Verruga Peruviana

VERRUGA PERUVIANA, Peruvian wart, Carrion's disease (Verruga de Carrion), Oroya fever, an infectious disease endemically existing in certain regions of Peru and affecting both natives and visitors. Symptoms of the disease: intermittent or irregular fever, with general weakness, progressive anemia, headaches and rheumatoid pains in the muscles and joints, and swelling of the lymph glands. Skin changes appear in the form of erythematous-vesicular eruptions, more often erythematous spots and petechiae. The eruptions are distributed strictly symmetrically: on the face, neck, chest, and outer surfaces of the limbs, as well as on the mucous membranes and conjunctiva (serous membranes and internal organs may also be affected). Subsequently, against the background of the erythema and spots, within a few days or hours, bright or dark crimson-colored groups of papules (from 0.5 to 2 cm) arise, which are painful upon pressure, cylindrical in shape, or protruding on a stalk. Some of them turn into skin nodules and ulcerate; others shrivel and disappear. In addition, especially in the area of the joints, lumpy subcutaneous tumors appear, which over time, disintegrating, form deep atonic ulcers that bleed heavily. Histologically, the matter reduces to formations of the infectious granuloma type, with extravasates and the presence of a large number of dilated lymph and blood vessels containing thrombi. V. p. is caused by Barton's bacillus (see Bartonella). The duration and incubation period vary. In the case of the medical student Carrion (Daniel Carrion), which cost him his life, the incubation of V. p., inoculated experimentally, lasted 39 days, and death followed 15 days later. Usually, however, the disease proceeds in attacks, often lasting for several months and accompanied by eruptions of new foci on the skin and mucous membranes. The average mortality rate is 15%. Differential diagnosis is made with Mycosis fungoides (from which V. p. differs by the absence of a premycotic stage and intense itching), as well as with yaws (in which, however, there are usually no such severe general symptoms as in V. p.). Treatment: change of climate (seacoast); local symptomatic. Among internal remedies: neosalvarsan, which Castellani considers even a specific remedy.

N. Efron.

VERRUCOUS, verrucosus (from Latin verruca—wart), warty. This term denotes such a change in any surface that is expressed in the appearance on it of a series of protrusions, small warts. Examples: V. endocarditis¹—inflammation of the endocardium, accompanied by the development on it of small protrusions, warts (syn. papillary endocarditis); V. pericarditis—fibrinous inflammation of the pericardium with the formation of fibrin protrusions on the surface of the pericardial sac (syn. hairy heart); V. lupus—a form of lupus with warty growths on the skin.