DermKnowledgeBASE: Verruga Peruana

Verruga Peruana

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The text is the summary of recent articles on Verruga Peruana at 75 thresold from National Library of Medicine (NLM). This information is subject to NCBI's Disclaimer and Copyright notice.

An outbreak Fever killed several thousand workmen and was named oroya fever after the place it was first reported [1]. Some workers who survived the outbreak developed verruga peruana which are Nodular ulcerating skin lesions [2]. Although disease manifestations vary, two disparate syndromes can occur independently or sequentially [3]. The first, oroya fever, occurs approximately 60 days following the bite of an infected sand fly, in which infection of nearly all erythrocytes results in an acute hemolytic Anemia with attendant symptoms of Fever, jaundice, and myalgia [4]. The majority of human infections are caused by Bartonella henselae, Bartonella quintana and Bartonella bacilliformis, although other Bartonella spp [5].

Without treatment, Bartonella infection can cause high mortality [6]. To date, no single treatment is effective for all Bartonella-associated diseases [7]. In the absence of systematic reviews, treatment decisions for Bartonella infections are based on case reports that test a limited Number of patients [8]. Antibiotics do not significantly affect the cure rate in patients with Bartonella lymphadenopathy [9]. Rifampicin or streptomycin can be used to treat verruga peruana [10].

Bartonella-induced angiogenesis leads to the formation of vascular Tumors including verruga peruana and bacillary angiomatosis [11]. In this study, after infecting human brain vascular pericytes (HBVPs) with Bartonella henselae, we found that these bacteria were able to invade HBVPs and that bacterial infection resulted in decreased pericyte proliferation and increased pericyte production of Vascular endothelial growth factor (VEGF) when compared to the uninfected control Cells [12]. Cat-scratch disease, bacillary angiomatosis, and peliosis hepatis are increasingly being recognized as causes of human disease, especially in susceptible population groups such as HIV-infected persons [13]. The causative agent, Bartonella bacilliformis, is endemic in specific regions of Peru and Ecuador [14]. Histology of splenic Biopsy was suggestive of bacillary angiomatosis, but immunohistochemistry ruled out B [15].

Bacilliformis isolates tested, and EC-01 antigen reacted with 13/20 oroya fever sera [16]. Bacilliary angiomatosis-like lesions were also detected in the spleen of the patient, who was inapparently infected with B [17]. In humans, bartonellosis can result in angioproliferative lesions that are potentially life threatening to the patient, including bacillary angiomatosis, bacillary peliosis, and verruga peruana [18]. verruga peruana is a clinical syndrome caused by the bacterium Bartonella bacilliformis, and is characterized by the development of hemangioma-like lesions, in which bacteria colonize endothelial Cells [19]. To gain insight into how this bacteria induces angiogenesis in vivo, we performed in situ hybridization of clinical specimens of verruga peruana for the angiogenesis factors Vascular endothelial growth factor (VEGF), its receptors VEGFR1 and VEGFR2, and angiopoietin-2 [20].

High-level expression of angiopoietin-2 and VEGF receptors was observed in the endothelium of verruga peruana [21]. Bacillary angiomatosis (BA), which presents as Disseminated Vascular lesions in immunosuppressed patients, and verruga peruana (VP), which presents as crops of vascular Nodules in immunocompetent persons, are caused by infection with Bartonella [22]. Thus, the question was raised whether Bartonella could be associated with the development of PG, also a vasoproliferative Lesion like BA and VP [23]. In the tissue phase of disease (verruga peruana), infection leads to infection of endothelial Cells and a pronounced proliferation of these cells, resulting in characteristic skin Eruptions of Papules and Nodules [24]. We have studied the properties of endothelial Cells infected in vitro [25].

Extensive cytoskeletal remodelling of endothelial Cells occurred after infection in vitro with B [26]. The Cells became spindle shaped and contained arrays of actin stress fibres orientated parallel to the long axis of the cell [27]. The biologic behavior of these lesions ranges from self-resolving, in the case of hemangiomas and pyogenic granulomas, to lethal Metastatic neoplasms in the case of angiosarcoma [28]. In addition, infectious endothelial Tumors stained strongly with this Antibody, similar to benign Tumors [29]. Most infectious diseases are associated with an Exanthematous reaction [30].

Bartonelloses: group of infections due to alpha-proteobacteria such as Bartonella [31]. Bartonella henselae (BH) and Bartonella quintana (BQ), are the causal agents of bacillary angiomatosis (BA), described in 1983, in which angiomatous Papules or Nodules with an appearance like botryomycomas, are associated with visceral lesions [32]. That disease occurs either as an acute form with severe infectious hemolytic Anemia (or Oroya fever), or as benign cutaneous Tumors, also called verruga peruana [33]. Quintana can be responsible for endocarditis, bacillary angiomatosis and Chronic or Recurrent bacteremia [34]. Elizabethae, the reservoir of which is currently unknown, can be responsible for endocardites [35].

There is evidence from pre-Columbian artifacts that verruga peruana, the cutaneous form of the disease, was present in Ecuador at least 1,000 years prior to the arrival of Europeans [36]. These artifacts were discovered in the coastal province of Manabi, a low-lying area very different from the high Andean valleys of Peru with which bartonellosis is normally associated [37]. The present review addresses the historical, epidemiologic, clinical, etio- and histopathogenic aspects of the verruga peruana (VP) [38]. VP is a disease thus far endemic to high Andean valleys and characterized by Dermal angioblastic proliferation in association with reactivation of latent Bartonella bacilliformis organisms [39]. From a series of lesions of verruga peruana, we selected five Atypical lesions, two of them closely resembling epithelioid angiosarcoma [40].

On the basis of our experience and reading of the literature, we conclude that angiolymphoid hyperplasia with eosinophilia, histiocytoid hemangioma of the testis, epithelioid hemangioendothelioma, and probably spindle cell hemangioendothelioma, constitute a group of related conditions best called the histiocytoid hemangiomas [41]. These lesions are currently considered to be endothelial hyperplasias and to share many features [42]. Dendrocytes were identified in the three types of angiomatous growth [43]. Because of clinical similarity between this condition and the verruga peruana phase of bartonellosis, we sought to further characterize this disease as well as its causative agent and to compare it to bartonellosis [44]. Many examples can be cited, including the heroic self-experiments of CarriĆ³n of Peru with verruga peruana and those of Goldberger with pellagra and Pediculoides ventricosus [45].

Bacteria are found in the interstitium and within the cytoplasm of endothelial Cells (Rocha-Lima inclusion) [46]. Bacilliformis possess an activity that stimulates endothelial cell proliferation up to three times that of control [47]. One consists of sheets or islands of Cells arranged in an epithelioid or pseudoepithelioid pattern (cases 1 and 2) in which the following histologic diagnoses were considered: squamous Carcinoma, sweat gland Carcinoma, epithelioid hemangioendothelioma, epithelioid sarcoma, melanoma and metastatic carcinoma [48]. It was present not only in patients with oroya fever but also in some healthy individuals as well as in one patient with Chronic bartonellosis (verruga peruana) [49]. Contain diseases like parasite dermatosis (mal de Pinto, verruga peruana, leishmaniasis, blastomycosis and pain) have close relation with the different ecosystem of the peruvian territory [50].

References: 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ,

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About Me

I have varied research interests ranging from eHealth, Health Information Exchange, Clinical Trials and Research, Contact Dermatitis, Bioinformatics, and Cosmetic Dermatology. I have work experience in Canada as an eHealth analyst, and in Dubai and India as a Specialist Dermatologist.


Bell Raj Eapen
Hamilton, ON