性贫血为特征（奥罗亚热），随后是良性慢性皮肤病变（秘鲁疣）。病原体巴尔通体杆菌在秘鲁和厄瓜多尔的特定地区流行。我们描述了一名外籍患者的非典型感染，该患者在访问厄瓜多尔3年后出现急性脾肿大和贫血。患者血液和血清的初始血清学检测及聚合酶链反应（PCR）结果显示，针对汉赛巴尔通体、五日热巴尔通体和杆菌状巴尔通体均为阴性。脾脏活检的组织学表现提示杆菌性血管瘤，但免疫组织化学排除了汉赛巴尔通体和五日热巴尔通体。随后从患者血液中培养出杆菌（分离株EC - 01），并使用多位点序列分型、蛋白质凝胶电泳及Western印迹法，以及针对一组秘鲁奥罗亚热患者血清的免疫荧光试验（IFA）进行分析。EC - 01核苷酸序列（gltA和内转录间隔区）及蛋白质条带模式与来自秘鲁安卡什卡拉兹地区的杆菌状巴尔通体分离株亚群最为相似，该地区是杆菌状巴尔通体的流行区。通过IFA检测，患者血清与所检测的三株秘鲁杆菌状巴尔通体分离株中的两株反应强烈，且EC - 01抗原与13/20份奥罗亚热血清发生反应。在该患者的脾脏中也检测到了类似杆菌性血管瘤的病变，该患者隐性感染了杆菌状巴尔通体，推测其感染发生在厄瓜多尔一个原本认为不是杆菌状巴尔通体流行区的地方。这项研究表明，杆菌状巴尔通体的分布范围可能正在从厄瓜多尔的流行区向外扩展，且感染可能表现为非典型临床疾病。
