Bacillary angiomatosis: Description, Causes and Risk Factors:
Bacillary angiomatosis is an opportunistic bacterial infection caused by either Bartonella henselae or Bartonella quintana. The classic histologic presentation of bacillary angiomatosis involves three components: a lobular proliferation of capillaries with enlarged endothelial cells, neutrophilic debris, and clumps of finely granular material identified as bacteria with staining techniques. Pseudoepitheliomatous hyperplasia is a histologic reaction pattern characterized by epithelial proliferation in response to a variety of stimuli, including mycobacterial, fungal, and bacterial infections.
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 is the key to prevention of infection in both cats and humans.
Nearly all cases of bacillary angiomatosis are seen in immunocompromized patients, with most cases reported in patients with AIDS. Immunocompetent persons can also develop the disease, but it is rare.
Patients with bacillary angiomatosis usually report having scattered cutaneous papules and nodules or a subcutaneous nodule resembling a common bacterial abscess. Some of the nodules can be rather large (up to 10 cm in diameter). Patients may have only one lesion or hundreds of lesions. The four different skin lesions seen in this disease are (1) globular angiomatous papules or nodules resembling pyogenic granuloma, (2) violaceous nodules resembling Kaposi sarcoma, (3) a lichenoid violaceous plaque, or (4) a subcutaneous nodule with or without ulceration.
Because the disease can cause pathology in other parts of the body besides the skin, a patient may have weight loss and lymphadenopathy. B henselae can also infect the liver causing hepatica peliosis, which results in nausea, vomiting, diarrhea, and fever with hepatosplenomegaly.
Cutaneous bacillary angiomatosisis characterized by the presence of lesions on or under the skin. Appearing in numbers from one to hundreds, these lesions may take several forms:
Papules or nodules which are red, globular and non-blanching, with a vascular appearance.
Purplish nodules sufficiently similar to Kaposi's sarcoma that a biopsy may be required to verify which of the two it is.
A purplish lichenoid plaque.
A subcutaneous nodule which may have ulceration, similar to a bacterial abscess.
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.
A physical examination of the patient for the characteristic lesions and biopsy of the lesions helps to confirm the diagnosis of bacillary angiomatosis. Hematoxylin and eosin (H&E) stained slides contain sections with many blood vessels of varying dimensions lined by swollen endothelial cells that contain bacilli. The bacteria can be stained more clearly with Warthin-Starry silver stain. Infiltrates of acute and chronic inflammatory cells as well as fibrin deposits may also be seen.
Bacillary angiomatosis 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.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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