Diagnosis and Treatment
The diagnosis is made upon a finding of bartonellas within the red blood cells in acutely anemic patients. Blood and bone marrow cultures are the most useful diagnostic test for carrier cases in the endemic zones.
The eruptive phase is easily identified with some clinical experience, but surgical biopsy is required to show the bartonella inside the histiocytes in the Giemsa stain. The cultured tissue is positive.Before the advent of antibiotics the mortality rate from Carrion’s disease was very high. In acute severe cases, 30 to 70 percent of patients died in the anemic phase, either directly from the bartonella infection or from secondary complications. Antibiotics have a powerful antibactericidal effect; the anemia is arrested, and blood regeneration starts immediately. Until now, Chloromycetin has been the most effective antibiotic in the anemic stage, because it is also specific for salmonellosis, the most serious complication. Streptomycin is the ideal antibiotic during the eruptive phase. In 4 to 5 days, the eruption shrinks and the verrucose nodes subside without any scar.
According to our experiments a specific vaccine must be prepared with attenuated live bartonellas. However, it must be kept in mind that the live germ vaccine will produce the acute anemic phase in Splenectomized patients.