Bacillary angiomatosis

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Bacillary angiomatosis
Other names: Epithelioid angiomatosis[1]
Bartonella (bacterial species which causes this condition)
SpecialtyInfectious disease
SymptomsPapules and nodules[2]
CausesBartonella henselae or B. quintana[3]
Diagnostic methodBiopsy[1]
Differential diagnosisKaposi sarcoma, pyogenic granuloma, and epitheliod hemangioma[1]
TreatmentErythromycin or doxycycline[1]

Bacillary angiomatosis (BA) is a form of angiomatosis associated with bacteria of the genus Bartonella.[4]Often it affects people with weakened immune systems, such as those with HIV infection, this in turn leads to vascular proliferative lesions, which can appear on the skin and in internal organs[5]

Treatment involves antibiotics, like erythromycin or doxycycline[6].

Symptoms and signs

Cutaneous BA is characterised by the presence of lesions on or under the skin. Appearing in numbers from one to hundreds, these lesions may take several forms:[1][2][4]

  • Papules or nodules which are red, globular and non-blanching, with a vascular appearance
  • Purplish nodules sufficiently similar to Kaposi's sarcoma
  • A purplish lichenoid plaque
  • A subcutaneous nodule which may have ulceration, similar to a bacterial abscess

While cutaneous BA is the most common form, it can also affect several other parts of the body, such as the brain, bone, bone marrow, lymph nodes, gastrointestinal tract, respiratory tract, spleen, and liver. Symptoms vary depending on which parts of the body are affected; for example, those whose livers are affected may have an enlarged liver and fever, while those with osseous BA experience intense pain in the affected area.BA is characterised by the proliferation of blood vessels, resulting in them forming tumour-like masses in the skin and other organs.[7][1][8][4]

  • Characteristic tumor-like skin lesions

    Characteristic tumor-like skin lesions

  • Nodular painful rash involving palms, arms

    Nodular painful rash involving palms, arms

  • Violaceous and erythematous nodules over tumor on the back of the right hand and third finger

    Violaceous and erythematous nodules over tumor on the back of the right hand and third finger

Complications

The complications of Bacillary angiomatosis is consistent with:[1]

  • Gastrointestinal bleeding
  • Encephalopathy
  • Endocarditis
  • Laryngeal obstruction

Causes

It is caused by either Bartonella henselae or B. quintana.[3]

  • B. henselae is most often transmitted through a cat scratch or bite,[9] though ticks and fleas may also act as vectors.
  • B. quintana is usually transmitted by lice.[5]

It can manifest in people with AIDS and rarely appears in those who are immunocompetent.[10][11]

Risk factors

Chronic lymphocytic leukemia

Among the risk factors for Bacillary angiomatosis is as follows:[2]

Transmission

If a cat is carrying Bartonella henselae, then it may not exhibit any symptoms; cats may be bacteremic for weeks to years, but infection is more common in young cats. Transmission to humans is thought to occur via flea feces inoculated into a cat scratch or bite, and transmission between cats occurs only in the presence of fleas. Therefore, elimination and control of fleas in the cat's environment are key to prevention of infection in both cats and humans.[12][13][14]

Diagnosis

Diagnosis is based on a combination of clinical features and biopsy, as well as :[4][1][2]

Pyogenic granuloma

Differential diagnosis

The DDx of Bacillary angiomatosis is based on the following:[1]

  • Epitheliod hemangioma

Treatment

Doxycycline[15]

While curable, BA is potentially fatal if not treated. BA responds dramatically to several antibiotics. Usually, erythromycin will cause the skin lesions to gradually fade away in the next four weeks, resulting in complete recovery. [4][1][6][2]

Doxycycline may also be used. However, if the infection does not respond to either of these, the medication is usually changed to tetracycline. If the infection is serious, then a bactericidal medication may be coupled with the antibiotics[4][1][6][2]

Prognosis

In terms of the prognosis of Bacillary angiomatosis we find that relapses are common in immunocompromised individuals and occur after therapy ends[1]

History

The condition that later became known as bacillary angiomatosis was first described by Stoler and associates in 1983.[16] Being unaware of its infectious origin, it was originally called epithelioid angiomatosis.[17] Following documentation of bacilli in Warthin-Starry stains and by electron microscopy in a series of cases by LeBoit and colleagues, the term bacillary angiomatosis was widely adopted.[18]

See also

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 Akram, Sami M.; Anwar, Muhammad Yasir; Thandra, Krishna C.; Rawla, Prashanth (4 July 2023). "Bacillary Angiomatosis". StatPearls [Internet]. StatPearls Publishing. PMID 28846267.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 "Bacillary angiomatosis (bartonella infection)". DermNet®. 26 October 2023. Archived from the original on 10 October 2024. Retrieved 15 October 2024.
  3. ↑ 3.0 3.1 Koehler JE, Sanchez MA, Garrido CS, et al. (December 1997). "Molecular epidemiology of bartonella infections in patients with bacillary angiomatosis-peliosis". N. Engl. J. Med. 337 (26): 1876–83. doi:10.1056/NEJM199712253372603. PMID 9407154.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 "Bacillary Angiomatosis: Practice Essentials, Background, Pathophysiology". 2017-02-09. Archived from the original on 2021-06-09. Retrieved 2021-05-28. {{cite journal}}: Cite journal requires |journal= (help)
  5. ↑ 5.0 5.1 "About Bartonella quintana". Bartonella Infection. 10 June 2024. Retrieved 31 October 2024.
  6. ↑ 6.0 6.1 6.2 "Bacillary Angiomatosis - Bacillary Angiomatosis". Merck Manual Professional Edition. Retrieved 16 October 2024.
  7. ↑ Hofman, Paul (2016). "Bacillary Angiomatosis". Infectious Disease and Parasites. Springer International Publishing: 45–47. doi:10.1007/978-3-319-30009-2_1010 (inactive 2024-10-22). ISBN 978-3-319-30009-2. Retrieved 21 October 2024.{{cite journal}}: CS1 maint: DOI inactive as of October 2024 (link)
  8. ↑ Breitschwerdt, Edward B.; Kordick, Dorsey L. (1 January 2016). "Bartonella Species and Vascular Pathology". Vascular Responses to Pathogens. Academic Press. pp. 61–74. ISBN 978-0-12-801078-5.
  9. ↑ Mateen FJ, Newstead JC, McClean KL (July 2005). "Bacillary angiomatosis in an HIV-positive man with multiple risk factors: A clinical and epidemiological puzzle". Can J Infect Dis Med Microbiol. 16 (4): 249–52. doi:10.1155/2005/230396. PMC 2095030. PMID 18159553.
  10. ↑ Gasquet S, Maurin M, Brouqui P, Lepidi H, Raoult D (1998). "Bacillary angiomatosis in immunocompromised patients". AIDS. 12 (14): 1793–803. doi:10.1097/00002030-199814000-00011. PMID 9792380.
  11. ↑ Plettenberg, A.; Lorenzen, T.; Burtsche, B. T.; Rasokat, H.; Kaliebe, T.; Albrecht, H.; Mertenskötter, T.; Bogner, J. R.; Stoehr, A.; Schöfer, H. (2000). "Bacillary angiomatosis in HIV-infected patients--an epidemiological and clinical study". Dermatology (Basel, Switzerland). 201 (4): 326–331. doi:10.1159/000051547. ISSN 1018-8665. PMID 11146343.
  12. ↑ "Veterinary Guidance for Bartonella". Bartonella Infection. 17 May 2024. Retrieved 21 October 2024.
  13. ↑ Álvarez-Fernández, Alejandra; Breitschwerdt, Edward B.; Solano-Gallego, Laia (4 December 2018). "Bartonella infections in cats and dogs including zoonotic aspects". Parasites & Vectors. 11 (1): 624. doi:10.1186/s13071-018-3152-6. ISSN 1756-3305.
  14. ↑ Pennisi, Maria Grazia; Marsilio, Fulvio; Hartmann, Katrin; Lloret, Albert; Addie, Diane; Belák, Sándor; Boucraut-Baralon, Corine; Egberink, Herman; Frymus, Tadeusz; Gruffydd-Jones, Tim; Hosie, Margaret J; Lutz, Hans; Möstl, Karin; Radford, Alan D; Thiry, Etienne; Truyen, Uwe; Horzinek, Marian C (July 2013). "Bartonella Species Infection in Cats: ABCD guidelines on prevention and management". Journal of Feline Medicine and Surgery. 15 (7): 563–569. doi:10.1177/1098612X13489214. ISSN 1098-612X.
  15. ↑ "Prescription Doxycycline". NIAID. 20 November 2024. Retrieved 1 December 2024.
  16. ↑ Stoler MH, Bonfiglio TA, Steigbigel RT, Pereira M (Nov 1983). "An atypical subcutaneous infection associated with acquired immune deficiency syndrome". Am J Clin Pathol. 80 (5): 714–8. doi:10.1093/ajcp/80.5.714. PMID 6637883.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. ↑ Cockerell CJ, Whitlow MA, Webster GF, Friedman-Kien AE (Sep 1987). "Epithelioid angiomatosis: a distinct vascular disorder in patients with the acquired immunodeficiency syndrome or AIDS-related complex". Lancet. 2 (8560): 654–6. doi:10.1016/s0140-6736(87)92442-1. PMID 2887942.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. ↑ LeBoit PE, Berger TG, Egbert BM, Beckstead JH, Yen TS, Stoler MH (1989). "Bacillary angiomatosis. The histopathology and differential diagnosis of a pseudoneoplastic infection in patients with human immunodeficiency virus disease". Am J Surg Pathol. 13 (11): 909–20. doi:10.1097/00000478-198911000-00001. PMID 2802010.

External links

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External resources
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