Bacterial and Atypical Mycobacterial Infections
Clay J. Cockerell, Antoanella Calame in Cutaneous Manifestations of HIV Disease, 2012
First identified in 1983, bacillary angiomatosis (BA) is a vascular infection caused by Bartonella species. It is a rare cutaneous disease that presents most commonly in moderately immunocompromised HIV-positive patients, such as those with CD4 cell counts of less than 200 × 106/l. Some studies suggest that the incidence of BA within the HIV-positive population is approximately 0.1%. The etiological agents have been identified as both Bartonella henselae, the organism responsible for cat scratch disease, and Bartonella quintana, the causative organism of trench fever. The skin as well as many different visceral organs may be involved, but the most common extracutaneous site of involvement is the liver, with peliosis hepatis. Bacteremia and sepsis are also complications.24
Dermatological emergencies in tropical infections and infestations
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
Bacillary angiomatosis is characterized by proliferative vascular lesions, is caused by Bartonella henselae and B. quintana, and is common in immunocompromised individuals. Domestic cat (Felis domesticus) and human body louse (Pediculus humanus) are the transmission vectors for B. henselae and B. quintana, respectively. Internal organ involvement may result in biliary obstruction and jaundice, gastrointestinal bleeding, encephalopathy, laryngeal obstruction, and asphyxiation. The illness responds well to antibiotic therapy but runs a chronic progressive course in untreated patients and may be fatal [43].
Azithromycin
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Azithromycin is recommended for cat scratch disease (adults: 500 mg on day 1, followed by 250 mg daily for 4 additional days; children: 10 mg/kg/day for day 1 and 5 mg/kg dilay for 4 additional days) (Stevens et al., 2014). In a small randomized trial, azithromycin treatment led to lymph node regression at 30 days more frequently than placebo (Bass et al., 1998). Bacillary angiomatosis typically occurs in immunocompromised patients, especially patients with AIDS. Erythromycin or doxycycline is recommended for the treatment of bacillary angiomatosis (Stevens et al., 2014), although a case report has reported efficacy with azithromycin (Guerra et al., 1993). Azithromycin is an appropriate option for tularemia during pregnancy in regions where the infecting strains of Francisella tularensis have no natural resistance to macrolides (Dentan et al., 2013). North American strains are generally sensitive to macrolides, in contrast to European isolates (Johansson et al., 2002). Azithromycin may be used for the treatment of toxoplasmosis, particularly in immunocompetent patients (Wei et al., 2015). Azithromycin treatment of toxoplasmosis during pregnancy can reduce the sequelae rate among infected infants at 1 year of age (Foulon et al., 1999), and is also widely used in the treatment of refractory ocular toxoplasmosis (Bosch-Driessen et al., 2002; Commodaro et al., 2009; Rothova et al., 1998; Yazici et al., 2009). Azithromycin alone or combined with pyrimethamine or sulfamethoxazole–trimethoprim is an option for secondary prevention of HIV toxoplasmic encephalitis when pyrimethamine–sulfadiazine is unavailable or contraindicated (Wei et al., 2015).
Isolated hepatosplenic abscess from cat scratch disease in a patient with HIV
Published in Baylor University Medical Center Proceedings, 2021
Bhanusowmya Buragamadagu, Chen Song, Shambo GuhaRoy, Gul Madison
B. henselae is a small pleomorphic, fastidious, facultative gram-negative bacillus that was first observed from a lymph node of a patient infected with CSD in 1983.1,3 The average annual incidence of CSD is reported to be 0.7 to 0.8 per 100,000 population.4,5 CSD is frequently seen in children aged <14 years, followed by adults. The organism’s affinity to the vascular endothelium and its effects on vascular endothelial growth factor are thought to cause its intraerythrocytic proliferation.2,6 Typical CSD frequently presents as an erythematous papule followed by isolated regional lymphadenopathy with or without fever. It is considered a self-limiting illness rarely requiring treatment, including antibiotics or lymph node drainage.2 Immunocompromised patients frequently have atypical presentations such as retinitis, Parinaud oculoglandular syndrome, hepatosplenic abscess, endocarditis, osteomyelitis, and vasoproliferative manifestations like bacillary angiomatosis and bacillary peliosis.2,5 Diagnosis of atypical CSD can be challenging in the absence of relevant clinical history. Blood cultures and tissue cultures have prolonged incubation periods.2 The polymerase chain reaction and serological tests are used in diagnosis.2,7–9
Management of Intraocular Infections in HIV
Published in Ocular Immunology and Inflammation, 2020
Ilaria Testi, Sarakshi Mahajan, Rupesh Agrawal, Aniruddha Agarwal, Alessandro Marchese, Andre Curi, Moncef Khairallah, Yee Sin Leo, Quan Dong Nguyen, Vishali Gupta
Bartonella henselae is the causative agent of cat-scratch disease and, in immunocompromised patients, of bacillary angiomatosis. Ocular complications associated with the infection have been reported in immunocompetent patients and less often in HIV patients.110111112–113 Bartonella infection in HIV-infected patients usually presents differently from the typical presentation of neuroretinitis. Due to the relationship between the bacteria and vascular endothelium, the response tends to be vasoproliferative. Vasoproliferative lesions can be seen both in the skin (bacillary angiomatosis) and in the retina.110 Diagnosis is based on serologic tests in peripheral blood and titers of IgG >1/256 are considered acute or recent infection.114
Cat Scratch Disease: Not a Benign Condition
Published in Ocular Immunology and Inflammation, 2018
Sandra Barros, Gabriel Costa de Andrade, Cecilia Cavalcanti, Heloisa Nascimento
Vascular proliferation may be one of the most important events in Bartonella infection, and this was evident since the isolation of Bartonella species in bacillary angiomatosis.20 The first reports of vascular lesions involving the eye associated with ocular bartonellosis dates back to the 90s, with descriptions of «peripapillary angiomatosis»21 and «inflammatory mass of the optic nerve head».22 Bartonella-induced vascular proliferation seems to be elicited by stimulation of the production of vascular endothelial growth factor (VEGF) by infected macrophages, triggering of vascular proliferation and inhibition of apoptosis.23
Related Knowledge Centers
- Angiomatosis
- Bartonella
- Kaposi's Sarcoma
- Biopsy
- Abscess
- Hepatomegaly
- Fever
- Bartonella Henselae
- Bartonella Quintana
- Tick