Oroya

Abstract: Bartonella bacilliformis is the bacterial agent of Carrion's disease and is presumed to be transmitted between humans by phlebotomine sand flies. Carrion's disease is endemic to high-altitude valleys of the South American Andes, and the first reported outbreak (1871) resulted in over 4,000 casualties. Since then, numerous outbreaks have been documented in endemic regions, and over the last two decades, outbreaks have occurred at atypical elevations, strongly suggesting that the area of endemicity is expanding. Approximately 1.7 million South Americans are estimated to be at risk in an area covering roughly 145,000 km2 of Ecuador, Colombia, and Peru. Although disease manifestations vary, two disparate syndromes can occur independently or sequentially. The first, Oroya fever, occurs approximately 60 days following the bite of an infected sand fly, in which infection of nearly all erythrocytes results in an acute hemolytic anemia with attendant symptoms of fever, jaundice, and myalgia. This phase of Carrion's disease often includes secondary infections and is fatal in up to 88% of patients without antimicrobial intervention. The second syndrome, referred to as verruga peruana, describes the endothelialcell-derived, blood-filled tumors that develop on the surface of the skin. Verrugae are rarely fatal, but can bleed and scar the patient. Moreover, these persistently infected humans provide a reservoir for infecting sand flies and thus maintaining B. bacilliformis in nature. Here, we discuss the current state of knowledge regarding this life-threatening, neglected bacterial pathogen and review its host-cell parasitism, molecular pathogenesis, phylogeny, sand fly vectors, diagnostics, and prospects for control.

Abstract: The large scale of nonferrous metal smelting has created a chronic public health issue in La Oroya, Peru. In this reconnaissance study, the distributions of lead, arsenic, and cadmium in drinking water, indoor dust, and soil were measured at five sites to estimate their impact on children's health. As expected, median soil metal levels dropped exponentially with distance from the smelting complex (3,177 ppm Pb, 1,658 ppm As, and 127 ppm Cd at La Oroya Antigua). Indoor dust metal concentrations were also elevated at La Oroya Antigua (2,574 ppm Pb, 1,071 ppm As, 28 ppm Cd), and drinking water As values were elevated relative to Pb and Cd (8.5 ppb As, 0.28 ppb Pb, and 0.05 ppb Cd), suggesting selective loss of Pb and Cd relative to As. Exposure and dose-response modeling (IEUBK) indicate soil Pb and As are serious health problems in need of remediation.

Abstract: This article offers an analytical account of the human rights trade-offs faced by residents of La Oroya, Peru. The community is confronted with the dilemma of having to sacrifice its human right to health in order to preserve job opportunities at the town's smelter, which is the main source of environmental pollution. The article demonstrates how traditional mechanisms to assess human rights trade-offs fail to fully assess the predicament of the La Oroya community and offers an alternative analytical lens titled a “Human Rights Systemic Model.” By applying this model, this article reveals how a constellation of institutional, social, environmental, and personal factors structure a context of systemic lack of freedom in La Oroya. In particular, the article explains how such a context creates the fundamental conditions for the La Oroya community members to forfeit their own rights and how it diminishes people's agency to collectively defend their human rights.

Abstract: Report submitted to the Faculty of Medicine of Lima on physiological studies, pathophysiological and clinical undertaken in man of the Andean highlands, mainly in Oroya (12,200 feet) and Morococha (14,800 feet), 1927.