Bacillary Angiomatosis

Bacillary Angiomatosis

Bacillary angiomatosis is a systemic illness caused by Bartonellaquintana and Bartonellahenselae characterized by vascular proliferation. It results in copious subcutaneous nodules andcommonly affects people with weakened immune status especially AIDS patients. [1] The disease isusually brought about by exposure to flea-infested cats and human body louse infected with Bartonellaspecies. It can also arise from complication of catscratch disease in immunocompromisedpersons.[2] HIV patients who have bacillary angiomatosis usually have CD4+ cell counts of less than 200/μL. [3]

The most common initial manifestation of the disease is the appearance of several pinpoint purpleor bright red elevated lesions and nodules on or underneath the skin. The skin lesions can be few to as many as 100 occurring on any body part that may bleed when traumatized. The nodules are firm and may measure up to 10 cm in diameter. Patient may develop high grade fever, lymphadenopathy, sweats, chills, loss of appetite and vomiting. [2] Other symptoms may manifest as a result of visceral organ involvement.Jaundice may be observed when there is biliary obstruction as a result of lymph nodes compression.Psychiatric symptoms like seizures, anxiety and personality changes may also develop when there is CNSinvolvement. Patient may also have difficulty of breathing when larynx gets obstructed. [3] The diseasecan be fatal if not diagnosed and treated immediately. [2]

Diagnosis of bacillary angiomatosis is often based on clinical features as assessed on a thoroughphysical examination and through laboratory studies usually biopsies and appropriate tissue staining. Thecausative agent Bartonella species may be cultured or detected by Polymerase Chain Reaction (PCR) orimmunohistochemical methods. If liver is suspected to be involved, levels of alkaline phosphatase,gamma-glutamyltransferase, and transaminase are determined. CT scan, MRI and X-ray also helpidentifying extracutaneous involvement. [3]

Patients with bacillary angiomatosis are treated with antibiotics. Drug of choice is erythromycingiven until skin lesions disappear usually about 3-4 weeks from start of drug administration. Second linedrugs include doxycycline, tetracycline, cotrimoxazole, and rifampicin. Analgesics are usually given forfever and pain. Large pus-filled lesions may need draining. [2]

References:

1. http://www.atsu.edu/faculty/chamberlain/Website/lectures/BacillaryAngiomatosis.htm

2. http://dermnetnz.org/bacterial/bacillary-angiomatosis.html

3. http://emedicine.medscape.com/article/212737-clinical

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