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Bacillary Angiomatosis

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Bacillary Angiomatosis, Epithelioid Angiomatosis

  • See Also
  1. Cat Scratch Disease
  2. Bartonella
  • Risk Factors
  1. AIDS (CD4 Count <100 cells/mm3)
  2. Immunocompromised patients on Chemotherapy or organ rejection medication
  • Causes
  1. Bartonella Henselae
  2. Bartonella Quintana
  • Symptoms
  1. Fever
  2. Chills
  3. Anorexia
  4. Weight loss
  5. Gastrointestinal symptoms
  • Signs
  1. Skin Lesions that appear similar to Kaposi's Sarcoma
  2. Vascular lesions in form or Papules, Nodules or pedunculated
  • Differential Diagnosis
  1. Kaposi's Sarcoma
  • Diagnosis
  1. Bartonella Antibody titer increased (or by PCR)
  2. Biopsy shows bacillary organisms
  • Management
  1. Risks
    1. Jarisch-Herxheimer Reaction (first 48 hours)
    2. Avoid use of TMP-SMZ, Ciprofloxacin, Penicillin, Cephalosporins
  2. Uncomplicated infection (skin only)
    1. Treat for 3 months (skin lesions may resolve as early as in 1-3 weeks)
    2. Doxycycline 100 mg oral or IV twice daily (preferred) OR
    3. Erythromycin 500 mg every 6 hours
      1. Other Macrolides have been used (Azithromycin, Clarithromycin)
  3. Disseminated infection
    1. Treat for at least 4 months
    2. Doxycycline 100 mg oral or IV twice daily AND
    3. Rifampin 300 mg orally twice daily
  4. Relapsing infection
    1. Repeat Antibiotic course as above AND
    2. Extend course for suppression until CD4 Count >200 for 6 months
  • Complications
  1. Disseminated infection to bone, mucous membranes, CNS
  2. Bacterial Endocarditis
  3. Bacillary Peliosis (Liver Cystic lesions)
  • References
  1. Spach in Bartlett (2016) Bartonella in HIV, UpToDate, ios app accessed 4/13/2016
  2. Angelakis (2014) Int J Antimicrob Agents 44:16–25 [PubMed]
  3. Goldschmidt (1999) J Am Board Fam Pract 12(1): 71-94 [PubMed]