(Verruga; Oroya fever; Carrion’s disease; Peruvian Warts)
Definition – A specific, febrile, infectious and inoculable disease, endemic in certain valleys of the Peruvian Andes, and presenting pin-head-sized or larger, reddish, rounded, itching, wart-like lesions.
Symptoms – This disease which may attack both natives and foreigners who pass through its endemic locality, begins some weeks after inoculation, with fever, profound anemia and considerable pain in the muscles, bones and joints. The cutaneous symptoms appear in from three weeks to six months after the inoculation and usually occur first on the face and extremities, later appearing elsewhere on the skin as well as on the mucous and serous membranes. The initial lesions are itchy, red, pin-head- to pea-sized macules, papules or vesicles. Later they become warty or vegetating, increase in size and may be sessile or pedunculated. When these growths become larger, they may be very painful, ulcerated and bleed freely. They may be discrete or confluent, in small or large areas, but after a variable period running into months they undergo involution and become scaly or horny and disappear without scarring, unless ulceration has occurred.
Etiology and Pathology – The endemic nature of this disease has been mentioned although rarely a sporadic case may be found. It is transmissible by inoculation and attacks both sexes at all ages. Debility from such causes as a moist or warm climate or malaria may act as a predisposing factor, but the essential cause is a bacillus that has specific staining qualities and is somewhat larger than the tubercle bacillus. Microscopically the lesions resemble sarcoma or the infective granulomata and the connective tissue growths in the upper part of the corium are apt to be vascular or even cavernous.
Diagnosis – Verruga in the preeruptive stage may be difficult to differentiate because rheumatism, malaria and the pains of syphilis may resemble it. A history of travel or residence in an endemic district should be significant and when the eruption appears the disease is easy to recognize.
Prognosis and Treatment – The former is always grave for the mortality rate is from 6 to 12 per cent. among the natives and much higher among the whites or in certain epidemics. The disease often lasts for weeks or months and it is wise that nothing be done to discourage the eruptive tendency. Hence physiological principles such as a sustaining diet, etc., and removal from the affected region to the seashore are advisable. The following remedies have many points of similarity to the symptoms presented: Condurango, Kali brom., Lachesis, Petro., Phosphorus, and Thuja.