BARTONELLOSIS IN ECUADOR - SEROSURVEY AND CURRENT STATUS OF CUTANEOUSVERRUCOUS DISEASE

Human bartonellosis is a classically biphasic disease caused by infect ion with the alpha-2 Proteobacteria Bartonella bacilliformis, which is phylogenetically related to the etiologic agents of cat scratch disea se, bacillary angiomatosis, and trench fever. In Ecuador, typical bart onellosis has remained endemic for the past century in highland provin ces near the Peruvian border. During the past six years, public health officials have noted an increasing number of atypical cases in which monophasic verrucous cutaneous disease is the only clinical manifestat ion. Epidemiologic, immunologic, histopathologic, and molecular biolog ical studies have confirmed the presence of sporadic, atypical bartone llosis in residents of the lowland province of Manabi, where archeolog ic evidence exists of bartonellosis in pre-Colombian times. Between 19 87 and 1995, 11 cases of cutaneous bartonellosis were investigated and serologic studies were done on 224 persons from five villages, two lo wland and three highland. In the lowland village of Pajan in the provi nce of Manabi, there was a 21% seropositivity proportion in contacts o f index cases. These combined data suggest that bartonellosis is signi ficantly under-reported due to the existence of mild clinical disease, possibly associated with less virulent bacterial strains, which are n ow disseminating or re-emerging in previously disease-free areas.