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South American bartonellosis: Oroya fever and verruga peruana

David H Spach, MD
Ciro P Maguina, MD
Eloy E Ordaya, MD
Section Editors
Stephen B Calderwood, MD
Morven S Edwards, MD
Deputy Editor
Elinor L Baron, MD, DTMH


South American bartonellosis, or Carrion's disease, is an infection caused by Bartonella bacilliformis that is transmitted by phlebotomine sand flies. Typically, this condition has been considered a biphasic illness characterized by an initial febrile phase, known as Oroya fever, followed by a secondary phase characterized by development of skin lesions, known as verruga peruana. Subsequently, however, variable clinical patterns associated with this infection have been observed, ranging from asymptomatic bacteremia to fulminant illness [1,2].

Issues related to B. bacilliformis will be reviewed here; issues related to infection caused by other Bartonella species are discussed separately. (See related topics.)


There is evidence from pre-Columbian artifacts that the cutaneous form of the disease was present in South America at least 1000 years prior to the arrival of Europeans [3]. During the Inca era, the disease was called "Sirki," which means "warts in blood."

In 1885, Daniel Alcides Carrión, a Peruvian medical student, demonstrated that the two phases of illness are caused by the same organism, via self-inoculation with infectious skin lesion material from a patient with verruga peruana; soon thereafter, he developed a fatal infection with fever and severe anemia. As a tribute to him, the disease is also known as Carrion's disease [4].


Carrion's disease is endemic to the "verruga zone," a region in the Andes Mountains of Peru, Colombia, and Ecuador [2]. Sporadic cases have been reported from Bolivia, Chile, and Guatemala [5].

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Literature review current through: Nov 2017. | This topic last updated: May 26, 2017.
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