eMedicine Specialties > Dermatology > Bacterial Infections

Bacillary Angiomatosis: Follow-up

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): W Clark Lambert, MD, PhD, Professor and Head, Dermatopathology, Departments of Pathology and Dermatology, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: May 6, 2009

Follow-up

Further Inpatient Care

Because bacillary angiomatosis is a potentially fatal systemic disease, patients must be carefully monitored to be sure that the cutaneous and visceral lesions have resolved after appropriate antibiotic therapy.

Deterrence/Prevention

B henselae has been shown to adhere to and invade mature human erythrocytes.15 Thus, erythrocytes may serve as the primary target in Bartonella infections. Studies are warranted to prevent possible Bartonella transfusional transmission.

Complications

Bacillary angiomatosis may cause disease of many different organs, including the heart, brain, liver, and spleen, if not treated promptly.

Prognosis

With proper treatment, the prognosis is excellent. However, a delay can result in spread of disease. Deaths have been reported.

Miscellaneous

Medicolegal Pitfalls

Because bacillary angiomatosis is usually a curable systemic disorder that can be fatal untreated, care must be taken to facilitate the diagnosis and management. Be particularly cautious in patients with Kaposi sarcoma and AIDS because they are at increased risk for the development of bacillary angiomatosis.

 


More on Bacillary Angiomatosis

Overview: Bacillary Angiomatosis
Differential Diagnoses & Workup: Bacillary Angiomatosis
Treatment & Medication: Bacillary Angiomatosis
Follow-up: Bacillary Angiomatosis
Multimedia: Bacillary Angiomatosis
References
[ CLOSE WINDOW ]

References

  1. Stoler MH, Bonfiglio TA, Steigbigel RT, Pereira M. An atypical subcutaneous infection associated with acquired immune deficiency syndrome. Am J Clin Pathol. Nov 1983;80(5):714-8. [Medline].

  2. Cockerell CJ, Whitlow MA, Webster GF, Friedman-Kien AE. Epithelioid angiomatosis: a distinct vascular disorder in patients with the acquired immunodeficiency syndrome or AIDS-related complex. Lancet. Sep 19 1987;2(8560):654-6. [Medline].

  3. LeBoit PE, Berger TG, Egbert BM, Beckstead JH, Yen TS, Stoler MH. Bacillary angiomatosis. The histopathology and differential diagnosis of a pseudoneoplastic infection in patients with human immunodeficiency virus disease. Am J Surg Pathol. Nov 1989;13(11):909-20. [Medline].

  4. LeBoit PE. The expanding spectrum of a new disease, bacillary angiomatosis. Arch Dermatol. Jun 1990;126(6):808-11. [Medline].

  5. Pons I, Sanfeliu I, Nogueras MM, et al. Seroprevalence of Bartonella spp. infection in HIV patients in Catalonia, Spain. BMC Infect Dis. May 1 2008;8:58. [Medline].

  6. Vassallo C, Ardigo M, Brazzelli V, et al. Bartonella-related pseudomembranous angiomatous papillomatosis of the oral cavity associated with allogeneic bone marrow transplantation and oral graft-versus-host disease. Br J Dermatol. Jul 2007;157(1):174-8. [Medline].

  7. Woo SB, Treister N. Ciclosporin-induced fibrovascular polyps vs. bacillary angiomatosis. Br J Dermatol. Jan 17 2008;[Medline].

  8. Stockmeyer B, Schoerner C, Frangou P, Moriabadi T, Heuss D, Harrer T. Chronic vasculitis and polyneuropathy due to infection with Bartonella henselae. Infection. Apr 2007;35(2):107-9. [Medline].

  9. Hoey JG, Valois-Cruz F, Goldenberg H, et al. Development of an Immunoglobulin M Capture-Based Enzyme-Linked Immunosorbent Assay for Diagnosis of Acute Infections with Bartonella henselae. Clin Vaccine Immunol. Feb 2009;16(2):282-4. [Medline].

  10. Amsbaugh S, Huiras E, Wang NS, Wever A, Warren S. Bacillary angiomatosis associated with pseudoepitheliomatous hyperplasia. Am J Dermatopathol. Feb 2006;28(1):32-5. [Medline].

  11. Keynan Y, Yakirevitch E, Shusterman T, et al. Bone marrow and skin granulomatosis in a patient with Bartonella infection. J Med Microbiol. Jan 2007;56(Pt 1):133-5. [Medline].

  12. Milam MW, Balerdi MJ, Toney JF, Foulis PR, Milam CP, Behnke RH. Epithelioid angiomatosis secondary to disseminated cat scratch disease involving the bone marrow and skin in a patient with acquired immune deficiency syndrome: a case report. Am J Med. Feb 1990;88(2):180-3. [Medline].

  13. Meghari S, Rolain JM, Grau GE, et al. Antiangiogenic effect of erythromycin: an in vitro model of Bartonella quintana infection. J Infect Dis. Feb 1 2006;193(3):380-6. [Medline].

  14. Vasquez T P, Chanqueo C L, Garcia C P, et al. [Bacillary angiomatosis caused by Bartonella quintana in an human immunodeficiency virus positive patient.]. Rev Chilena Infectol. Apr 2007;24(2):155-9. [Medline].

  15. Pitassi LH, Magalhaes RF, Barjas-Castro ML, de Paula EV, Ferreira MR, Velho PE. Bartonella henselae infects human erythrocytes. Ultrastruct Pathol. Nov-Dec 2007;31(6):369-72. [Medline].

  16. Adal KA, Cockerell CJ, Petri WA Jr. Cat scratch disease, bacillary angiomatosis, and other infections due to Rochalimaea. N Engl J Med. May 26 1994;330(21):1509-15. [Medline].

  17. Ahsan N, Holman MJ, Riley TR, Abendroth CS, Langhoff EG, Yang HC. Peloisis hepatis due to Bartonella henselae in transplantation: a hemato-hepato-renal syndrome. Transplantation. Apr 15 1998;65(7):1000-3. [Medline].

  18. Angritt P, Tuur SM, Macher AM, et al. Case for diagnosis. Cat-scratch disease. Mil Med. May 1988;153(5):M25-32. [Medline].

  19. Angritt P, Tuur SM, Macher AM, et al. Epithelioid angiomatosis in HIV infection: neoplasm or cat-scratch disease?. Lancet. Apr 30 1988;1(8592):996. [Medline].

  20. Anonymous. Epithelioid angiomatosis: a variant of Kaposi's sarcoma. Lancet. Nov 21 1987;2(8569):1214-5. [Medline].

  21. Arias-Stella J, Lieberman PH, Erlandson RA, Arias-Stella J Jr. Histology, immunohistochemistry, and ultrastructure of the verruga in Carrion's disease. Am J Surg Pathol. Sep 1986;10(9):595-610. [Medline].

  22. Arrese Estrada J, Pierard GE. Dendrocytes in verruga peruana and bacillary angiomatosis. Dermatology. 1992;184(1):22-5. [Medline].

  23. Baron AL, Steinbach LS, LeBoit PE, Mills CM, Gee JH, Berger TG. Osteolytic lesions and bacillary angiomatosis in HIV infection: radiologic differentiation from AIDS-related Kaposi sarcoma. Radiology. Oct 1990;177(1):77-81. [Medline].

  24. Berger TG, Tappero JW, Kaymen A, LeBoit PE. Bacillary (epithelioid) angiomatosis and concurrent Kaposi's sarcoma in acquired immunodeficiency syndrome. Arch Dermatol. Nov 1989;125(11):1543-7. [Medline].

  25. Birtles RJ, Harrison TG, Taylor AG. The causative agent of bacillary angiomatosis. N Engl J Med. Nov 14 1991;325(20):1447-8. [Medline].

  26. Brenner DJ, O'Connor SP, Winkler HH, Steigerwalt AG. Proposals to unify the genera Bartonella and Rochalimaea, with descriptions of Bartonella quintana comb. nov., Bartonella vinsonii comb. nov., Bartonella henselae comb. nov., and Bartonella elizabethae comb. nov., and to remove the family Bartonellaceae from the order Rickettsiales. Int J Syst Bacteriol. Oct 1993;43(4):777-86. [Medline].

  27. Cockerell CJ, Bergstresser PR, Myrie-Williams C, Tierno PM. Bacillary epithelioid angiomatosis occurring in an immunocompetent individual. Arch Dermatol. Jun 1990;126(6):787-90. [Medline].

  28. Cockerell CJ, LeBoit PE. Bacillary angiomatosis: a newly characterized, pseudoneoplastic, infectious, cutaneous vascular disorder. J Am Acad Dermatol. Mar 1990;22(3):501-12. [Medline].

  29. Cockerell CJ, Tierno PM, Friedman-Kien AE, Kim KS. Clinical, histologic, microbiologic, and biochemical characterization of the causative agent of bacillary (epithelioid) angiomatosis: a rickettsial illness with features of bartonellosis. J Invest Dermatol. Nov 1991;97(5):812-7. [Medline].

  30. Drancourt M, Mainardi JL, Brouqui P, et al. Bartonella (Rochalimaea) quintana endocarditis in three homeless men. N Engl J Med. Feb 16 1995;332(7):419-23. [Medline].

  31. Fernandez-Bussy RA, Alonso AB, Carlson D. Bacillary angiomatosis in an HIV-positive patient. Good response to Dapsone. J Eur Acad Dermatol Venereol. 1995;4:289-93.

  32. Guerra LG, Neira CJ, Boman D, Ho H, Casner PR, Zuckerman M, et al. Rapid response of AIDS-related bacillary angiomatosis to azithromycin. Clin Infect Dis. Aug 1993;17(2):264-6. [Medline].

  33. Hall AV, Roberts CM, Maurice PD, McLean KA, Shousha S. Cat-scratch disease in patient with AIDS: atypical skin manifestation. Lancet. Aug 20 1988;2(8608):453-4. [Medline].

  34. Harris PJ. Intracerebral bacillary angiomatosis in HIV. Ann Intern Med. Nov 1 1992;117(9):795. [Medline].

  35. Haught WH, Steinbach J, Zander DS, Wingo CS. Case report: bacillary angiomatosis with massive visceral lymphadenopathy. Am J Med Sci. Oct 1993;306(4):236-40. [Medline].

  36. Jimenez-Acosta F, Pardo RJ, Cohen RJ, Gould EW, Penneys NS. Bacillary angiomatosis of acquired immunodeficiency syndrome: case report and literature review. J Am Acad Dermatol. Mar 1990;22(3):525-9. [Medline].

  37. Jung AC, Paauw DS. Diagnosing HIV-related disease: using the CD4 count as a guide. J Gen Intern Med. Feb 1998;13(2):131-6. [Medline].

  38. Karakas M, Baba M, Aksungur VL, Homan S, Memisoglu HR, Uguz A. Bacillary angiomatosis on a region of burned skin in a immunocompetent patient. Br J Dermatol. Sep 2000;143(3):609-11. [Medline].

  39. Karem KL. Immune aspects of Bartonella. Crit Rev Microbiol. 2000;26(3):133-45. [Medline].

  40. Karem KL, Paddock CD, Regnery RL. Bartonella henselae, B. quintana, and B. bacilliformis: historical pathogens of emerging significance. Microbes Infect. Aug 2000;2(10):1193-205. [Medline].

  41. Kemper CA, Lombard CM, Deresinski SC, Tompkins LS. Visceral bacillary epithelioid angiomatosis: possible manifestations of disseminated cat scratch disease in the immunocompromised host: a report of two cases. Am J Med. Aug 1990;89(2):216-22. [Medline].

  42. Knobler EH, Silvers DN, Fine KC, Lefkowitch JH, Grossman ME. Unique vascular skin lesions associated with human immunodeficiency virus. JAMA. Jul 22-29 1988;260(4):524-7. [Medline].

  43. Koehler JE, Glaser CA, Tappero JW. Rochalimaea henselae infection. A new zoonosis with the domestic cat as reservoir. JAMA. Feb 16 1994;271(7):531-5. [Medline].

  44. Koehler JE, LeBoit PE, Egbert BM, Berger TG. Cutaneous vascular lesions and disseminated cat-scratch disease in patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex. Ann Intern Med. Sep 15 1988;109(6):449-55. [Medline].

  45. Koehler JE, Quinn FD, Berger TG, LeBoit PE, Tappero JW. Isolation of Rochalimaea species from cutaneous and osseous lesions of bacillary angiomatosis. N Engl J Med. Dec 3 1992;327(23):1625-31. [Medline].

  46. Koehler JE, Tappero JW. Bacillary angiomatosis and bacillary peliosis in patients infected with human immunodeficiency virus. Clin Infect Dis. Oct 1993;17(4):612-24. [Medline].

  47. Levell NJ, Bewley AP, Chopra S, et al. Bacillary angiomatosis with cutaneous and oral lesions in an HIV-infected patient from the U.K. Br J Dermatol. Jan 1995;132(1):113-5. [Medline].

  48. Lopez-Elzaurdia C, Fraga J, Sols M, Burgos E, Sanchez Garcia M, Garcia-Diez A. Bacillary angiomatosis associated with cytomegalovirus infection in a patient with AIDS. Br J Dermatol. Aug 1991;125(2):175-7. [Medline].

  49. Lucey D, Dolan MJ, Moss CW, Garcia M, Hollis DG, Wegner S, et al. Relapsing illness due to Rochalimaea henselae in immunocompetent hosts: implication for therapy and new epidemiological associations. Clin Infect Dis. Mar 1992;14(3):683-8. [Medline].

  50. Malane MS, Laude TA, Chen CK, Fikrig S. An HIV-1-positive child with fever and a scalp nodule. Lancet. Dec 2 1995;346(8988):1466. [Medline].

  51. Matar GM, Koehler JE, Malcolm G, Lambert-Fair MA, Tappero J, Hunter SB, et al. Identification of Bartonella species directly in clinical specimens by PCR-restriction fragment length polymorphism analysis of a 16S rRNA gene fragment. J Clin Microbiol. Dec 1999;37(12):4045-7. [Medline].

  52. Moore EH, Russell LA, Klein JS, White CS, McGuinness G, Davis LG, et al. Bacillary angiomatosis in patients with AIDS: multiorgan imaging findings. Radiology. Oct 1995;197(1):67-72. [Medline].

  53. Morgan J, Robinson MJ, Rosen LB, Unger H, Niven J. Malignant endovascular papillary angioendothelioma (Dabska tumor). A case report and review of the literature. Am J Dermatopathol. Feb 1989;11(1):64-8. [Medline].

  54. Ohl ME, Spach DH. Bartonella quintana and urban trench fever. Clin Infect Dis. Jul 2000;31(1):131-5. [Medline].

  55. Omulecki A. Bacillary (epithelioid) angiomatosis-nowa zakazna choroba zwiazana z AIDS. Przegl Dermatol. 1992;74:172-6.

  56. Perkocha LA, Geaghan SM, Yen TS, et al. Clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection. N Engl J Med. Dec 6 1990;323(23):1581-6. [Medline].

  57. Petersen K, Earhart KC, Wallace MR. Bacillary Angiomatosis in a Patient with Chronic Lymphocytic Leukemia. Infection. Dec 28 2007;[Medline].

  58. Plettenberg A, Lorenzen T, Burtsche BT, et al. Bacillary angiomatosis in HIV-infected patients--an epidemiological and clinical study. Dermatology. 2000;201(4):326-31. [Medline].

  59. Pulliainen AT, Dehio C. Bartonella henselae: Subversion of vascular endothelial cell functions by translocated bacterial effector proteins. Int J Biochem Cell Biol. 2009;41(3):507-10. [Medline].

  60. Raoult D, Drancourt M, Carta A, Gastaut JA. Bartonella (Rochalimaea) quintana isolation in patient with chronic adenopathy, lymphopenia, and a cat. Lancet. Apr 16 1994;343(8903):977. [Medline].

  61. Relman DA. Isolation of Rochalimaea species. N Engl J Med. May 13 1993;328(19):1422-3. [Medline].

  62. Relman DA, Loutit JS, Schmidt TM, Falkow S, Tompkins LS. The agent of bacillary angiomatosis. An approach to the identification of uncultured pathogens. N Engl J Med. Dec 6 1990;323(23):1573-80. [Medline].

  63. Rudikoff D, Phelps RG, Gordon RE, Battone EJ. Acquired immunodeficiency syndrome-related bacillary vascular proliferation (epithelioid angiomatosis): rapid response to erythromycin therapy. Arch Dermatol. May 1989;125(5):706-7. [Medline].

  64. Sanchez MR, del Rocio Flashner Z. Angiomatosis bacilar una nueva enfermedad infecciosa. Medico Interamericano. 1995;12:517-9.

  65. Sander A, Penno S. Semiquantitative species-specific detection of Bartonella henselae and Bartonella quintana by PCR-enzyme immunoassay. J Clin Microbiol. Oct 1999;37(10):3097-101. [Medline].

  66. Santos R, Cardoso O, Rodrigues P, et al. Bacillary angiomatosis by Bartonella quintana in an HIV-infected patient. J Am Acad Dermatol. Feb 2000;42(2 Pt 1):299-301. [Medline].

  67. Schwartz RA, Gallardo MA, Kapila R, Gascón P, Herscu J, Siegel I, et al. Bacillary angiomatosis in an HIV seronegative patient on systemic steroid therapy. Br J Dermatol. Dec 1996;135(6):982-7. [Medline].

  68. Schwartz RA, Janniger CK. Bacillary angiomatosis. J Am Acad Dermatol. 1991;24:802-3, 807-8.

  69. Schwartz RA, Nychay SG, Janniger CK, Lambert WC. Bacillary angiomatosis: presentation of six patients, some with unusual features. Br J Dermatol. Jan 1997;136(1):60-5. [Medline].

  70. Schwartzman WA. Infections due to Rochalimaea: the expanding clinical spectrum. Clin Infect Dis. Dec 1992;15(6):893-900. [Medline].

  71. Schwartzman WA, Marchevsky A, Meyer RD. Epithelioid angiomatosis or cat scratch disease with splenic and hepatic abnormalities in AIDS: case report and review of the literature. Scand J Infect Dis. 1990;22(2):121-33. [Medline].

  72. Slater LN, Coody DW, Woolridge LK, Welch DF. Murine antibody responses distinguish Rochalimaea henselae from Rochalimaea quintana. J Clin Microbiol. Jul 1992;30(7):1722-7. [Medline].

  73. Slater LN, Welch DF, Min KW. Rochalimaea henselae causes bacillary angiomatosis and peliosis hepatis. Arch Intern Med. Mar 1992;152(3):602-6. [Medline].

  74. Spach DH. Bacillary angiomatosis. Int J Dermatol. Jan 1992;31(1):19-24. [Medline].

  75. Spach DH, Kanter AS, Dougherty MJ, et al. Bartonella (Rochalimaea) quintana bacteremia in inner-city patients with chronic alcoholism. N Engl J Med. Feb 16 1995;332(7):424-8. [Medline].

  76. Szaniawski WK, Don PC, Bitterman SR, Schachner JR. Epithelioid angiomatosis in patients with AIDS. Report of seven cases and review of the literature. J Am Acad Dermatol. Jul 1990;23(1):41-8. [Medline].

  77. Tappero JW, Mohle-Boetani J, Koehler JE, et al. The epidemiology of bacillary angiomatosis and bacillary peliosis. JAMA. Feb 10 1993;269(6):770-5. [Medline].

  78. Tompkins DC, Steigbigel RT. Rochalimaea's role in cat scratch disease and bacillary angiomatosis. Ann Intern Med. Mar 1 1993;118(5):388-90. [Medline].

  79. Torok L, Viragh SZ, Borka I, Tapai M. Bacillary angiomatosis in a patient with lymphocytic leukaemia. Br J Dermatol. May 1994;130(5):665-8. [Medline].

  80. Ueno H, Muramatsu Y, Chomel BB, Hohdatsu T, Koyama H, Morita C. Seroepidemiological survey of Bartonella (Rochalimaea) henselae in domestic cats in Japan. Microbiol Immunol. 1995;39(5):339-41. [Medline].

  81. Webster GF, Cockerell CJ, Friedman-Kien AE. The clinical spectrum of bacillary angiomatosis. Br J Dermatol. Jun 1992;126(6):535-41. [Medline].

  82. Welch DF, Pickett DA, Slater LN, Steigerwalt AG, Brenner DJ. Rochalimaea henselae sp. nov., a cause of septicemia, bacillary angiomatosis, and parenchymal bacillary peliosis. J Clin Microbiol. Feb 1992;30(2):275-80. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

bacillary angiomatosis, BA, epithelioid angiomatosis, bartonellosis, Bartonella henselae, B henselae, bartonellosis, Bartonella quintana, B quintana, catscratch disease, cat scratch disease, cat scratch fever, catscratch fever, trench fever

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

W Clark Lambert, MD, PhD, Professor and Head, Dermatopathology, Departments of Pathology and Dermatology, UMDNJ-New Jersey Medical School
W Clark Lambert, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Dermatological Association, American Society of Dermatopathology, International Academy of Pathology, Medical Society of New Jersey, Sigma Xi, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Ponciano D Cruz Jr, MD, Vice-Chair, JB Shelmire Professor, Department of Dermatology, University of Texas Southwestern Medical Center
Ponciano D Cruz Jr, MD is a member of the following medical societies: Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.