Merck Manual

Please confirm that you are a health care professional

honeypot link

Oroya Fever and Verruga Peruana

(Carrión Disease)


Larry M. Bush

, MD, FACP, Charles E. Schmidt College of Medicine, Florida Atlantic University;

Maria T. Vazquez-Pertejo

, MD, FACP, Wellington Regional Medical Center

Reviewed/Revised Apr 2022

Oroya fever and verruga peruana are infections caused by the gram-negative bacterium Bartonella bacilliformis. Oroya fever occurs after initial exposure; verruga peruana occurs after recovery from the primary infection. Diagnosis is clinical and confirmed by blood cultures (for Oroya fever) and sometimes by biopsy (for verruga peruana). Treatment is with antibiotics.

Endemic only to the Andes Mountains in Colombia, Ecuador, and Peru, both Oroya fever and verruga peruana are passed from human to human by the Phlebotomus sandfly.

Oroya fever

Symptoms of Oroya fever include fever and profound anemia, which may be sudden or indolent in onset. The anemia is primarily hemolytic, but myelosuppression also occurs. Muscle and joint pain, severe headache, and often delirium and coma may occur. Superimposed bacteremia caused by Salmonella or other coliform organisms may occur. Case fatality rates may exceed 50% in untreated patients.

Diagnosis of Oroya fever is confirmed by blood cultures.

Because Oroya fever is often complicated by Salmonella bacteremia, ciprofloxacin with ceftriaxone for 14 days is the treatment of choice. Chloramphenicol combined with a beta-lactam antibiotic (eg, amoxicillin/clavulanate) is an alternative in the event of ciprofloxacin resistance. Azithromycin has also been used successfully.

Verruga peruana

Verruga peruana manifests as multiple skin lesions that strongly resemble bacillary angiomatosis Bacillary Angiomatosis Bacillary angiomatosis is skin infection caused by the gram-negative bacteria Bartonella henselae or B. quintana. Diagnosis is based on histopathology of the skin lesions, cultures... read more Bacillary Angiomatosis ; these raised, reddish purple skin nodules usually occur on the limbs and face. The lesions may persist for months to years and may be accompanied by pain and fever.

Verruga peruana is diagnosed by its appearance and sometimes by biopsy showing dermal angiogenesis.

Treatment with most antibiotics produces remission, but relapse is common and requires prolonged therapy.

Typical treatment for verruga peruana is rifampin 10 mg/kg orally once a day for 10 to 14 days or streptomycin 15 to 20 mg/kg IM once a day for 10 days. Ciprofloxacin 500 mg orally 2 times a day for 7 to 10 days has been used successfully, as have azithromycin, doxycycline, and trimethoprim/sulfamethoxazole.

Drugs Mentioned In This Article

Drug Name Select Trade
Cetraxal , Ciloxan, Cipro, Cipro XR, OTIPRIO, Proquin XR
Ceftrisol Plus, Rocephin
AK-Chlor, Chloromycetin, Chloroptic, Chloroptic S.O.P., Ocu-Chlor
Amoxil, Dispermox, Moxatag, Moxilin , Sumox, Trimox
Azasite, Zithromax, Zithromax Powder, Zithromax Single-Dose , Zithromax Tri-Pak, Zithromax Z-Pak, Zmax, Zmax Pediatric
Rifadin, Rifadin IV, Rimactane
No brand name available
Acticlate, Adoxa, Adoxa Pak, Avidoxy, Doryx, Doxal, Doxy 100, LYMEPAK, Mondoxyne NL, Monodox, Morgidox 1x, Morgidox 2x , Okebo, Oracea, Oraxyl, Periostat, TARGADOX, Vibramycin, Vibra-Tabs
Primsol, Proloprim, TRIMPEX
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
quiz link

Test your knowledge

Take a Quiz!