Bacillary angiomatosis (BA) is a systemic infection caused by Bartonella species, occurring nearly exclusively in HIV-infected individuals, characterized by cutaneous vascular tumors resembling Kaposi’s sarcoma and symptomatic multisystemic infection, most commonly involving the liver (peliosis hepatis) and/or spleen (parenchymal bacillary peliosis).
Causes of Bacillary Angiomatosis
Bartonella spp. cause vascular proliferation (angiogenesis): B.bacilliformis, verruga peruana; B.henselae and B.quintana, BA.
Additional risk factors for bacillary angiomatosis associated with B quintana infection include the following:
- Homelessness
- Low socioeconomic status
- Exposure to body and hair lice
Risk factors for bacillary angiomatosis include the following:
- HIV infection
- Chronic lymphocytic leukemia
- Cytotoxic chemotherapy
- Organ transplantations
Symptoms of Bacillary Angiomatosis
- high fever
- tender and swollen lymph nodes
- nausea
- vomiting
- sweats
- chills
- poor appetite
- Weight loss
- Gastrointestinal symptoms
Diagnosis
Clinical findings confirmed by demonstration of Bartonella bacilli on silver stain of lesional biopsy specimen or culture or antibody studies.
Treatment
Antimicrobial Therapy Given for 8 to 12 weeks. A Jarisch-Herxheimer type reaction may occur shortly after beginning therapy.
- Erythromycin 500 mg PO qid or
- Doxycycline 100 mg PO bid or
- Ciprofloxacin 750 mg PO bid or
- Azithromycin 500 mg PO qd
SecondaryProphylaxis Lifelong maintenance if relapses occur.
Prevention
HIV-infected individuals should avoid contact with cats, especially kittens, to minimize the risk for acquiring BA, as well as toxoplasmosis.
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