jueves, 30 de septiembre de 2010

DAY OF PERUVIAN MEDICINE



OCTOBER 5th, DAY OF PERUVIAN MEDICINE
Named in Daniel Alcides Carrión honour, a Peruvian medical student, (August 13th, 1857 - October 5th, 1885).



Daniel Alcides Carrión was born in Cerro de Pasco (4330 meters) and began the study of medicine in 1879 at San Marcos University in Lima. Some years earlier there had been a severe outbreak of an epidemic on the railroad construction between Lima's seaport town Callao and La Oroya (3730 metres). The disease, characterised by fever, quickly progressing anaemia and a high rate of mortality, killed thousands, chiefly among the workers recruited from outside. The physicians were at a loss, never having seen anything like it before.



Railroad construction 1885


As a new factor of the problem was a noticeable increase in Peruvian Verruca or ("Verruga Peruana"). This disease, which manifests with wart-like skin eruptions of various shapes and sizes, it had been present in Peru already in pre-Columbian times, and which had been described in some writings from the Spanish time.

In his journeys from Cerro de Pasco to Lima and vice versa Carrion had met people with verrucous skin eruptions people with fever and caught an interest in the disease. From 1881 he conducted extensive research on "Verruga Peruana", including clinical studies at the "Dos de Mayo hospital" in Lima.

Carrion recognised that the disease was endemic, but not contagious, and that it was caused by an "verrucous agent", possibly by a parasite attacking the blood and destroying red cells. In order to find out whether the disease could be inoculated and to study its clinical course, Carrión decided to conduct an experiment in himself.

On August 27th, 1885, Carrion took blood from a red coloured verruca in the area of the eyebrows from a 14 year old boy about to be released from the hospital. As Carrion had trouble inoculating himself, friends took the lancet and made four inoculations, two in each of Carrión's arms. In accordance with his plans Carrion made detailed notes on the inoculation and the course of the disease. His notes have later been published.

Carrion experienced the first symptoms of the disease on September 17th, and from September 26th he was too feeble to make his own notes, which were continued by his friends attending him at the bedside. Carrion's condition now rapidly deteriorated and on October 5th he succumbed to the disease.

Through his experiment Carrion had proved that Oroya fever and verruca are two phases of the same, inoculant disease. In 1909 Alberto Barton reported patients whose erythrocytes had been attacked by microorganisms which he considered to be agents of the disease. The microorganism was named "Bartonella bacilliformis".



Bartonella Baciliformes


By cultivating "Bartonella bacilliformis" from Oroya fever and verruca-patients in the years 1926-1927, the Japanese bacteriologist Hideyo Noguchi (1876-1928) was able to demonstrate scientifically that Oroya Fever and Peruvian Verruca are two manifestations of the same infection.

Carrion´s disease
Also know as:
• "Verruga Peruana" = Peruvian Verruca
• Oroya´s fever
• Bartonellosis
• Bartoneliasis.

A disease occurring in the valleys in the Andes Mountains in Peru and Ecuador at altitudes of 600 to 3000 meters. It is a generalized, acute, febrile, endemic, and systemic form of bartonellosis that appears in an acute febrile anaemic stage followed in several weeks by a nodular skin eruption.

Two forms are recognized: the mild form "Verruga Peruana" and the severe form Oroya fever. The mild form is characterized by mild anaemia and either miliary or nodular eruptions resembling Kaposi's sarcoma. The severe form is characterized by acute fever, pernicious anaemia, and muscular pain and weakness.



Wart-like skin eruptions


Alberto Leopoldo Barton (1871-1950) identified the parasite which causes Oroya fever and "Verruga Peruana" in 1909. The disease is caused by Bartonella bacilliformis and transmitted by the sandfly Phlebotomus verrucarum.



Phletomus verrucarum

On October 7th, 1991, the Peruvian government announced a law (Law Nº 25342), declaring Daniel Alcides Carrión to be a "National Hero"






Este año 2010, el 5 de octubre, también realizamos un homenaje a Daniel Alcides Carrión presentando a nuestros lectores que tienen problemas con la lengua española un resumen de su vida (en Inglés); Carrión, estudiante de sexto año de la Facultad de Medicina "San Fernando" de la Universidad Nacional Mayor de San Marcos de Lima - Perú, en año de 1885 se inoculó la sangre del verrucoma de un enfermo y luego desarrolló una anemia grave febril, que lo llevó a la muerte el 5 de octubre de 1885. Demostrando así, que las dos dolencias descritas en forma separada eran diferentes formas clínicas de una sola enfermedad.

La enfermedad causada por la bacteria Bartonella bacilliformes, ahora se denomina Bartonellosis o Enfermedad de Carrión. Se le conoce también como "Fiebre de la Oroya"; no porque la enfermedad se presente en la ciudad de La Oroya (3730 metros), sino porque en el año de 1885, la etapa febril aguda y mortal, se presentaba en los trabajadores que construyeron el ferrocarril Lima - La Oroya. La mayoría de las personas la adquirieron en el valle de Matucana, al ser picados por el mosquito Phlebotomus verrucarum (agente vector), produciéndose miles de muertos.

En el Perú el 5 de octubre los Médicos celebramos el "Día de la Medicina Peruana" en honor a Carrión; siendo por tradición los médicos sanmarquinos de La Oroya y Cerro de Pasco los que sienten más identificación con dicha efeméride.

Ver: Biografía inédita de Daniel Alcides Carrión en este blog



Dr. Aquiles Monroy

DIA DE LA MEDICINA EN LA OROYA


Médicos del Hospital Alberto Hurtado, Essalud y del Centro Médico Chulec

El 5 de octubre 2010, en Ceremonia por el Día de la Medicina

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