ABSTRACT
This is the first reported case of bacillary angiomatosis associated with Bartonella henselae in Thailand. The clinical, pathological, and microbiological findings are presented. The bacterium was isolated from a biopsy of skin lesions obtained on admission and identified by cellular morphology, characteristics of colonies on chocolate agar, extensive biochemical tests and 16S ribosomal DNA sequencing.
Subject(s)
Adult , Angiomatosis, Bacillary/microbiology , Bartonella henselae/genetics , Base Sequence , Female , HIV Infections , Humans , Molecular Sequence Data , Skin/microbiology , ThailandABSTRACT
The human bartonelloses are a group of diseases with a rapidly increasing clinical spectrum. Well known manifestations such as Carrion's disease, trench fever, cat-scratch disease, and bacillary angiomatosis are examples of Bartonella spp. infection. Along with these diseases, recurrent bacteremia, endocarditis, septicemia, erythema nodosum, erythema multiforme, trombocytopenic purpura and other syndromes have been reported having been caused by bacteria of this genus. The infectious process and the pathogenesis of these microorganisms are poorly understood. The bartonelloses may have a benign and self-limited evolution in a host, or a potentially fatal one. These bacteria can provoke a granulomatous or an angioproliferative histopathologic response. As these diseases are not yet well defined, we have reviewed the four main human bartonelloses and have examined unclear points about these emergent diseases
Subject(s)
Animals , Cats , Humans , Bartonella Infections/microbiology , Bartonella/classification , Angiomatosis, Bacillary/diagnosis , Angiomatosis, Bacillary/microbiology , Angiomatosis, Bacillary/transmission , Bartonella Infections/pathology , Bartonella Infections/transmission , Bartonella/pathogenicity , Cat-Scratch Disease/diagnosis , Cat-Scratch Disease/microbiology , Cat-Scratch Disease/transmission , Immunocompromised Host , Trench Fever/diagnosis , Trench Fever/microbiology , Trench Fever/transmissionABSTRACT
Bacillary angiomatosis is known to be caused by a rickettsial organism; Rochalimaea henselae. This causative agent has been compared with different microorganisms and clinical conditions that appear in similar settings but that have been clearly differentiated from them; e.i. Cat-scratch disease (Afipia felis), Bartonella bacilliformis, other Rochalimaea sp., Kaposi;s sarcoma, Lobular capillary hemangioma, Angiosarcoma, and Epithelioid hemangioma. Clinically the bacillary angiomatosis (BA) skin lesions vary from a single lesion to thousands. The cutaneous lesion appears as a bright-red round papule, subcutaneous nodule, or as a cellulitic plaque. When the lesion is biopsied it tends to blanch-out, bleed, and cause pain. The patient might present with signs and symptoms of chills, headaches, fever, malaise, and anorexia with or without weight loss. The extracutaneous lesions found in BA tend to be from multiple organs affecting from the oral lesions to anal mucosal lesions to widespread visceral lesions. The sites of preferences for BA lesion manifestation tend to be the liver, spleen, lymph nodes, and bone. To diagnose bacillary angiomatosis the physician should prepare a differential diagnosis based primarily on its histopathological and clinical characteristics. To confirm the results from the stain, electron microscopy can identify the bacillus and pin-point the diagnosis of bacillary angiomatosis. The lesions presented by BA respond well to therapy with erythromycin 500mg four times daily for a duration of 2 weeks to 2 months. In case of intolerance to erythromycin the second line of drug that successfully treats the BA bacillus is doxycycline. If relapses of the BA lesion recur, then a prolonged antibiotic therapy is necessary and in AIDS patients the duration may be extended as life-long suppressive therapy