Bacillary angiomatosis is a disease of the blood vessels. Bacillary angiomatosis is pseudoneoplastic and is an infectious disease. The pathogen responsible for bacillary angiomatosis is the bacterial species Bartonella henselae. This is a bacterial germ that causes the so-called cat scratch disease. Somewhat less commonly, infection with Bartonella quintana leads to bacillary angiomatosis.
What is bacillary angiomatosis?
Most often, bacillary angiomatosis affects people who suffer from a marked weakness of the body’s immune system. This includes, for example, people with HIV infection, which is why bacillary angiomatosis is particularly common in this group of patients. Basically, bacillary angiomatosis is a disease of the skin that occurs relatively rarely. Bacillary angiomatosis occurs most frequently in HIV patients, and less frequently in patients with other weaknesses of the immune system. In these people, two bacterial species are usually responsible for the development of bacillary angiomatosis, namely either Bartonella henselae or Bartonella quintana. These are the bacterial pathogens of cat scratch disease. Bacillary angiomatosis manifests itself in characteristic changes on the skin that result from angiogenesis. Thus, in bacillary angiomatosis, nodules and papules form on the skin, which have a reddish-brown color. Ulcers are also possible, as well as damage to the bones, which occur over larger areas. In bacillary angiomatosis, the skin changes are sometimes accompanied by chills, increased body temperature, as well as other general symptoms. In addition, it is possible that organs are affected by the symptoms of bacillary angiomatosis. Osteolysis also occurs frequently as a result of bacillary angiomatosis. In addition, peliosis hepatis of the liver and so-called hepatosplenomegaly often develop. In addition, patients affected by bacillary angiomatosis sometimes suffer from aseptic meningitis, neuroretinitis, and proliferative lesions in the central nervous system. Bacillary angiomatosis occurs in the majority of cases in HIV patients. Other individuals with a weakened immune system are also at particular risk for disease.
Causes
The cause of bacillary angiomatosis is found in infection with certain bacterial pathogens. Thus, Bartonella quintana and Bartonella henselae bacteria, in particular, cause Bartonella quintana. These are also the two germs that cause cat scratch disease. However, only about one third of all patients with bacillary angiomatosis have had contact with cats. Other favoring factors for the development of bacillary angiomatosis can be found in HIV, EBV or CMV disease. The diseased cells lead to an increase in growth factors so that proliferation of endothelial cells develops.
Symptoms, complaints, and signs
The symptoms of bacillary angiomatosis are particularly apparent on the skin. As a result of increased proliferation of the capillaries, nodules and papules develop that are distributed over the entire body and are hardly clustered in certain areas of the body. The papules are reddish to brown in color and occur either singly or in groups. The color of the nodules depends in particular on how deeply the lesions extend into the skin layers. The consistency of the papules is elastic, with ulceration sometimes developing after a certain extent. The skin symptoms of bacillary angiomatosis often lead to confusion with Kaposi’s sarcoma, which also occurs more frequently in HIV patients. In some cases, bacillary angiomatosis also causes symptoms in the muscles, spleen, liver, lymph nodes, and eye. Bones are affected by the disease in about 25 percent of patients with bacillary angiomatosis, with painful foci of osteolytis.
Diagnosis and course
The diagnosis of bacillary angiomatosis should be made by a specialist, such as a dermatologist. During the anamnesis, the investigation of possible chronic underlying diseases and immune deficiencies is particularly important. For example, HIV disease already indicates bacillary angiomatosis.The clinical examination also initially begins with a check of the immune status of patients suffering from bacillary angiomatosis. The physician detects the pathogens responsible for bacillary angiomatosis by molecular genetic techniques, using either diseased tissue of the skin or the patient’s blood as a basis. The investigation of bacillary angiomatosis requires an extensive differential diagnosis. In doing so, the physician excludes Kaposi’s sarcoma, granuloma teleangiectaticum, dermatofibromas, and hemangiomas. The disease must also be differentiated from ulcerative pyoderma, papular exanthema, subcutaneous tumors, verruga peruana, syphilis type 2 or 3, and Oroya fever.
Complications
Bacillary angiomatosis is a rare skin disease that may be associated with pseudoneoplastic vascular disease. The symptom can affect persons with severe immunodeficiency and is comparatively more common in HIV-infected patients. The disease is triggered by bacteria and pathogens of the so-called cat scratch disease. This can already lead to complications in non-infected people due to its protracted flu symptoms. Affected persons with immune deficiency react much more sensitively to bacillary angiomatosis. Reddish-colored nodules may form all over the body, standing either singly or in groups. The larger and more bulging the nodules grow, the more likely they are to reach ulcer-like proportions. If symptoms are not treated, the dermatologic lesions can cause chills, fevers, and headaches. In addition, inflammatory lesions may affect the organs, lymph nodes, eyes, muscles, and the entire central nervous system and bony apparatus. As the most difficult complication consequence, meningitis or heart valve inflammation can develop. In order to reduce severe secondary problems in the case of immunodeficiency, affected persons, especially children and adolescents, must seek medical attention immediately. Bacillary angiomatosis can be diagnosed by microscopy and molecular genetics. After a thorough anamnesis, the treatment plan is drawn up. Here, the bacterial skin infection is successfully treated a priori with antibiotics internally as well as externally. If the symptom occurs repeatedly, lifelong therapy must be targeted.
When should you go to the doctor?
Infectious bacillary angiomatosis mainly affects people whose immune systems are weakened. It is striking that mainly HIV patients become infected with the bacterial pathogens that are also the causative agents of the so-called cat-scratch disease. These are the bacterium Bartonella henselae and, much more rarely, Bartonella quintana. Cases in which people with intact or with artificially suppressed immune systems are affected are very rare. As soon as visible papules or nodules with a brown to reddish-brown color appear scattered evenly over the entire skin surface, a dermatologist should be consulted for clarification and possible drug therapy. Even persons with an intact immune system should definitely seek medical help. For example, a differential diagnosis must be made to determine whether other serious diseases such as Kaposi’s sarcoma, various hemangiomas, tumors, syphilis and others are hidden behind the skin symptoms. Moreover, in a more serious course of bacillary angiomatosis, internal organs, mainly liver and spleen, may also be affected. In addition, there is a risk that the infection – if left untreated – will spread to lymph nodes, bones, eyes, muscles and even the CNS with the consequence of serious permanent damage. Spread of the infection is usually associated with nonspecific symptoms such as chills, fevers, and headaches. Symptoms are similar to those of a flu-like infection.
Treatment and therapy
Treatment of bacillary angiomatosis primarily uses drug approaches. Patients receive erythromycin either as an intravenous injection or in tablet form. With this form of therapy, the prognosis of bacillary angiomatosis is comparatively favorable. At the end of a successful treatment, the changes on the skin usually disappear. In some cases, hyperpigmentation remains on the damaged areas. In the case of individual lesions of bacillary angiomatosis, surgical removal, cryotherapy and curettage are also possible.
Outlook and prognosis
The prognosis of bacillary angiomatosis is considered favorable. Drug treatment combats the pathogens so that they die and can be transported out of the organism. Following the therapy, the skin lesions heal to a large extent in the coming days and the patient is free of symptoms. It is also possible to cure the disease without medical care. The organism can be strengthened and supported with various natural products. Through the self-healing powers of the human being it is possible that recovery takes place. In addition, creams can be applied, which have a healing influence on the healing process of the skin. However, the healing process is significantly prolonged when this method is chosen and requires a healthy as well as stable immune system. If the affected person is weakened by other previous diseases, complications can arise with the outbreak of bacillary angiomatosis, which have a negative impact on the patient’s health. If the pathogen manages to spread strongly, the self-healing powers are usually not sufficient. In addition, the risk increases that skin lesions will remain stronger after the pathogen is eliminated. In most cases, the skin changes cannot be completely reversed. Therefore, in a medical treatment, the damaged skin areas are further treated until the unwanted skin changes disappear.
Prevention
Concrete ways to prevent bacillary angiomatosis are currently unknown. This is because deliberate avoidance of the causative disease germs often proves difficult in reality. HIV patients take advantage of regular medical checkups.
Follow-up
With this disease, the affected person usually has no or only a few measures and options of aftercare available, so that the affected person is thereby primarily dependent on a quick and, above all, an early diagnosis to prevent further complaints or complications. In the worst case, the affected person can also die as a result of this infection, since it is not possible for the infection to heal on its own. Therefore, the focus is on early diagnosis with subsequent treatment. In most cases, the symptoms are treated with the help of medication. The patient is dependent on a regular intake with a correct dosage, in order to relieve the complaints permanently and above all completely. If there are any questions or uncertainties, a doctor should be contacted first and foremost. Furthermore, the damaged areas on the skin should always be checked by a doctor to prevent the development of a tumor. The life expectancy is usually not reduced by this disease. Contact with other affected people can also be very useful in this disease.
This is what you can do yourself
In any case, bacillary angiomatosis requires comprehensive medical treatment. Medical therapy can be supported by dietary measures and the use of various remedies from homeopathy. First of all, it is recommended to change the diet. Affected persons should pay attention to balanced meals, which should not be spicy or strongly seasoned. Certain foods such as onions or asparagus can reduce the typical skin irritation associated with the disease. The physician will work with the patient to create an individualized diet plan or refer the affected person to a nutritionist. In addition to a change in diet, attention must be paid to strict personal hygiene. Regular showering with gentle care products alleviates the characteristic itching and increases overall well-being. People suffering from complaints of the eye, muscles or internal organs should inform the doctor immediately. It is possible that bacillary angiomatosis has already spread to other parts of the body and must be treated in a clinic. People who suffer severely from the symptoms should see a therapist to accompany the medical treatment. In a conversation with the specialist, fears and uncertainties, but also inferiority complexes triggered by skin changes can be discussed and thus overcome more quickly.
