bacillary angiomatosis


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Related to bacillary angiomatosis: Kaposi Sarcoma

Bacillary Angiomatosis

 

Definition

A life-threatening but curable infection that causes an eruption of purple lesions on or under the skin that resemble Kaposi's sarcoma. The infection, which occurs almost exclusively in patients with AIDS, can be a complication of cat-scratch disease.

Description

Bacillary angiomatosis is a re-emerging bacterial infection that is identical or closely related to one which commonly afflicted thousands of soldiers during World War I. Today, the disease, caused by two versions of the same bacteria, is linked to homeless AIDS patients and to those afflicted with cat-scratch disease.
The infection is rarely seen today in patients who don't have HIV. According to the U.S. Centers for Disease Control and Prevention (CDC), an HIV patient diagnosed with bacillary angiomatosis is considered to have progressed to full-blown AIDS.

Causes and symptoms

Scientists have recently isolated two varieties of the Bartonella bacteria as the cause of bacillary angiomatosis: Bartonella (formerly Rochalimaea quintana) and B. henselae (cause of cat-scratch disease).
B. quintana infection is known popularly as trench fever, and is the infection associated with body lice that sickened European troops during World War I. Lice carry the bacteria, and can transmit the infection to humans. The incidence of trench fever was believed to have faded away with the end of World War I. It was not diagnosed in the United States until 1992, when 10 cases were reported among homeless Seattle men.
The related bacteria B. henselae was first identified several years ago as the cause of cat-scratch fever. It also can lead to bacillary angiomatosis in AIDS patients. Bacillary angiomatosis caused by this bacteria is transmitted to AIDS patients from cat fleas.
These two different types of bacteria both cause bacillary angiomatosis, a disease which is characterized by wildly proliferating blood vessels that form tumor-like masses in the skin and organs. The nodules that appear in bacillary angiomatosis are firm and don't turn white when pressed. The lesions can occur anywhere on the body, in numbers ranging from one to 100. They are rarely found on palms of the hands, soles of the feet, or in the mouth. As the number of lesions increase, the patient may develop a high fever, sweats, chills, poor appetite, vomiting, and weight loss. If untreated, the infection may be fatal.

Key terms

Cat-scratch disease — An infectious disease caused by bacteria transmitted by the common cat flea that causes a self-limiting, mild infection in healthy people.
Kaposi's sarcoma — A malignant condition that begins as soft brown or purple lesions on the skin that occurs most often in men with AIDS.
In addition to the basic disease process, the two different types of bacteria cause some slightly different symptoms. Patients infected with B. henselae also experience blood-filled cysts within the liver and abnormal liver function, whereas B. quintana patients may have tumor growths in the bone.

Diagnosis

This life-threatening but curable infection is often misdiagnosed, because it may be mistaken for other conditions (such as Kaposi's sarcoma). A blood test developed in 1992 by the CDC detects antibodies to the bacteria. It can be confirmed by reviewing symptoms, history and negative tests for other diseases that cause swollen lymph glands. It isn't necessary to biopsy a small sample of the lymph node unless there is a question of cancer of the lymph node or some other disease.

Treatment

Recent research indicates that antibiotics used to treat other HIV opportunistic infections can both prevent and treat bacillary angiomatosis. Treatment is usually given until the lesions disappear, which typically takes three or four weeks. A severely affected lymph node or blister may have to be drained, and a heating pad may help swollen, tender lymph glands. Acetaminophen (Tylenol) may relieve pain, aches, and fever over 101 °F (38.3 °C).

Prognosis

In most cases, prompt antibiotic treatment in patients with AIDS cured the infection caused by either variety of the bacteria, and patients may resume normal life. Early diagnosis is crucial to a cure.

Prevention

Studies suggest that antibiotics may prevent the disease. Patients also should be sure to treat cats for fleas.

Resources

Periodicals

Koehler, J. E. "Zoonoses: Cats, Fleas and Bacteria." Journal of the American Medical Association 271 (1994): 531-535.

bac·il·la·ry an·gi·o·ma·to·sis

1. an infection of immunocompromised patients by a newly recognized bacterium, Bartonella henselae, characterized by fever, granulomatous cutaneous nodules, and peliosis hepatis in some cases. Skin biopsy shows vascular proliferation and infiltration of vessel walls by neutrophils and clumps of organisms seen with Warthin-Starry silver staining.
2. infectious disease characterized by fever and granulomatous cutaneous lesions. There are two forms. In one, associated with Bartonella henselae, cat bites and scratches are predisposing; lymph nodes and viscera may be involved, and bacillary peliosis of liver and spleen can occur. A separate form, associated with B. quintana, is linked with conditions of poor hygiene (louse infestation, poverty, poor or no housing); subcutaneous and bone lesions are more predominant.

bacillary angiomatosis

[bas′əler′ē]
a condition of multiple angiomata caused by an infection of Bartonella. The infectious agent is associated with contact with young cats infected with fleas and is also the cause of cat-scratch fever. It is manifested in persons with cellular immunodeficiency, such as human immunodeficiency virus (HIV)-infected patients, as small hemangioma-like lesions of the skin but may also involve the lymph nodes and viscera. The skin lesions are often mistaken for Kaposi's sarcoma. Infection is curable but can be fatal if untreated. Treatments include oral erythromycin, tetracycline, trimethoprim, and rifampicin.
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Bacillary angiomatosis

bacillary angiomatosis

A distinct vascular proliferative disorder of the skin and lymph nodes seen in HIV-positive subjects.
 
Aetiology
Rochalimaea quintana is the most common cause; R henselae is less common, but may also cause bacteraemia in immunocompetent hosts, as well as bacillary peliosis hepatis and splenitis.
 
Clinical findings
Erythematous papules and nodules, fever, bacteraemia.
 
DiffDx
Kaposi sarcoma.

Management
Erythromycin, other antibiotics.

bacillary angiomatosis

Epithelioid angiomatosis Infectious disease A distinct vascular proliferative disorder of the skin and lymph nodes seen in HIV-positive subjects Etiology.Rochalimaea quintana is the most common cause of BA; R henselae is less common, but may also cause bacteremia, as well as bacillary peliosis hepatis, and splenitis Clinical Erythematous papules and nodules, fever, bacteremia Treatment Erythromycin, other antibiotics. See AIDS, Peliosis hepatitis.

bac·il·la·ry an·gi·o·ma·to·sis

(bas'i-lar-ē an'jē-ō-mă-tō'sis)
An infection of immunocompromised patients by the rickettsial species Bartonella henselae, characterized by fever and granulomatous cutaneous nodules, and peliosis hepatis in some cases. Skin biopsy shows vascular proliferation and infiltration of vessel walls by neutrophils and clumps of organisms seen with Warthin-Starry silver staining.
References in periodicals archive ?
It can be a factor in endocarditis and may result in bacillary angiomatosis in those coinfected with HIV.
Immimohistochemical and electron microscopic profiles of cutaneous Kaposi's sarcoma and bacillary angiomatosis.
Lymph node architecture can be partially replaced in conditions such as lymph node infarction, vascular transformation of the sinuses, bacillary angiomatosis, and metastatic angiosarcoma.
Bartonella infection causing bacillary angiomatosis, Mycobacterium tuberculosis, M.
The classical lesions of KS should be differentiated from bacillary angiomatosis.
The appearance of the lesions, along with the history, led to the following possible diagnoses: bacillary angiomatosis, cutaneous cryptococcosis, nodular Kaposi sarcoma or cutaneous histoplasmosis.
quintana has been recognized to cause a broad spectrum of disease, including trench fever, chronic bacteremia, endocarditis, and bacillary angiomatosis (1-4).
Clinically, IPEH can be misdiagnosed as a mucocele, hemangioma, pyogenic granuloma, Kaposi sarcoma, angiosarcoma, Kimura disease, intravenous atypical vascular proliferation, endovascular papillary angioendothelioma, papular angioplasia, or bacillary angiomatosis.
These included Epstein-Barr virus-associated chronic active hepatitis, hepatic bacillary angiomatosis due to Bartonella henselae, and granulomatous Pneumocystis carinii pneumonia.
henselae, the predominantly identified species, has been associated with cat scratch disease, peliosis hepatis, and bacillary angiomatosis in humans.
Polymerase chain reaction (PCR) was positive for bacillary angiomatosis.