Bacillary angiomatosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Bacillary angiomatosis (BA) is a bacterial infection caused by either Bartonella henselae or Bartonella quintana. Bartonella henselae is most often transmitted through a cat scratch or bite, though ticks and fleas may also act as a vector. On the other hand, Bartonella quintana is usually transmitted by lice.

Pathophysiology

Bacillary angiomatosis is characterized by the proliferation of blood vessels, resulting in them forming tumor-like masses in the skin and other organs. It most commonly manifests in people with AIDS, rarely appearing in those who are immunocompetent. While curable, it is potentially fatal if not treated.

Differential Diagnosis

Bacillary angiomatosis should be differentiated from other diseases presenting as purplish papules or nodules on extremities. The differentials include the following:

Diseases Etiology Congenital Acquired Demography Clinical manifestations Lab findings Gold standard diagnosis Associated findings
Symptoms Signs CBC LFT ESR/CRP Histopathology
Appearance Fever Bleeding BP Hepatosplenomegaly Lymphadenopathy Other WBC Hb Plt
Bacillary angiomatosis [1] + Any age, usually between 20 -50 years Solitary or multiple red, purple, flesh-colored, or colorless papules ± ± Nl Nl Nl Nl Nl Nl Clinical manifestation
Arteriovenous malformation [2] + Any age Nl + Nl Nl Nl Nl Nl Nl NA Imaging
Acroangiodermatitis[3] Any age, more in males Purplish-blue to brown papules and plaques Nl
  • Paralysed legs
Nl Nl Nl Nl Nl Clinical manifesttations
Angiosarcoma [4] Adults, more in males Enlarging bruise, a blue-black nodule, or an unhealed ulceration Nl Nl Nl Nl Biopsy NA
Diseases Etiology Congenital Acquired Demography Appearance Fever Bleeding BP Hepatosplenomegaly Lymphadenopathy Other WBC Hb Plt LFT ESR/CRP Histopathology Gold standard diagnosis Associated findings
Masson's hemangioma [5] Rare
  • Normal
Nl Nl Nl Nl Nl Nl Biopsy
Seborrheic keratosis [6] + Any age Nl Nl Nl Nl Nl Nl
  • Papillomatous epithelial proliferation containing horn cysts
Clinical manifestations
Systemic lupus erythematosus (SLE) [7] More common in female, typically in the 20 to 30 years ± ± ± Nl Nl Clinical manifestations
Pyogenic granuloma [8]
  • Trauma
  • Hormonal influences
  • Viruses
  • Cytogenetic clonal deletion abnormalities
+ + Any age, usually in 20-30 years + Nl Nl Nl Nl Nl Nl Clinical manifestation NA
Benign lymphangioendothelioma [9] + Any ages, median age is 50 years Nl Nl Nl Nl Nl Nl
  • Thin-walled endothelial-lined spaces that are interspersed between strands of collagen
Biopsy NA
Cavernous hemangioma [10] Usually in third to fifth decades of life.
  • Painless, slowly progressive protrusion or bulging of their globe
Nl Nl Nl Nl Nl Nl
  • Engorged vascular channels, which are tightly knit and separated by fibrous septae
Clinical manidestation
Diseases Etiology Congenital Acquired Demography Appearance Fever Bleeding BP Hepatosplenomegaly Lymphadenopathy Other WBC Hb Plt LFT ESR/CRP Histopathology Gold standard diagnosis Associated findings

Symptoms

Cutaneous BA is characterized by the presence of lesions on or under the skin. Appearing in numbers from one to hundreds, these lesions may take several forms:

While cutaneous BA is the most common form of BA, BA 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 will experience intense pain in the affected area.

Medical Therapy

Pharmacotherapy

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. 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.

Bacillary angiomatosis[11]

  • Preferred regimen (1): Erythromycin 500 mg PO qid for 2 months at least
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 2 months at least

Prevention

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.

Related Chapters

References

  • Gasquet S, Maurin M, Brouqui P, Lepidi H, Raoult D (1998). "Bacillary angiomatosis in immunocompromised patients". AIDS. 12 (14): 1793–803. PMID 9792380.
  1. Tappero JW, Perkins BA, Wenger JD, Berger TG (July 1995). "Cutaneous manifestations of opportunistic infections in patients infected with human immunodeficiency virus". Clin. Microbiol. Rev. 8 (3): 440–50. PMC 174635. PMID 7553576.
  2. Whitehead KJ, Smith MC, Li DY (February 2013). "Arteriovenous malformations and other vascular malformation syndromes". Cold Spring Harb Perspect Med. 3 (2): a006635. doi:10.1101/cshperspect.a006635. PMC 3552339. PMID 23125071.
  3. Lugović L, Pusić J, Situm M, Buljan M, Bulat V, Sebetić K, Soldo-Belić A (2007). "Acroangiodermatitis (pseudo-Kaposi sarcoma): three case reports". Acta Dermatovenerol Croat. 15 (3): 152–7. PMID 17868541.
  4. Barttelbort SW, Stahl R, Ariyan S (July 1989). "Cutaneous angiosarcoma of the face and scalp". Plast. Reconstr. Surg. 84 (1): 55–9. PMID 2734404.
  5. Park KK, Won YS, Yang JY, Choi CS, Han KY (July 2012). "Intravascular Papillary Endothelial Hyperplasia (Masson tumor) of the Skull : Case Report and Literature Review". J Korean Neurosurg Soc. 52 (1): 52–4. doi:10.3340/jkns.2012.52.1.52. PMC 3440504. PMID 22993679.
  6. Noiles K, Vender R (2008). "Are all seborrheic keratoses benign? Review of the typical lesion and its variants". J Cutan Med Surg. 12 (5): 203–10. doi:10.2310/7750.2008.07096. PMID 18845088.
  7. Uva L, Miguel D, Pinheiro C, Freitas JP, Marques Gomes M, Filipe P (2012). "Cutaneous manifestations of systemic lupus erythematosus". Autoimmune Dis. 2012: 834291. doi:10.1155/2012/834291. PMC 3410306. PMID 22888407.
  8. Kamal R, Dahiya P, Puri A (January 2012). "Oral pyogenic granuloma: Various concepts of etiopathogenesis". J Oral Maxillofac Pathol. 16 (1): 79–82. doi:10.4103/0973-029X.92978. PMC 3303528. PMID 22434943.
  9. Guillou L, Fletcher CD (August 2000). "Benign lymphangioendothelioma (acquired progressive lymphangioma): a lesion not to be confused with well-differentiated angiosarcoma and patch stage Kaposi's sarcoma: clinicopathologic analysis of a series". Am. J. Surg. Pathol. 24 (8): 1047–57. PMID 10935645.
  10. Goldberg RE, Pheasant TR, Shields JA (December 1979). "Cavernous hemangioma of the retina. A four-generation pedigree with neurocutaneous manifestations and an example of bilateral retinal involvement". Arch. Ophthalmol. 97 (12): 2321–4. PMID 229814.
  11. Spach DH, Koehler JE (1998). "Bartonella-associated infections". Infect Dis Clin North Am. 12 (1): 137–55. PMID 9494835.

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