[Infection and angiomatous cutaneous lesions]. / Infection et lésions cutanées angiomateuses.

The occurrence of angiomatous cutaneous lesions in the presence of an infective process is not a frequent phenomenon. Most infectious diseases are associated with an exanthematous reaction. The combination of an infective illness and angiomatous lesions is seen essentially in the bartonelloses and in Kaposi's disease. Bartonelloses: group of infections due to alpha-proteobacteria such as Bartonella. Bartonella bacilliformis (BB), is the causal agent of Carrion's disease, the chronic cutaneous form of which (verruga peruana), in which the vector is an arthropod of the Lutzomyia species found in South America, presents superficial and deep angiomatous cutaneous nodules. Spontaneous regression occurs in a few months or years. Bartonella henselae (BH) and Bartonella quintana (BQ), are the causal agents of bacillary angiomatosis (BA), described in 1983, in which angiomatous papules or nodules with an appearance like botryomycomas, are associated with visceral lesions. The characteristic histological features (with the demonstration or the bacilli by Warthin-Starry stain) together with culture of the bacterium in various tissues (including the blood) are diagnostic. BA occurs most commonly, but not exclusively, in patients with HIV infection. Furthermore, BH is responsible for cat scratch disease while BQ causes trench fever. The reservoir of BH is the cat. The bartonella produce angiogenic factors responsible for the neovascularisation seen in angiomatous lesions. The differential diagnosis is between botryomycomas and Kaposi's disease. Numerous antibiotics are effective against botryomycomas, particularly chloramphenicol and penicillin for BB and macrolides, cyclins and fluoroquinolones for BH and BQ. Kaposi's disease (KD): whether classical, endemic or epidemic (due to HIV infection) is characterised by cutaneous and visceral angiomatous lesions: these are associated with multifocal tumorous proliferations (of endothelial and fusiform cells) affected by angiogenic growth factors (PDGF, FGF, IL6, alphaTGF, HIVtat, androgens) and strongly linked to the lymphocytic and endothelial tropism of a gamma herpes virus (HHV8, Chang and Moore 1994). HHV8 infection, probably sexually transmitted, is also the cause of lymphomas occurring in cavities and of Castleman's disease. The course of KD is very variable: from the indolent form in elderly HIV-ve patients, to the explosive forms in the immunodepressed (particularly in HIV+ve patients.

Rochalimaea henselae infection. A new zoonosis with the domestic cat as reservoir.

OBJECTIVE: To determine the reservoir and vector(s) for Rochalimaea henselae, a causative agent of bacillary angiomatosis (BA) and cat scratch disease, and to estimate the percentage of domestic cats with R henselae bacteremia in the Greater San Francisco Bay Region of Northern California. DESIGN: Hospital-based survey of patients diagnosed with BA who also had significant exposure to at least one pet cat, as well as a convenience sampling of pet or impounded cats for prevalence of Rochalimaea bacteremia. SETTING: Community and university hospitals and clinics; veterinary clinics treating privately owned or impounded cats. PATIENTS: Patients with or without human immunodeficiency virus infection, with biopsy-confirmed BA, who had prolonged exposure to pet cats prior to developing BA. MAIN OUTCOME MEASURES: Cultures and laboratory studies were performed on blood drawn from pet cats associated with patients with BA. The Rochalimaea species infecting pet cats and fleas and causing the BA lesions in human contacts of these cats was identified by culture, polymerase chain reaction-restriction fragment length polymorphism analysis, and DNA sequencing. The presence of R henselae bacteremia in pet cats was documented, and predictor variables for culture positivity were evaluated. RESULTS: Four patients diagnosed with BA who had prolonged contact with seven pet cats were identified. The Rochalimaea species causing BA lesions in these patients was determined to be R henselae. The seven pet cats were found to be bacteremic with R henselae; this bacterium was also detected in fleas taken from an infected cat by both direct culture and polymerase chain reaction. Blood samples were cultured from pet and impounded cats (N = 61) in the Greater San Francisco Bay Region, and R henselae was isolated from 41% (25/61) of these cats. CONCLUSION: We have documented that the domestic cat serves as a major persistent reservoir for R henselae, with prolonged, asymptomatic bacteremia from which humans, especially the immunocompromised, may acquire potentially serious infections. Antibiotic treatment of infected cats and control of flea infestation are potential strategies for decreasing human exposure to R henselae.

Rochalimaea henselae infection in acquired immunodeficiency syndrome causing inflammatory disease without angiomatosis or peliosis. Demonstration by immunocytochemistry and corroboration by DNA amplification.

Rochalimaea henselae causes bacillary angiomatosis, bacillary peliosis, and persistent bacteremia. Difficult to cultivate, it is detectable in infected tissues by immunocytochemistry. This technique demonstrated R henselae in autopsy specimens obtained from three deceased patients who had acquired immunodeficiency syndrome, with pathologic tissue changes lacking neoangiogenic features. From the first patient, the cause of nodular collections of lymphocytes and nonepithelioid histiocytes in the liver, spleen, lymph nodes, bone marrow, and heart eluded detection until immunocytochemical identification of R henselae. In the second case, unexpected gross and microscopic necroinflammatory nodules in the liver and spleen contained Warthin-Starry-staining bacilli identified as R henselae immunocytochemically. The third patient was found to have pathologic changes in his liver and spleen comparable with those of the second case, as well as several other disseminated infections. In two cases, identification of R henselae was corroborated through sequencing polymerase chain reaction-amplified bacterial DNA recovered from tissue; in one case, DNA could not be amplified, possibly because of postmortem degradation. Application of the immunocytochemical technique thus has expanded the recognized spectrum of histopathologic findings associated with R henselae infection in acquired immunodeficiency syndrome, as well as proving to be potentially more sensitive than DNA amplification for this purpose when applied to autopsy tissues.

[Bacillary angiomatosis]. / Bacillaris angiomatosis.

In a 78 years old patient with chronic lymphoid leukemia, diabetes mellitus a cat scratch induced disseminated angiomatous papules were observed. In the lesions great number of bacilluses were observed with light -and electron microscope. As a result of antibiotic treatment the lesions regressed without trace. This opportunist infection resulting general symptoms as well, may be regarded as a cutaneous manifestation of immunodeficiency. The adequate antibiotic treatment depends on the exact diagnosis.

Angiomatosis bacilar / Bacillary angiomatosis

La Angiomatosis Bacilar (AB) es una rara enfermedad infecciosa que afecta piel y vísceras de pacientes con el virus de inmunodeficiencia adquirida y otros inmunodeprimidos. Se caracteriza por presentar lesiones cutáneas vasculares asintomáticas que pueden diseminarse sistémicamente. El agente causal de la angiomatosis bacilar está estrechamente relacionada con la Rocha-limaea henselae

Angiomatosis bacilar / Bacillary angiomatosis

La Angiomatosis Bacilar (AB) es una rara enfermedad infecciosa que afecta piel y vísceras de pacientes con el virus de inmunodeficiencia adquirida y otros inmunodeprimidos. Se caracteriza por presentar lesiones cutáneas vasculares asintomáticas que pueden diseminarse sistémicamente. El agente causal de la angiomatosis bacilar está estrechamente relacionada con la Rocha-limaea henselae

Cytomegalovirus, angiomatosis, and Kaposi's sarcoma: new observations of a debated relationship.

Kaposi's sarcoma (KS) encompasses a broad spectrum of lesions ranging from foci of muco-cutaneous angiomatosis to tumor masses of internal organs. Its strong association with immune deficiency and the marked differences in incidence between the various populations at risk are suggestive of an infectious etiology. The agent most often suspected of being implicated in the etiology of KS is cytomegalovirus (CMV); however, despite sustained research on this subject, its role remains controversial. The present work includes six cases of KS with a broad variety of lesions in which, with the use of light and electron microscopy, immunohistochemistry, and in situ hybridization, we investigated the presence of CMV and examined its relationship with KS. CMV was present in all six cases and showed a remarkable propensity for the KS lesions where both intranuclear and intracytoplasmic forms were not only next to but frequently within KS cells. Areas of angiomatosis, hemorrhage, and KS had usually an abundance of CMV. Herpes-like virus particles inside KS nuclei were documented by light and electron microscopy and identified as CMV by immunohistochemistry and in situ hybridization. The selective morphologic presence of this virus within the tumor cells, not previously demonstrated, indicates a strong association between CMV and KS, the significance of which remains to be established.

The agent of bacillary angiomatosis. An approach to the identification of uncultured pathogens.

BACKGROUND: Bacillary angiomatosis is an infectious disease causing proliferation of small blood vessels in the skin and visceral organs of patients with human immunodeficiency virus infection and other immunocompromised hosts. The agent is often visualized in tissue sections of lesions with Warthin-Starry staining, but the bacillus has not been successfully cultured or identified. This bacillus may also cause cat scratch disease. METHODS: In attempting to identify this organism, we used the polymerase chain reaction. We used oligonucleotide primers complementary to the 16S ribosomal RNA genes of eubacteria to amplify 16S ribosomal gene fragments directly from tissue samples of bacillary angiomatosis. The DNA sequence of these fragments was determined and analyzed for phylogenetic relatedness to other known organisms. Normal tissues were studied in parallel. RESULTS: Tissue from three unrelated patients with bacillary angiomatosis yielded a unique 16S gene sequence. A sequence obtained from a fourth patient with bacillary angiomatosis differed from the sequence found in the other three patients at only 4 of 241 base positions. No related 16S gene fragment was detected in the normal tissues. These 16S sequences associated with bacillary angiomatosis belong to a previously uncharacterized microorganism, most closely related to Rochalimaea quintana. CONCLUSIONS: The cause of bacillary angiomatosis is a previously uncharacterized rickettsia-like organism, closely related to R. quintana. This method for the identification of an uncultured pathogen may be applicable to other infectious diseases of unknown cause.

Visceral bacillary epithelioid angiomatosis: possible manifestations of disseminated cat scratch disease in the immunocompromised host: a report of two cases.

Opportunistic infection with the causative agent of cat scratch disease may be responsible for an unusual vascular proliferative lesion, referred to as bacillary epithelioid angiomatosis, previously described only in human immunodeficiency virus (HIV)-infected patients. We present a case of an HIV-infected patient with bacillary epithelioid angiomatosis involving the liver and bone marrow causing progressive hepatic failure. We also report a case of a cardiac transplant recipient with hepatic and splenic bacillary epithelioid angiomatosis manifesting as a fever of unknown origin, a previously unreported event in a non-HIV-infected patient. These cases represent the first documentation of bacillary epithelioid angiomatosis with visualization of cat scratch-like organisms involving internal organs.

Bacillary epithelioid angiomatosis occurring in an immunocompetent individual.

Within the last several years, a newly characterized condition known as bacillary epithelioid angiomatosis (BEA) has been described in a number of patients with human immunodeficiency virus (HIV) infection. All cases heretofore described have been seen in patients with the HIV infection. We recently evaluated a 37-year-old healthy man who had a localized form of BEA confirmed by biopsy, special strains, electron microscopy, and culture. We conclude that BEA as previously defined may occur in healthy, non-HIV-infected individuals.