The hemolytic anemia of human bartonellosis.

By CEsAR REYNAFARJE AND JOSE RAMOS H UMAN bartonellosis, or Carrion’s disease, is characterized by rapid development of severe hemolytic anemia in the acute stage of the disease caused by infestation of the erythrocytes by Bartonella bacilliformis. The bacterium described by Barton’ in 1905 is visible in the red cells at the acute stage, so that their examination makes the diagnosis very easy ( fig. 1 ) . Fever of sudden onset and irregular course, generalized bone pain, and general malaise are the most frequent symptoms which accompany the anemic phase. There follows a quiescent period in which the parasite disappears from the red blood cells, the anemia improves and, after a variable time, the second stage begins. This is characterized by the appearance in the skin and in some organs of nodules composed l)y histoid granulomata with capillary prolife ration, to which the disease owes its name, verruga peruana. Although studies had been made of this anemia since 1898, its hemolytic character was first described by Monge in 1915. Hemolysis was demonstrated by the elevated indirect bilirubin,5’ the increased phagocytosis of erythrocytes seen in autopsies,7.8 the indications of red cell regeneration, i.e., reticulocytosis and bone marrow hyperplasia,69’#{176} and by the increase in fecal urobilinogen.’#{176}’ Other characteristics have been described by Hurtado, Merino and Pons.#{176} However, some aspects of the hemolytic process in this disease could not be adequately studied until recent developments in hematologic technics became available. In the past three years we have carried out studies related to red cell survival, the mechanical fragility or parasitized red cells, metabolism of iron, immunohematologic observations, the site of sequestration of the red cells, and other investigations of the hemolytic process in this disease. Some of the findings have been presented in preliminary form.1213 In the present paper we are evaluating all the studies, as well as reviewing the anemia of human bartonellosis in general.