Visceral form of disease starting 15–40 days after injection with Bartonella bacilliformis bacteria during the bite of sand flies. Clinical symptoms are high fever, lymphadenitis, spleno- and hepatomegaly. The decreasing number of erythrocytes being lysed by the Bartonella-stages introduces anaemic symptoms. Months after this acute phase skin symptoms ( Verruga peruana) may occur. The disease is restricted to the western and eastern valleys of the Andes.