Introduction:
Stoler and associates first described bacillary angiomatosis in 1983, and it was first referred to as epithelioid angiomatosis. Later, LeBoit and colleagues documented bacilli using Warthin-Starry stains and electron microscopy in several cases, and they named it "bacillary angiomatosis". It is most frequently manifested in individuals with advanced HIV (human immunodeficiency virus) infection. It affects the skin and local lymph nodes. In addition, several internal organs, including the liver, spleen, bone, brain, lung, colon, and uterine cervix, have been affected by bacillary angiomatosis. Two organisms generally cause bacillary angiomatosis: Bartonella henselae, which causes cat-scratch disease, and B. quintana (Bartonella quintana), which causes trench fever. It is characterized by vascular skin lesions that resemble pyogenic granulomas (a tumor with abnormal blood vessels, although it is not malignant). Lesions bleed readily, are painful, and can range in number from one to thousands, usually growing more in number over time if the patient is left untreated.
What Is Bacillary Angiomatosis?
Bacillary angiomatosis is an opportunistic cutaneous and systemic bacterial illness typically affecting immunocompromised patients, and it is caused by two organisms called Bartonella quintana and Bartonella henselae. Chronic lymphocytic leukemia (blood and bone marrow cancer), AIDS (acquired immunodeficiency syndrome), and organ transplant patients are more likely to develop bacillary angiomatosis than the general population. However, the illness can also affect physically healthy individuals, including kids, following a serious local injury.
What Is the Etiology of Bacillary Angiomatosis?
Bartonella (Rochalimaea) quintana and henselae are gram-negative intracellular bacteria that cause bacillary angiomatosis. B. henselae is primarily found in cats, whereas B Quintana is primarily found in people. Cats' bites and scratches are the main sources of infection. Fleas and the human body louse are the main carriers of B Quintana.
What Are the Signs and Symptoms of Bacillary Angiomatosis?
Bacillary angiomatosis is the most prevalent among all. It may also affect the brain, bone marrow, lymph nodes, gastrointestinal system, respiratory tract, spleen, and liver, as well as other body parts. The symptoms depend on the affected organ. The initial signs of bacillary angiomatosis are often skin lesions. These lesions may appear in groups of one to hundreds and have different shapes. The sizes of papules and nodules range from a pinpoint to 4 inches. They are red, purple, violaceous, globular, and non-blanching, with a vascular appearance. The patient may experience a high temperature, sore, enlarged lymph nodes, nausea, vomiting, sweats, chills, and a lack of appetite as skin lesions increase.
The signs of bacillary angiomatosis are distinguished based on the location rather than modality.
-
Chest: Presented with the signs of lung nodule (abnormal growth within the lung), mediastinal adenopathy (enlargement of lymph nodes located in the chest), peripheral lymphadenopathy (enlargement of lymph nodes located due to a local or systemic, benign, self-limited, infectious disease), and pleural effusion (accumulation of the fluid between the layers of tissue that line the lungs and chest cavity).
-
Abdomen: Ascites (fluid accumulation within the abdomen results in abdominal pain, swelling, nausea, and vomiting), abdominal adenopathy (inflammation of abdominal glandular tissue or lymph nodes), soft-tissue masses like lipomas, fibromas, and epidermal and ganglion cysts. Additionally, liver and spleen lesions also manifested.
-
Musculoskeletal: Significantly manifested with osteomyelitis (bone infection).
Bacillary angiomatosis is identical to Kaposi's sarcoma (the lining of blood and lymph vessels can develop into a certain type of cancer); hence biopsy may be required to determine a purple lichenoid plaque. In addition, large subcutaneous tumors resembling bacterial abscesses can develop in HIV patients, and wounds can bleed freely and are more prone to ulceration.
What Are the Risk Factors of Bacillary Angiomatosis?
The infection can cause uncontrolled bulge of blood vessels in other organs, including the brain, bone, gastrointestinal system, and respiratory tract, with airway blockage and creating tumor-like lumps. Additionally, peliosis hepatis or bacillary peliosis are associated with bacillary angiomatosis. Peliosis hepatitis is an uncommon vascular disorder characterized by numerous, widespread cavities filled with blood throughout the liver. The cavities typically have a diameter between 0.5 and 1 inch. It may cause abdominal pain (especially right upper quadrant pain) or jaundice.
How to Diagnose Bacillary Angiomatosis?
Clinical diagnosis of bacterial angiomatosis is highly seen in patients with impaired immune systems. The common diagnostic aid used to rule out bacillary angiomatosis is:
-
Skin Biopsy: Biopsy is generally correlated with clinical manifestation. Giemsa or Warthin-Starry staining can confirm the presence of the microorganisms, which can be observed as basophilic clusters in the stroma and reveals an inflammatory infiltration with neutrophils and the growth of lobular blood vessels with epithelioid endothelial cells.
-
Polymerase Chain Reaction (PCR): The technique may be used to determine the causative agent of the condition.
What Are the Treatment Options for Bacillary Angiomatosis?
-
Bacillary angiomatosis can be fatal if left untreated. It reacts significantly to several antibiotics, like Erythromycin 500 mg, often causing the skin lesions to disappear progressively over the following four weeks.
-
Doxycycline is similar to Erythromycin to treat angiomatosis. Tetracycline is often substituted for either of these treatments if the infection does not improve.
-
Antibiotics may also be used with a bactericidal drug if the illness is severe. Generally, those antibiotics are advised for three to six months to prevent a recurrence. Eventually, large pus-filled lymph nodes or blisters are drained.
-
Supportive therapy includes hydration, and analgesics are prescribed for pain and fever. Warm moist compression aids in decreasing swelling and tenderness.
-
Other antibiotics include Trimethoprim combined with Sulfamethoxazole and Rifampicin, which are also effective against the infective condition.
How to Prevent Bacillary Angiomatosis?
Cats that are infected with Bartonella henselae may not exhibit symptoms. However, they can have bacterial illnesses for weeks to years. Transmission occurs when fleas are transmitted to humans. Therefore, getting rid of fleas in the cat's environment is essential to prevent illness. The delousing techniques (guidance for safe, effective, and efficient procedures for controlling outbreaks of louse-borne disease) advised for trench fever may also help prevent angiomatosis infections related to B. quintana.
Conclusion
Researchers focus on the impact of infection and the most effective approach for treating bacillary angiomatosis in both normal and immunodeficient individuals. Even though oral erythromycin is still the preferred treatment for bacillary angiomatosis, some individuals lack response to Erythromycin, but an adequate response is noted with Clarithromycin. Immunocompromised patients are more likely to experience relapses, which can happen after therapy is terminated. However, the illness might be fatal if it is not properly managed.
