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Dermatologic Manifestations of Bacillary Angiomatosis

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Dermatologic Manifestations of Bacillary Angiomatosis


Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD more... Updated: Feb 23, 2012

Background
Bacillary angiomatosis (BA) is a systemic disease first described by Stoler and associates in 1983.[1] They reported a 32-year-old patient with presumed acquired immunodeficiency syndrome (AIDS) who developed multiple subcutaneous nodules characterized histologically by a vascular proliferation. Bacillary forms were demonstrated, and the patient responded to erythromycin with an apparent cure. In 1987, Cockerell and associates [2] called widespread attention to bacillary angiomatosis, describing 6 patients with AIDS and unusual cutaneous papules and nodules distinct from Kaposi sarcoma. Being unaware of its infectious origin, they called it epithelioid angiomatosis. This name was selected because the deeper dermis has alterations similar to those of epithelioid hemangiomas, with endothelial cells adherent to one another in an epithelioid pattern. Its bacterial origin was later confirmed, and the name bacillary angiomatosis was proposed by LeBoit et al[3, 4] , originally as a transitional term pending proper identification of the causative agent(s). Its systemic nature became evident when postmortem examinations showed nodules in the larynx, gastrointestinal tract, peritoneum, and diaphragm. Others observed additional patients with bacillary angiomatosis and postulated a likely bacterial origin. The organism was found to have some features in common with the etiologic agent of cat scratch disease and some in common with that of bartonellosis. Originally proposed as a new species, Rochalimaea henselae and Rochalimaea quintana, the 2 agents of bacillary angiomatosis have been reclassified as Bartonella species rather than Rochalimaea species. Bacillary angiomatosis often responds to therapy with oral erythromycin, although other oral antibiotics and antituberculosis medications, including tetracycline, trimethoprim-sulfamethoxazole, and rifampin, may also be effective. While bacillary angiomatosis is treatable and curable, it may be life threatening if untreated. The Medscape Reference article Bacillary Angiomatosis (infectious diseases focus) may be helpful.

Pathophysiology
The etiologic agents of bacillary angiomatosis are 2 Bartonella species, Bartonella henselae and Bartonella quintana. Bacillary angiomatosis can occur in immunocompetent persons, although it has been linked most commonly with AIDS. DNA hybridization, 16S rRNA sequence homology, cellular fatty acid profiles, and cytosine and guanine content studies have shown these Bartonella species are closely related to Bartonella bacilliformis. Epidemiologic evidence has suggested that B henselae induced bacillary angiomatosis is also associated with exposure to cats. Speculation about nonhuman reservoirs and vectors of transmission is reasonable because both trench fever and bartonellosis are arthropod borne. Bacillary angiomatosis has been suggested to be caused with equal frequency by B henselae and B quintana. Infection with these tiny gram-negative bacilli that are difficult to culture results from exposure to flea-infested cats in B

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Dermatologic Manifestations of Bacillary Angiomatosis

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henselae infection and the human body louse in B quintana infection. B quintana can also cause bacteremia, urban trench fever, and endocarditis in immunocompetent persons. It is associated with lytic bone lesions. Peliosis hepatis and lymph node involvement are linked with B henselae.

Epidemiology
Frequency
International Serum samples collected from HIV patients treated at a hospital in Catalania and evaluated for antibodies to B henselae and B quintana from 340 patients by indirect immunofluorescence assay showed 76 (22.3%) patients reacted with one or more Bartonella antigens.[5] Thus, a high percentage of HIV patients have antibodies to Bartonella, which appears to be increasing with age.

Age
A wide age range exists, with infants to elderly people affected. The age range was 26-52 years in one early series of patients with AIDS.

Contributor Information and Disclosures


Author Robert A Schwartz, MD, MPH Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi Disclosure: Nothing to disclose. Coauthor(s) W Clark Lambert, MD, PhD Professor and Head, Dermatopathology, Departments of Pathology and Dermatology, UMDNJ-New Jersey Medical School W Clark Lambert, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Dermatological Association, American Society of Dermatopathology, International Academy of Pathology, Medical Society of New Jersey, Sigma Xi, and Society for Investigative Dermatology Disclosure: Nothing to disclose. Specialty Editor Board Ponciano D Cruz Jr, MD Vice-Chair, JB Shelmire Professor, Department of Dermatology, University of Texas Southwestern Medical Center Ponciano D Cruz Jr, MD is a member of the following medical societies: Texas Medical Association Disclosure: RCTS Consulting fee Independent contractor; Mary Kay Cosmetics Honoraria Consulting; Galderma Grant/research funds Principal Investigator Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association Disclosure: Nothing to disclose. Jeffrey Meffert, MD Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

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Dermatologic Manifestations of Bacillary Angiomatosis

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Disclosure: Nothing to disclose. Catherine M Quirk, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology Disclosure: Nothing to disclose. Chief Editor William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology Disclosure: Elsevier Royalty Other

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