Carrison’s disease, also known as Oroya fever or bartonellosis, is a rare disease in human species.
The causative agent for Carrison’s disease is Bartonella bacilliformis, harbored by sandfly of the genus Lutzomyia. It is characteristic to some countries such as Peru, Ecuador, and Columbia.
Carrison’s disease shows pleomorphism of signs and symptoms. It has two major stages of clinical presentations: acute phase and chronic phase. These two phases take place in two different cell types of the host. The acute phase takes place in the red blood cells, while the chronic phase takes place in the endothelial cells.
The acute phase which is also known as the haematic phase is characterized by fever, paleness, malaise, liver enlargement, enlarged lymph nodes, and spleen. In this phase, the patient suffers severe hemolytic anemia and transient immunosuppression.
The chronic phase is also referred to as the eruptive or tissue phase. During this phase, the patient develops a cutaneous rash, which results from the proliferation of endothelial cells and gives rise to lesions capable of ulceration and bleeding. These rashes known as Peruvian warts or verruga peruana can be classified into three categories, depending on the size and characteristics of the lesion; the smallest lesions being the miliary, followed by the nodular or subdermal lesions; the largest being the mular lesions. Also, the chronic phase clinically manifests with hyperplasia of the lesions and profuse mitosis and proliferation of damaged capillaries.
The acute phase of bartonellosis (Carrison’s disease) can be diagnosed by microscopical examination of Giemsa or Wright- stained blood smear. It was Alberto Barton who first identified the causative organism in the red blood cells. The causative organism can be isolated in a Columbia Blood Agar culture using blood or bone marrow specimen. Other molecular diagnostic procedures include immunoblot and indirect immunofluorescence and polymerase chain reaction (PCR).
Some cases of Carrison’s disease resolve without medical or surgical intervention. Antibiotics, especially Chloramphenicol, have been used for the treatment of Carrison’s disease, because Carrison’s disease is closely associated with salmonella infection, which is opportunistic in people with this disease.
During the acute phase of the disease, a combination of fluoroquinolones, such as Ciprofloxacin or Chloramphenicol, together with a B-lactam antibiotic like penicillins are usually used for treatment of children; while either Ciprofloxacin or Chloramphenicol are used for adults.
The eruptive phase of the disease does not respond to treatment with Chloramphenicol. However, antibiotics such as azithromycin, erythromycin, and ciprofloxacin have shown success in patients. Rifampin and macrolides are used in treating both adults and children.
It's possible to treat Bartonella-related pseudomembranous angiomatous papillomatosis of the oral cavitym using stem cells from the bone marrow of patients who are at risk of infections due to the activity of some pathogenic organisms, such as B. bacilliformis. Bone marrow transplant involves the harvesting of stem cells from the bone marrow, which are then filtered and treated before they are given back to the donor or another patient. The treatment procedure is aimed at transfusing healthy stem cells of the bone marrow after the unhealthy stem cells have been treated and the abnormal cells destroyed.
Patients with Carrison’s disease that had treatments of Bartonella-related pseudomembranous angiomatous papillomatosis can undergo a variety of bone marrow transplantation.
Autologous bone transplant is a type of bone marrow transplantation in which stem cells are harvested from the patient’s bone marrow. The harvested stem cells are treated, frozen and then given back to the patient.
This type of transplantation is often called bone marrow rescue.
Allogenic bone marrow transplant involves harvesting of healthy stem cells from genetically compatible donor, usually the patient’s sibling.
Bone marrow stem cells can also be harvested from a donor unrelated to the patient whose genetic make-up matches with the patient’s stem cells; this type is referred to as unrelated bone marrow transplantation.
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