Bacillary Angiomatosis - Causes, Symptoms and Treatment

Bacillary angiomatosis (BA) is a bacterial infection. It 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.Infection with these tiny gram-negative bacilli that are difficult to culture results from exposure to flea-infested cats in B 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. Bacillary angiomatosis may affect almost any organ system, although it most commonly affects skin and subcutaneous tissue. Subcutaneous lesions may erode into underlying bones (ie, osseous bacillary angiomatosis), especially the tibia, fibula, and radius. Involvement of ribs and vertebrae has been described. Rarely, skeletal muscles may be involved, resulting in pyomyositis. Mucous membranes of the conjunctiva and upper airway and perineum may be affected. Bacillary angiomatosis may be accompanied by disseminated visceral disease (peliosis), mainly in the liver (peliosis hepatis), spleen, and lymph nodes. It is associated with lytic bone lesions. Peliosis hepatis and lymph node involvement are linked with B henselae. It is occasionally reported in patients who are immunocompetent. It most commonly manifests in people with AIDS , rarely appearing in those who are immunocompetent

Bacillary angiomatosis was called epithelioid angiomatosis because of its histological appearance. Skin lesions are nodular and red or purplish in color, and may eventually ulcerate and drain. B henselae is a small, curved, gram-negative rod grown best in 5% carbon dioxide with high humidity on freshly poured agar containing 5% defibrinated rabbit blood. DNA sequencing shows it to be a rickettsialike organism closely related to B quintana. A specific antibody response to B henselae represents an alternative to diagnosis by culture. However, both the sensitivity and specificity of the B quintana assay have been questioned. Culture is the most convincing means of diagnosing BA, but it takes 20-40 days. BA is associated with exposure to cats. Speculation about nonhuman reservoirs and vectors of transmission for B henselae is reasonable because both trench fever and bartonellosis are arthropod borne. Approximately 40% of US patients with bacillary angiomatosis are white, 40% are black, and 20% are of Hispanic origin. Approximately 90% of US patients with bacillary angiomatosis are men, probably because a disproportionate number of patients infected with HIV also are men. Bacillary angiomatosis was reported in a patient who was HIV-seronegative but had idiopathic thrombocytopenic purpura, had undergone splenectomy, and had been administered long-term systemic prednisone

Causes of Bacillary Angiomatosis

Common Causes of Bacillary Angiomatosis

• HIV infection.
• Chronic lymphocytic leukemia.
• Cytotoxic chemotherapy.
• Exposure to body and hair lice
• B henselae and B quintana.

Sign and Symptoms of Bacillary Angiomatosisc

Common Sign and Symptoms of Bacillary Angiomatosis

• Enlarged liver.
• Fever.
• Red raised spots.
• Swollen lymph nodes.
• Nausea.
• Vomiting.
• Chills and poor appetite.

Treatment for Bacillary Angiomatosis

Common Treatment for Bacillary Angiomatosis

• Bacillary angiomatosis is effectively treated with antibiotics. Erythromycin appears to be the antibiotic of choice and is given until lesions resolve, usually within 3-4 weeks of starting therapy. Other antibiotics used include doxycycline, cotrimoxazole and rifampicin.
• Other oral antibiotics and antituberculosis drugs, including tetracycline, trimethoprim-sulfamethoxazole, and rifampin, may also be effective.
• Supportive therapy includes hydration and analgesics for pain and fever. Warm moist compresses to affected nodes may decrease swelling and tenderness.
• Corticosteroid therapy, cytotoxic therapy, or radiation therapy is not effective.
• Avoid contact with cats.

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