Request PDF on ResearchGate | On May 1, , M.-L. Batard and others published Angiomatose bacillaire au cours du SIDA. Pathogènes pour l’homme, R. quintana et surtout une nouvelle espèce R. henselae sont isolées du sang et des lésions d’angiomatose bacillaire observées . humaine notamment au cours de la maladie des griffes du chat, de l’ angiomatose bacillaire ou comme agents d’endocardites à hémocultures négatives.
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Angiomatose bacilar em paciente HIV positivo no nordeste brasileiro: It is a report of disseminated bacillary angiomatosis BA in a year-old female patient, who is HIV-positive and with fever, weight loss, hepatomegaly, ascites, and papular-nodular skin lesions.
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The clinical and diagnostic aspects involved in the case were discussed. Bacillary angiomatosis must always be considered in the diagnosis of febrile cutaneous manifestations in AIDS. Bacillary angiomatosis BA is an infectious disease caused by a facultative intracellular gram-negative mobile bacillus from the genus Bartonella and order Rickettsiales 1.
It has a worldwide distribution, and based on a recent review, Bartonella largely circulates among the Brazilian population 2with a prevalence of 1. The genus Bartonella includes more than 13 species determining several syndromes in humans 2. The most frequently observed are: Cats bacilllaire the main host of B. Bacillary angiomatosis denomination comes from the vascular proliferative histopathology of skin, lymph nodes, viscera, and bones 3.
Therefore, the organisms can be identified in the tissues by means of bacilliare staining bqcillaire more advanced methods are unavailable 3.
She had been complaining of bloody and watery diarrhea during the previous month, which worsened 3 days before her admission to the hospital.
Pathology Outlines – Bacillary angiomatosis
Candidiasis was observed on palate; the skin was dry with non-pruritic, painless erythematous papules on the face, trunk, and limbs Figure 1. The abdomen was distended due to ascitis, with painful hepatomegaly of 4 inches below the right costal margin, but no enlarged spleen was detected; she also had moderate lower limbs edema. Intravenous fluid therapy and trimethoprim-sulfamethoxazole, plus anti-parasitic drug and loperamide, were started, and despite of a clinical improvement in the first week of hospitalization, anorexia, malaise, and abdominal pain persisted.
Fever persisted in irregular spikes, the skin lesions increased in number and size consisting of erythematous papules and nodules on limbs and trunk Figure 2and some of the lesions progressed to ulceration.
Angiomatose bacillaire au cours du SIDA – EM|consulte
Smear and culture from bone marrow aspiration were negative for histoplasmosis, tuberculosis, and leishmaniasis smear only. Hepatitis B and C virus serologies were also negative; the myelogram displayed dysmyelopoiesis with mild plasmocytosis, and the abdominal ultrasound showed moderate hepatomegaly and ascites. Further increase was noted in the liver size, 8cm below the costal margin and in the number of erythematous papules with spontaneous bleeding in a few. Blood cultures isolated Staphylococcus aureus sensitive to vancomycin, and clinical improvements were observed after initiation of the sepsis treatment.
The following abdominal ultrasonography showed enlarged liver associated to signs of diffused parenchymal disease without nodules, with normal vessels. Lymphonodes were found in the peripancreatic, perihilar, and retroperitoneal regions, as well as moderate ascites and slight enlargement of the spleen. Histopathological examination of skin lesions by shaving disclosed vascular proliferation of capillaries with typical endothelial cells, accompanied by edema, neutrophils, and basophils packed with clumps of bacilli visible at Grocott stain, consistent with the diagnosis of bacillary angiomatosis.
Therapy was initiated with erythromycin mg orally, four times a day and gentamicin 1. The patient was discharged on the use of highly active antiretroviral therapy and erythromycin scheduled for 4 months. Bacillary angiomatosis is a systemic disease with frequent cutaneous involvement 4, 9. These manifestations occur as angiomatous papules or nodules of different sizes affecting different areas of the body surface, with erythematous, wine-like, or skin color lesions, with smooth or crusty aspect, which can be single or multiple, compressible, tense, or friable.
Regional lymphadenopathy can occur, and it is often painful 1, 4, Bacillary angiomatosis may be accompanied by disseminated visceral involvement as the one described in the current report 1. The tissues involved are bone, brain, lymph nodes, respiratory and gastrointestinal tracts, liver, and spleen 1. There may also be fever, anorexia, weight loss, abdominal pain, nausea, vomiting, and diarrhea, especially when there is visceral involvement, primarily liver and spleen, as in this case report 1, 4.
Internal involvement, especially of the liver, spleen, and bone marrow, can be manifested with or without peliosis. Bacillary peliosis is characterized by vascular dilatation and hemorrhagic cystic spaces surrounded by fibromyxoid stroma.
Generalized hepatomegaly, focal hepatic abscesses, and granulomatous hepatitis represent forms of hepatic pathology that have been associated with B. High levels of alkaline phosphatase are also frequently found in BA cases 1, 3, 9. The hepatic ultrasound of the current patient did not present any vascular abnormalities; however, it showed increased ALP and GGT enzymes.
All cases previously reported in Brazil 3, 5, were in HIV-positive patients, except one 5. In the same year, 13 cases of BA were described in Rio de Janeiro 3.
Among these, 10 The Brazilian case reported in a non-HIV-infected immuno-supressed patient was in a year-old renal-transplanted male. This patient complained of a painful reddish tumor in the cervical region, which increased progressively in a month and was associated to high fever, enlarged abdominal lymphnodes, and hepatosplenomegaly 5.
In the following year, another case was reported in the same city: A pedunculated tumor in the perineal region with irregular surface and erythematous base was observed as well as numerous small angiomatous papules all over the body. Diagnosis can be easily made by histological examination of skin lesions, mainly when electron microscopy is unavailable. Differential diagnoses of bacillary angiomatosis include Kaposi’s sarcoma that can coexist in the same patientpyogenic granuloma, Peruvian wart, cutaneous T-cell lymphoma, Hodgkin and non-Hodgkin’s lymphomas, atypical mycobacterial infection, and disseminated histoplasmosis 4.
The most efficient treatment consists of erythromycin, mg four times a day for 8 to 16 weeks, or doxycycline, two times a day for 8 to 16 weeks.
A second option consists of clarithromycin, mg, and azithromycin, mg, twice a day 4. Bartonella infection offers a good response to antibiotics and has to be taken into account in the investigation of febrile cutaneous manifestations in AIDS.
The skin lesion and the histopathological study can easily define angoimatose diagnosis. An Bras Dermatol ; Mem Inst Oswaldo Cruz ; Angiomatose bacilar em doente imunocompetente: Arq Med ; Bacillary Angiomatosis After Kidney Transplantation.
J Bras Nefrol ; Rev Chil Infectol ; Bone lesions due to bacillary angiomatosis: Angiomatosw Bras Ortop ; Severe anemia, panserositis, and cryptogenic hepatitis in an HIV patient infected with Bartonella henselae.
Ultrastruct Pathol ; Rev Soc Bras Med Trop ; All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License.
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