Intercurrent infections occurred in nearly half of all hospitalized cases of Carrion's disease studied, and were responsible for the death in two-thirds of the fatal cases.
The different intercurrent infections had varied prognosis according to the stage of the disease in which they developed. In cases with Bartonella bacilliformis anemia, intercurrent infections had a very severe prognosis due in most part to the decreased defenses of the host. Septicemias produced by enteric organisms proved to be fatal in almost every instance and accounted for half of the fatalities. The clinical picture in these infected cases consisted in a rise in temperature, diarrhea, splenomegaly, leukocytosis with marked shift to the left in the polymorphonuclear series, followed shortly by death. Amebic colitis greatly resembled the picture produced by salmonellosis and was fatal in three cases observed.
Malaria was the most frequent intercurrent infection occurring in approximately one-fourth of the cases. The immunological course of Carrion's disease is not significantly affected by intercurrent malaria infection, as no mortality was recorded in 28 cases. The clinical picture is most cases was very atypical for both diseases, the fever was usually irregular and without the characteristic periodicity of malaria, there was profuse sweating, enlargement of the spleen, anemia and a significant monocytosis. Intercurrent malaria was followed by prompt regression and thrombosis of the verrugae.
The host defenses against intercurrent infections did not appear to be decreased during the preeruptive or eruptive stages of Carrion's disease.
From the Frank Billings Clinics, Department of Medicine, the University of Chicago.