Angiomatosis bacilar y sarcoma de Kaposi en lesión cutánea de paciente VIH positivo / Bacillary angiomatosis and Kaposi's sarcoma in skin lesion of HIV positive patient

La angiomatosis bacilar (AB) es una enfermedad infec-ciosa poco frecuente, causada por bacterias del género Bartonella spp. transmitidas por vectores como pulgas, piojos y mosquitos. En el ser humano provoca diferentes síndromes clínicos. En pacientes con infección por el virus de inmunodeficiencia humana (VIH) con recuento de LT CD4 + <100 cél/µL se asocia a lesiones angiomatosas con neovascularización que comprometen la piel y, en menor medida, mucosas, hígado, bazo y huesos.El sarcoma de Kaposi (SK) es una neoplasia caracteriza-da por hiperplasia vascular multifocal de origen endotelial relacionada con el herpes virus humano 8. También puede afectar piel, mucosas y vísceras, siendo la variante epidé-mica una enfermedad marcadora de la infección avanzada por VIH. El principal diagnóstico diferencial clínico para las lesiones cutáneas y mucosas del SK es la AB.Presentamos un paciente con enfermedad VIH/sida que desarrolló AB y SK en forma concomitante en la misma lesión cutánea

Bacillary angiomatosis (BA) is a rare infectious disease, caused by bacteria of the genus Bartonella spp, transmitted by vectors such as fleas, lice and mosquitoes. It causes different clinical syndromes in humans. In patients with human immunodeficiency virus (HIV) infection with an LT CD4 + <100 cell/µL count, it is associated with the development of angiomatous lesions with neovascularization involving the skin and, with less frequency, mucous membranes, liver, spleen and bones. Kaposi's sarcoma (KS) is a neoplasm characterized by multifocal vascular hyperplasia of endothelial origin related to human herpes virus 8. It can also compromiso the skin, mucous membranes and viscera, with the epidemic variant being a marker disease of advanced HIV infection. The main clinical differential diagnosis for KS skin and mucosal lesions is the BA.Herein we present a patient with HIV/AIDS disease that developed BA and KS concomitantly in the same skin lesion

Bacillary angiomatosis with bone invasion

Abstract Bacillary angiomatosis is an infection determined by Bartonella henselae and B. quintana, rare and prevalent in patients with acquired immunodeficiency syndrome. We describe a case of a patient with AIDS and TCD4+ cells equal to 9/mm3, showing reddish-violet papular and nodular lesions, disseminated over the skin, most on the back of the right hand and third finger, with osteolysis of the distal phalanx observed by radiography. The findings of vascular proliferation with presence of bacilli, on the histopathological examination of the skin and bone lesions, led to the diagnosis of bacillary angiomatosis. Corroborating the literature, in the present case the infection affected a young man (29 years old) with advanced immunosuppression and clinical and histological lesions compatible with the diagnosis.

Manifestaciones dermatológicas asociadas a la infección por VIH/SIDA / Dermatologic manifestations associated with HIV/AIDS

The ongoing human immunodeficiency virus (HIV) infection epidemic coupled with more efficacious and available treatments has led to a larger number of patients living with HIV or AIDS. As a result, skin manifestations related to HIV/AIDS or its therapy have become increasingly more common and are reported to occur in as many as 95% of patients. Herein, we review the most common HIV/AIDS related cutaneous pathologies and classify them into inflammatory, HAART-associated, neoplastic, and infectious manifestations. Cutaneous manifestations should be promptly recognized and treated by physicians and health care personnel in order to provide optimal care.

La epidemia del virus de la inmunodeficiencia humana (VIH) sumado al mayor acceso a terapias antiretrovirales (TARV) han llevado a un aumento del número y la sobrevida de pacientes que viven con esta infección crónica. Se estima que hasta 95% de los pacientes con infección por VIH/SIDA presentarán alguna manifestación cutánea, por lo cual, debemos conocerlas. En la presente revisión se estudiarán las manifestaciones cutáneas de la infección por el VIH/SIDA clasificadas como: manifestaciones inflamatorias, manifestaciones asociadas a la TARV, manifestaciones neoplásicas y manifestaciones infecciosas asociadas a infección por VIH/SIDA (bacterianas, virales, fúngicas y parasitarias). Estas manifestaciones deben ser reconocidas por los médicos y el personal de salud a cargo del tratamiento y control de los pacientes con esta patología crónica.

Angiomatosis bacilar por Bartonella quintana como primera manifestación de infección por VIH: Report of one case / Bacillary angiomatosis

Background: Bacillary angiomatosis is an unusual infectious disease, with angioproliferative lesions, typical of immunocompromised patients. It is caused by Bartonella quintana and Bartonella henselae, two infectious agents of the genus Bartonella, which trigger variable clinical manifestations, including cutaneous vascular and purpuric lesions, and regional lymphadenopathy, and even a systemic disease with visceral involvement. We report a 38-year-old HIV positive male presenting with a history of six months of cutaneous growing purple angiomatous lesions, located also in nasal fossae, rhi-nopharynx and larynx. The skin biopsy was compatible with bacillary angiomatosis. Polymerase chain reaction of a tissue sample showed homology with B. quintana strain Toulouse. The patient was treated with azithromycin and ciprofloxacin with a favorable evolution.

Erythema Elevatum Diutinum in Human Immunodeficiency Virus Infected Patient

Erythema elevatum diutinum (EED) is emerging as a specific HIV-associated dermatosis which can be easily misdiagnosed as Kaposi's sarcoma or bacillary angiomatosis. Until now, no case of HIV-associated EED had been reported in Korea. We report a case of EED in a 49-year-old man with HIV infection. The patient was diagnosed with HIV-infection and treated with a combination of anti-retroviral agents and dapsone. Two years after the start of treatment the lesion had regressed.

Bacillary angiomatosis in HIV-positive patient from Northeastern Brazil: a case report / Angiomatose bacilar em paciente HIV positivo no nordeste brasileiro: relato de caso

It is a report of disseminated bacillary angiomatosis (BA) in a 23-year-old female patient, who is HIV-positive and with fever, weight loss, hepatomegaly, ascites, and papular-nodular skin lesions. The clinical and diagnostic aspects involved in the case were discussed. Bacillary angiomatosis must always be considered in the diagnosis of febrile cutaneous manifestations in AIDS.

Relato de angiomatose bacilar (AB) disseminada em paciente do sexo feminino de 23 anos, HIV positiva, com febre, emagrecimento, hepatomegalia, ascite e lesões de pele pápulo-nodulares. Foram discutidos os aspectos clínicos e diagnósticos envolvidos no caso. Angiomatose bacilar deve sempre ser considerada no diagnóstico de doença febril com manifestações cutâneas na AIDS.

Bronchoscopy and endobronchial disease in patients with human immunodeficiency virus infection.

The natural history of human immunodeficiency virus (HIV) infection has been significantly altered since the advent of antiretroviral therapy (ART). However, lung diseases are still common in these patients. This makes flexible fibreoptic bronchoscopy a valuable diagnostic tool. Knowledge of the visual appearance of various diseases would be of utmost importance to the bronchoscopist. Timely recognition of the endobronchial appearance of these diseases can narrow the differential diagnosis and potentially mitigate an avoidable delay in the diagnosis.

Bartonella henselae: first reported isolate in a human in Thailand.

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.

Angiomatosis bacilar por Bartonella quintana en un paciente con infección por virus de inmunodeficiencia humana / Bacillary angiomatosis caused by Bartonella quintana in an human immunodeficiency virus positive patient

We report the first case of bacillary angiomatosis due to Bartonella quintana affecting a Chilean a HIV positive patient in Chile. He was a 27 years old, heterosexual male, indigentman known to be HIV positive serological status known from September, 2003, under irregular medical control. On April, 2005, he presented a progressive abscess in the frontal region and erythematous papules in the extremities, that extended to face, thorax and mucoses, becoming nodular and violaceous lesions. Bacillary angiomatosis diagnosis was initially sustained on account of the clinical manifestations, and was confirmed by serology and Warthin Starry staining from a skin biopsy. The etiological agent was identified as Bartonella quintana through universal RPC performed from a cutaneous nodule to detect 16S rRNA gen. Azithromycin plus ciprofloxacin was started, besides of anti retroviral therapy antiretroviral, with the lesions being progressively disappearing.

Reportamos el primer caso de angiomatosis bacilar por Bartonella quintana en un paciente con infección por VIH en nuestro país. Este corresponde a un hombre de 27 años, heterosexual, indigente, seropositivo para VIH conocido desde septiembre de 2003, en control irregular. En abril de 2005, el paciente desarrolló un aumento progresivo de volumen en la región frontal y aparición de pápulas eritematosas en las extremidades, que luego se extendieron a la cara, tórax y mucosas, tornándose nodulares y violáceas. El diagnóstico de angiomatosis bacilar se planteó inicialmente por el cuadro clínico del paciente, siendo confirmado por serología y tinción de Warthin Starry positiva en la biopsia de piel. El agente causal se identificó como Bartonella quintana por RPC universal para el gen del 16S ARNr de un nódulo cutáneo. Se inició terapia antimicrobiana con azitromicina y ciprofloxacina, además de terapia antiretroviral, con desaparición de las lesiones en forma progresiva.

Angiomatosis bacilar: resolución espontánea? / Bacillary angiomatosis: spontaneous resolutión?

La angiomatosis bacilar es una enfermedad infecciosa oportunista con manifestaciones sistémicas, no conocidas antes de la epidemia del virus de la inmunodeficiencia humana (HIV). Se manifiesta usualmente en pacientes inmunodeprimidos con recuentos de linfocitos T CD4+ inferiores a 200 células /µL y su evolución, sin tratamiento, cuenta con elevados índices de mortalidad. Presentamos un paciente de sexo masculino, de 27 años, con antecedentes de SIDA, que había iniciado HAART 18 días antes de su derivación a nuestro servicio. Al examen físico se observaban lesiones generalizadas de 1 mes de evolución, compatibles clínica e histológicamente con angiomatosis bacilar, que resolvieron en forma espontánea en 4 semanas.

Angiomatose bacilar pós-transplante renal: apresentação de um caso / Bacillary angiomatosis after kidney transplantation

A bartonela causa a Doença da arranhadura do gato, mas em imunossuprimidos pode levar à doença sistêmica, denominada angiomatose bacilar.Descrição do caso: Masculino, 15 anos, transplantado há 3 anos, em uso de FK, MMF e prednisona com função renal preservada. Refere tumoraçãoavermelhada e dolorosa na região mandibular esquerda há 30 dias, com febre elevada há 7 dias. Esta em regular estado geral, descorado, 39ºC, commassa submandibular de 4cm de diâmetro, consistência carnosa com vesículas na superfície e hepato-esplenomegalia. Bx da massa compatível com Angiomatose Bacilar. Evoluiu bem com Cloranfenicol e Eritromicina. Apresentou elevação da creatinina sérica, sendo feita hipótese de rejeição e realizadopulso de metilprednisolona com normalização da função renal. Conclusões: Como a soroprevalência de Bartonela, em gatos, é elevada em nosso meio, deve-se estar alerta para seu diagnóstico. Pacientes imunossuprimidos podem apresentar formas sistêmicas graves de infecções comuns que, pelararidade, podem ser diagnosticadas tardiamente e carrear maior morbidade.

Bartonela sp causes cat scratch disease but in immunosuppressed hosts it can be associated with a systemic disease named bacillary angiomatosis.Description of case: A 15-year old boy with a successful kidney transplant for 3 years had been treated with FK, MMF and prednisone. He reported ared and painful mass in the left submandibular area for 30 days, and high fever for the last 7 days. He looked sick, pale and had a submandibular mass of 4cm in diameter with vesicles in its surface and hepatosplenomegaly. Biopsy of the mass was suggestive of bacillary angiomatosis. He was treated withchloramphenicol and erythromycin and had a favorable course. An increase of creatinine, interpreted as rejection, was successfully managed with a pulseof methylprednisolone. Conclusions: As the prevalence of bartonelosis in cats is elevated in our country, physicians should be aware of that diagnosticpossibility. Immunocompromised hosts may present rare systemic forms of common diseases that can be diagnosed late and produce sequels.

Manifestações bucais associadas à Síndrome da Imunodeficiência Adquirida / Oral manifestations associated to Acquired Immunodeficiency Syndrome

Muitas lesões bucais têm sido relatadas em pacientes com Síndrome da Imunodeficiência Adquirida (Sida), desde seus primeiros ralatos publicados em 1981, em homens homossexuais moradores da Califórnia, EUA. A prevalência de lesões bucais está mudando com os avanços na terapia, como o exemplo da HAART. Os autores realizam revisão da literatura sobre as manifestações bucais que podem acometer pacientes com Sida, bem como os tratamentos mais indicados destas lesões

Reporte de un caso de angiomatosis bacilar en un niño con infección por VIH / Bacillary angiomatosis in a child with HIV infection

Se reporta el caso de un lactante de 1 año y 2 meses, con serología positiva para VIH, natural y procedente de la Merced, que presentó cuadro de angiomatosis bacilar y peliosis, confirmada por anatomía patológica. El paciente respondió a la terapia convencional con eritromicina.

Angiomatose bacilar: revisäo da literatura e documentaçäo iconográfica / Bacillary angiomatosis: literature review and iconographic documentation

A angiomatose bacilar é uma das bartoneloses humanas. É doença sistêmica de manifestaçäo cutânea freqüente. Caracteriza-se por lesöes angioproliferativas causadas pela Bartonella henselae e pela B. quintana, que comprometem especialmente indivíduos imunodeficientes. Deve ser bem conhecida pelos dermatologistas, pois é potencialmente fatal, mas responsiva à antibioterapia. Para estabelecer o diagnóstico nosológico eles deveräo sugeri-lo ao anatomopatologista, facilitando a diferenciaçäo histológica, sobretudo, com o granuloma piogênico e o sarcoma de Kaposi. O presente artigo apresenta revisäo da literatura e fotografias clínicas, de microscopia de luz e eletrônica de transmissäo.

Identificación de Bartonella sp mediante reacción en cadena de la polimerasa y métodos microbiológicos / Identification of Bartonella sp by polymerase chain reaction and microbiological methods

En el Perú la Angiomatosis bacillar (AB) y la enfermedad de Arañazo de Gato (EAG) han sido reportados confirmando el diagnóstico en laboratorios de investigación o del extranjero, no contándose con métodos de rápido diagnóstico. Se captaron 23 pacientes y se estudiaron 8 muestras de tejidos con sospecha de EAG,AB o Verruga Peruana (VP). Se realizaron cultivos en condiciones requeridas. Extracción de DNA de sangre, cultivos y tejidos mediante buffers de digestión fueron estandarizados para cada caso. Se amplificó el DNA con primers 16S-ITRFf y 23S-ITRr ó CS-ITRf y CSITRr; en gel de agarosa 1 por ciento, y cuantificados con DNA -Hind III. Cultivos controles mostraron banda en B. bacilliformis de 948 pb, B. quintana 1310 pb, B henselae 1427 pb. M. tuberculosus 563 pb. Un paciente con diagnóstico confirmado de EAG por B. henselae, mostró banda concordante con control de B. henselae utilizando los primers 16S y 23S. Una muestra de VP mostró banda concordante con control de B. bacilliformis. una muestra confirmada por patología de AB mostró bandas concordantes a B. henselae utilizando el primer CS. Se confirmaron casos de EAG, AB y VP en base a muestras de aspirados de ganglio o biopsia mediante PCR. El PCR permitió el diagnóstico diferencial de adenomagalias por EAG y Micobacterias, y de AB en la Verruga Peruana.

What do we (not) know about the human bartonelloses?

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