THE ETIOLOGY OF VERRUGA PERUANA.

A saline suspension of a subcutaneous nodule excised from a verruga patient, and kept in the refrigerator for 14 days, on inoculation into two young Macacus rhesus monkeys (Nos. 33 and 34) induced irregular febrile reactions and enlargement of the lymph glands, and in one instance a subcutaneous nodule arose, independently of direct inoculation, on the tail. A microorganism has been isolated from the blood of both animals, and from the experimental nodule, which in pathogenic properties and in cultural and morphological characteristics is indistinguishable from the strain of Bartonella bacilliformis isolated from a case of Oroya fever. The spontaneous skin lesion of Monkey 34 and the subcutaneous nodules induced by intradermal inoculation of cultures of the microorganism were histologically typical of experimental verruga lesions in monkeys and identical with the skin lesions induced in monkeys by Bartonella bacilliformis. The organism, like Bartonella bacilliformis, is an intracellular parasite, being found in the cytoplasm of the proliferating endothelial cells of the lesions and in the erythrocytes of the blood. The same variations in the manifestations of disease which have been noted in experimental infection with Bartmetta bacilliformis were observed in the experimental verruga infection. In the second passage (Monkey 41) the infection induced by local inoculation of cultures was severe both locally and constitutionally and was accompanied by marked anemia. The organisms were found in the red cells in large numbers. In the third passage the systemic infection was less severe, but the local lesions were more striking. Detection of the parasites in the blood is far more certain by the cultural method than by microscopic examination, the latter procedure being successful only in rather severe infections. The result of blood culture is therefore the decisive method in the final diagnosis of the disease. Preliminary serological study shows that the organism isolated in the present instance from the skin lesion of a verruga patient and that previously obtained from the blood of a case of Oroya fever belong to the same serological group. The data obtained justify the conclusion that verruga peruana is caused by Bartonella bacilliformis. They also definitely establish the fact that the inoculation of blood or sanguineous exudate from lesions of verruga peruana is capable of inducing in susceptible individuals a severe febrile systemic infection, such as that to which Carrion succumbed. The designation "Carrion's disease" is therefore the appropriate one for both forms of the infection. Bartonella bacilliformis may be regarded as a bacterium, since it has the essential features of that group of microorganisms.