( CNN ) -- A packed passenger bus tumbled into a river near the Peruvian city of Trujillo early Saturday , killing at least 33 people , state media reported , citing regional authorities . The bus was carrying 43 seated passengers , but there were many others standing in the aisle , leading authorities to believe the death toll might rise , according to ANDINA , the state-run news agency . Among the dead were many doctors and nurses , the agency reported . Photos from the scene showed the mangled wreckage of the red bus in the middle of small rapids on the rocky Moche River , flanked on either side by steep green slopes . The bus was heading from Huamacho to Trujillo when it went off the road and into the river , local police told ANDINA . Authorities believe the accident happened around 4:10 a.m. ( 5:10 a.m . ET ) , the agency reported . Fiery multi-vehicle crash kills 36 in Nigeria . 24 killed in South Africa bus crash . Bus overturns killing 9 in Lebanon .
The bus toppled off a mountain road and into a river , reports say . The death toll may rise . It happened early Saturday morning near the city of Trujillo .