Bacillary Angiomatosis Treatment & Management

  • Author: KoKo Aung, MD, MPH, FACP; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Sep 6, 2011
 

Medical Care

Bacillary angiomatosis can be cured in most patients with antibiotics, so recognition is critical. Treatment recommendations are based on retrospective studies or clinical observations. No antibiotics have been studied prospectively.

Clinical experience strongly favors the use of erythromycin or a tetracycline derivative. Erythromycin remains the drug of choice because it yields an excellent clinical response in almost all patients. Tetracyclines are the first alternative in patients who cannot tolerate erythromycin. A combination of doxycycline (100 mg PO/IV q12h) plus rifampin (300 mg PO bid) may be used in immunocompromised patients with severe disease.

Other antibiotics display in vitro activity, but in vitro susceptibility data do not accurately predict success in vivo. Penicillins and cephalosporins have no activity against Bartonella species despite in vitro susceptibilities. Clarithromycin, azithromycin, chloramphenicol, ciprofloxacin, trimethoprim-sulfamethoxazole, rifampin, isoniazid, and gentamicin combined with either doxycycline or ciprofloxacin produce good clinical responses. These antibiotics have been used successfully in limited numbers of patients. Treatment failures with ciprofloxacin, trimethoprim-sulfamethoxazole, isoniazid, and rifampin have been reported.

A reaction resembling the Jarisch-Herxheimer reaction has been described upon the initiation of appropriate antibiotic therapy. The reaction is characterized by fever, myalgias, and constitutional symptoms.

The optimal duration of therapy is not known. Recommendations are based on clinical experience rather than scientific data. Usually, recommendations indicate to treat skin lesions for 8-12 weeks and osseous and liver lesions for at least 3 months, although these have not been studied in prospective randomized trials. Patients with HIV infection may require life-long therapy if relapses occur.

The cutaneous lesions resolve substantially after approximately 4-7 days of therapy, and they usually resolve completely after 1 month.

Corticosteroid therapy, cytotoxic therapy, or radiation therapy is not effective.

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Surgical Care

Cryotherapy, electrodesiccation and curettage, and surgical excision of solitary cutaneous lesions can be useful as adjunctive therapy. However, antibiotic therapy provides treatment for possible occult dissemination of bacteria, in addition to regression of the lesions.

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Consultations

  • Infectious diseases specialist
  • Dermatologist
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Diet

  • No special dietary restrictions
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Activity

  • No restriction of physical activity
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Contributor Information and Disclosures
Author

KoKo Aung, MD, MPH, FACP  Associate Professor, Department of Medicine, University of Texas Health Science Center at San Antonio; Adjunct Associate Professor of Public Health, University of Texas School of Public Health

KoKo Aung, MD, MPH, FACP is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Thwe T Htay, MD  Assistant Professor, Department of Medicine, University of Texas Health Science Center at San Antonio

Thwe T Htay, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Romeo Papica II  MD, Staff Physician Premier Physicians

Disclosure: Nothing to disclose.

Harvey Kantor, MD  Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Texas Tech University Health Science Center

Harvey Kantor, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Illinois State Medical Society, Infectious Diseases Society of America, New York Academy of Sciences, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Hesham M Elgouhari, MD  Hepatology/Transplant Hepatology Fellow, Cleveland Clinic

Hesham M Elgouhari, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society of Transplantation, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary L Gorby, MD  Associate Professor, Departments of Internal Medicine and Medical Microbiology and Immunology, Division of Infectious Diseases, Creighton University School of Medicine; Associate Professor of Medicine, University of Nebraska Medical Center; Associate Chair, Omaha Veterans Affairs Medical Center

Gary L Gorby, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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