By Gary M. White, MD

Verruga peruana (VP) is an infection by B. bacilliformis in which vascular lesions develop in the skin. It is the second phase of Carrión's disease--the first being Oroya fever.


About 60 days after the bite by an infected Phlebotomus sand fly, the patient develops fever, jaundice, myalgia and profound hemolytic anemia (Oroya fever). Secondary infections may complicate the course. Without treatment, Oroya fever can be fatal. One month later, the patient may develop multiple disseminated vascular lesions that bleed easily.


The latest treatment recommendations should be consulted. In the past, streptomycin (15 to 20 mg/kg of body weight intramuscularly once daily) for 10 days has been used. More recently, oral rifampin (e.g. 10 mg/kg/day for 10 to 14 days) has become the drug of choice for treatment of the eruptive phase of Carrion's disease. The efficacy of rifampin has been found to be comparable to that of streptomycin, with the disappearance of cutaneous lesions within a month of therapy. However, failures of rifampin treatment have also been reported. Even more recently, ciprofloxacin at 500 mg p.o. twice daily for 7 to 10 days has been used with success for the treatment of adults with multiple eruptive-phase lesions, as has azithromycin [Antimicrob Agents Chemother. 2004 Jun; 48(6): 1921–1933].

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