Bacillary Angiomatosis: Causes, Symptoms and Treatment.

The Bacillary angiomatosis Is an infection that causes the increase of small blood vessels in the skin and visceral organs.

Almost all cases of bacillary angiomatosis are seen in immunocompromised patients, with the majority of cases reported in patients with AIDS . Immunocompetent people may also develop the disease, but it is rare.

Bacterial angiomatosis bacterium, bartonella henselae.

In people with HIV / AIDS, the disease can cause severe inflammation of the brain, bone marrow, lymph nodes, lungs, spleen and liver, and can be fatal in people with HIV.

The disease is caused by a bacteria called Rochalimaea henselae , Which was reclassified as Bartonella henselae. It was named after Diane Hensel, a microbiologist.

Bacillary angiomatosis has also been termed cat scratch disease, cat scratch fever, regional lymphadenitis and benign lymphoreticulosis.

Causes of bacillary angiomatosis

Bacillary angiomatosis is caused by bacteria Bartonella quintana or Bartonella henselae . Bacterial infection can occur with the following organisms:

Bartonella henselae

  • Method of transmission - cat scratch / sting
  • Transmission vector - ticks / fleas

Bartonella quintana

  • Method of transmission - from one human being to another
  • Transmission vector - lice.

symptom

Injury to the skin

  • Its color varies from person to person (flesh color, purple, or colorless)
  • A single lesion or multiple lesions (papules) may appear on the skin.
  • Lesions resemble hemangiomas
  • Variable nodule size (from 1 mm to 10 cm)
  • Scaly nodules may also be present on the skin
  • They can also be found in large masses

The extremities can be affected by extensive plaques

  • Excessive pigmentation
  • Excessive keratinization

Areas most affected

  • Language
  • Oropharynx
  • Oral mucosa
  • Nose

Pain

Areas most affected by pain include the forearms and legs (pain in the bones).

Systemic involvement

  • Sweating during the night
  • Fever / chills
  • General consumption
  • Weightloss
  • Anorexy
  • Abdominal pain
  • It is often accompanied by nausea and vomiting

Mass in the abdomen

This mass is accompanied by bleeding into the gastrointestinal tract.

If the colon is affected

  • Diarrhea with blood
  • Abdominal cramps

If the central nervous system is affected

  • Headache
  • Back pain
  • Depression
  • Anxiety
  • Psychosis
  • Changes in personality
  • Excessive irritability
  • Neuralgia (most commonly affected - trigeminal nerve)
  • Seizures

If the larynx is obstructed

The patient may have difficulty breathing

The most common cardiac manifestation is endocarditis. Pulmonary involvement is rare and may take the form of pneumonia or pleural effusion.

Neurological complications of bacillary angiomatosis infection are rare, and the most common presentation is encephalopathy. Ocular manifestations are not rare, with neuroretinitis being the most frequent.

Diagnosis

Steps for diagnosis

  1. A complete physical examination with evaluation of the medical history is usually performed.
  1. The tissue is biopsied and sent to a laboratory for pathological examination.
  1. The pathologist examines the biopsy under a microscope. After gathering the clinical findings and special studies on the tissues, the pathologist arrives at a definitive diagnosis. For this it uses special techniques, such as Immunohistochemistry , Which help to reveal the presence of bacteria.
  1. Further testing may be necessary to rule out other clinical conditions in order to arrive at a definitive diagnosis, because many conditions may have similar signs and symptoms.

Differential diagnosis

The differential diagnosis of bacillary angiomatosis includes Kaposi's sarcoma , Pyogenic granuloma, Peruvian wart And various angiomas, particularly epithelioid hemangioma.

The differentiation of Kaposi's sarcoma is of greater importance, since both conditions usually occur in patients infected with HIV and in other states of immuno-communal competence.

Although bacillary angiomatosis is potentially treatable, if overlooked, the result can be fatal. Rarely Kaposi's sarcoma and bacillary angiomatosis can coexist in the same patient.

Patches, macules and superficial plaques characteristic of Kaposi's sarcoma are generally not seen in bacillary angiomatosis. If plaques appear in bacillary angiomatosis, the lesions are ill-defined and often resemble cellulitis.

Histopathological features also often allow differentiation between bacillary angiomatosis and Kaposi's sarcoma. Detection of granular groups of bacteria is a hallmark of bacillary angiomatosis.

Both conditions are proliferative angio, but the vascular spaces of bacillary angiomatosis are round while those of Kaposi's sarcoma are slit-shaped.

On the other hand, endothelial cells in bacillary angiomatosis are polygonal, but in Kaposi's sarcoma they are spindle-shaped. The hyaline globules frequently seen in Kaposi's sarcoma are absent in bacillary angiomatosis.

Pyogenic granulomas may be clinically indistinguishable from bacillary angiomatosis. Pyogenic lesions similar to granulomas are one of the main clinical presentations of bacillary angiomatosis and may also resemble them histopathologically.

Pyogenic granuloma is usually solitary, although clustered lesions have been reported as well as widely disseminated lesions.

In bacillary angiomatosis, lesions are often multiple and have variable morphology, although single lesions may occur.

Histopathology differs. Neutrophils in pyogenic granuloma are present only in eroded or ulcerated lesions. The clinical and histopathological similarities between bacillary angiomatosis and pyogenic granuloma have motivated investigations into a possible similarity in the cause, but none have been positive.

The Peruvian wart is endemic in parts of Peru and neighboring Andean countries, and the diagnosis should be considered only if the patient visited the endemic areas.

This is caused by the Bartonella bacilliformis May resemble bacillary angiomatosis, since the lesions are papules or nodules, some pedunculate, often hemangiomatous or hemorrhagic. The wounds in the Peruvian wart are usually multiple, and involve the face, limbs and mucous membranes.

The Peruvian wart biopsy, although showing the characteristics of angio proliferation, lacks a dense neutrophilic infiltrate. The Bartonella bacilliformis Can be observed in the cytoplasm of endothelial cells.

Vascular tumors, in particular epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia) may cause diagnostic difficulties in clinical diagnosis.

Solitary or multiple dermal or subcutaneous nodules are located primarily on the scalp and face. There is usually eosinophilia in the peripheral blood in the epithelial hemangioma.

In biopsy, there is a proliferation of small to medium sized blood vessels, which often show lobular architecture. Vascular canals are coated by enlarged endothelial cells (epithelioids). A perivascular infiltrate is composed primarily of lymphocytes and eosinophils, not neutrophils.

Treatment

Bacterial infection can be treated with antibiotics. Administration of these drugs can usually cause tumors to contract in size and disappear, resulting in complete recovery.

This can usually take more than a month. However, pharmacological therapy should continue for several months. If the underlying immunodeficiency can not be cured, relapses are likely. In these cases, antibiotic therapy will be resumed or prescribed for life.

Since tumors in most cases respond well to antibiotic therapy, surgery to remove them is usually not necessary. Follow-up care with regular check-ups and check-ups is important.

Medical Treatment Studies

Despite bacteriostatic properties, studies have shown that erythromycin has shown a dramatic effect on bacillary angiomatosis, as it significantly inhibits the proliferation of dermal microvascular cells induced by both strains (Bartonella quintana and Bartonella henselae).

It appears that doxycycline and gentamicin do not exert such an effect. These data indicate that erythromycin independently of its unique bacteriostatic effects markedly inhibited the proliferation of endothelial cells, which may be a clue to its efficacy against bacillary angiomatosis.

Doctors administer erythromycin normally at a dose of 2.0 g orally (most often 500 mg 4 times a day). It is used intravenously in cases of gastrointestinal intolerance or when further absorption is expected.

Some doctors recommend Clarithromycin (250 mg twice daily orally) or the Azithromycin (1.0 g a single daily dose). Clarithromycin has fewer gastrointestinal side effects. The drug concentrations of clarithromycin and azithromycin in the skin after oral administration are higher than that of erythromycin .

Doxycycline has also been found to be effective and can be given orally or intravenously. The doctor may prescribe Doxycycline 100 mg twice daily.

Combination therapy with the addition of rifampicin to erythromycin or doxycycline is recommended for immunocompromised patients with serious life-threatening illnesses.

Treatment failures have been observed when used Fluoroquinolones , Trimethoprim- Sulfamethoxazole Y Cephalosporins Of narrow spectrum.

For the extracutaneous involvement of bacillary angiomatosis, similar antibacterial regimens are used. Treatment depends on the affected organ.

Forecast

The prognosis of bacillary angiomatosis is very good, since patients usually respond very well to antibiotic treatment and lesions in all systems of affected organs are recomposed after cure.

Only slightly hardened hyperpigmented stains may remain on the skin. Late or absent therapy makes angiomatosis a life-threatening condition.

In order to avoid relapses, the immunocompromised condition must be treated. If that is not possible, the recurrence of bacillary angiomatosis tends to occur.

Prevention of bacillary angiomatosis

Current medical research has not established a way to prevent bacillary angiomatosis. However, any measures to prevent HIV infection also help prevent bacillary angiomatosis.

Cats, cat fleas and lice can transmit bacillary angiomatosis. Therefore, contact with unknown cats should be avoided and known cats should be regularly dewormed.

An adequate personal hygiene , As well as keeping clean clothes for personal use and bedding. If a lice infestation is found at home, school, or work, it should be treated immediately.

References

  1. Neal (2014). Bacillary Angiomatosis. University / Kirksville College of Osteopathic Medicine. Retrieved from: atsu.edu.
  2. Mddk Staff (2016). Bacillary Angiomatosis. Mddk Online Medical Doctor. Retrieved from: mddk.com.
  3. Christopher D.M. Fletcher (2015). Bacillary Angiomatosis. DoveMed Editorial Board. Retrieved from: dovemed.com.
  4. Symptoma Team (2013). Bacillary Angiomatosis. Symptoma. Retrieved from: symptoma.com.
  5. Witold Kamil Jacyk (2016). Bacillary Angiomatosis. Frontline Medical Communications. Retrieved from: mdedge.com.


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