What is bacillary angiomatosis, and what causes it?

An uncommon bacterial infection called bacillary angiomatosis causes the skin and internal organs' blood vessels to develop abnormally. Bartonella henselae and Bartonella quintana are the two species of Bartonella bacteria that cause it. Usually, human body lice (for B. quintana) or cat scratches or bites (for B. henselae) are the means of transmission, especially in immunocompromised people like those with HIV/AIDS.

What are the common symptoms of bacillary angiomatosis?

Red or purple nodules on the skin that may bleed or ulcerate Mucous membrane lesions (mouth, nose, anus, etc.) bone discomfort brought on by osseous involvement, systemic symptoms such chills, fever, sweats at night, and loss of weight, Visceral symptoms, such as nausea, abdominal pain, and, if internal organs are impacted, liver or spleen enlargement are common symptoms.

How is bacillary angiomatosis diagnosed?

Laboratory testing, biopsy, and clinical assessment are all used in the diagnosis of bacillary angiomatosis. Doctors evaluate the appearance of lesions and the patient's medical history, particularly any cat exposure or HIV status. Capillary expansion and neutrophil infiltration are commonly seen in lesion biopsies, and Bartonella organisms can be found using a Warthin-Starry stain. While imaging (such as CT or MRI) is utilized to determine whether internal organ involvement is present, PCR testing verifies the existence of Bartonella DNA.

What treatment options are available for bacillary angiomatosis?

The primary form of treatment is three to four months of long-term antibiotic therapy, typically doxycycline or erythromycin. In severe situations, intravenous antibiotics may be required. Antiretroviral therapy (ART) is essential for HIV patients to strengthen their immune systems and avoid relapse. Supportive therapy is used to alleviate pain from lesions or bone involvement; in rare cases, surgery may be required to remove troublesome growths.

Is bacillary angiomatosis associated with HIV/AIDS?

Indeed, there is a high correlation between bacillary angiomatosis and HIV/AIDS, as well as other immune-compromising diseases. It was initially discovered in AIDS patients in the 1980s, and immunocompromised patients continue to have a higher prevalence of it. Immune reconstitution and prompt HIV treatment are essential for controlling and preventing the illness.

Bacillary Angiomatosis: Complete Guide to Infectious Vascular Disease

Bacillary Angiomatosis: Complete Guide To Infectious Vascular Disease

It may surprise you, but there are a few diseases that can look like cancer but they are being caused by bacteria; Bacillary angiomatosis just happens to be one of them.

It comes from a group of bacteria called Bartonella, whereby the bacteria induce the formation of abnormal new blood vessels in the skin, beneath it, or within the internal organs. Bacillary angiomatosis has a very different reason and very different treatment from any other vascular disease, even though it is similar to them in appearance, perhaps even Kaposi's sarcoma.

Keep reading to open up everything about bacillary angiomatosis.

About Bacillary Angiomatosis

So what is bacillary angiomatosis? Bacillary angiomatosis is an infectious vascular disease characterized by the proliferation of small blood vessels. These proliferations produce red, nodular skin lesions that may ulcerate and bleed.

These infections may lead to severe sequelae when spread from the skin to the liver, spleen, bone and brain. This illness was first reported in the 1980s in persons with HIV/AIDS and remains an important entity in the immunocompromised.

Causes of Angiomatosis

Following are leading bacillary angiomatosis causes:

Cat scratches or bites (for Bartonella henselae)
Human body lice (for Bartonella quintana)
Those with a healthy immune system normally clear the infection without developing BA. Immunocompromised individuals—for instance, those with HIV/AIDS or those undergoing treatment for cancer or organ transplants-face greatly increased risks.

Symptoms of Bacillary Angiomatosis

The clinical presentation of bacillary angiomatosis varies, but common bacillary angiomatosis symptoms include:

Cutaneous Lesions

These may appear as solitary or multiple papules and nodules in color red, purple, or flesh, ranging from 1 millimeter to several centimeters in size; they could be huge, friable, pedunculated, or polypoid masses.

Oral and Mucosal Lesions

Lesions can involve oral mucosa, tongue, oropharynx, nose, penis, and anus.

Bone Pain

Frequently experienced in the forearms or legs.

Systemic Symptoms

These may include fever, chills, malaise, night sweats, anorexia, and weight loss.

Visceral Involvement

In some cases, internal organs such as the liver (peliosis hepatis) and spleen may be affected, leading to abdominal pain, nausea, and vomiting.

How Bacillary Angiomatosis Affects the Body?

Bacillary angiomatosis can affect different systems of the body, which also include:

Skin

Blood-filled cavities in the skin are the most common manifestations that correspond closely to the very classic pyogenic variables or Kaposi's sarcoma. Inflammatory lesions often occur with painful ulceration or bleeding.

Bones

Osseous nature can cause large lytic lesions within the bones, resulting in terrible bone pain, mainly localized to the extremities. Without intervention, such phenomena can lead to functional impairment.

Liver and Spleen

Visceral involvement may lead to peliosis hepatis, characterized by blood-filled cavities in the liver that give rise to abdominal pain and likely liver dysfunction. The spleen may also be involved, possibly resulting in splenomegaly.

Bacillary Angiomatosis vs. Kaposi Sarcoma: Key Differences

Keep reading to dig deeper into bacillary angiomatosis vs kaposi sarcoma:

Feature	Bacillary Angiomatosis	Kaposi Sarcoma
Cause	Bartonella bacterial infection	Human herpesvirus-8 (HHV-8)
Appearance	Red, nodular lesions that can ulcerate	Flat, purple plaques that do not ulcerate easily
Histology	Neutrophilic infiltration with bacterial colonies	Spindle cells with slit-like vascular spaces
Response to Antibiotics	Improves with antibiotics (e.g., doxycycline)	Does not respond to antibiotics

As they are very closely similar, biopsy and histological evaluation are important for the right diagnosis.

Diagnosis of Bacillary Angiomatosis

Proper medical evaluation for bacillary angiomatosis involves a combination of the following methods to distinguish it from other vascular conditions, such as Kaposi's sarcoma.

Clinical Assessment

This will basically comprise an enlightening interview with the patient regarding the presenting symptoms, characteristics of the lesion, and medical history, especially in terms of risk factors (e.g., HIV infection, contact with cats).

Histopathology

Skin biopsy shows clusters of small blood vessels surrounded by inflammatory neutrophils. Silver stains (such as Warthin-Starry staining) may increase the visibility of Bartonella bacteria in the examined tissue specimens.

Blood Cultures and PCR Testing

Blood cultures may isolate Bartonella species, but sensitivity rests on PCR tests which confirm the presence of bacterial DNA better.

Imaging Studies

When internal organs are involved, CT or MRI scans may help ascertain visceral involvement, i.e., some abnormalities in the liver and spleen.

Treatment of Bacillary Angiomatosis

No more stressing out! If you are exposed to bacillary angiomatosis, there are possible treatment options available to treat the problem without any hassle. Here are some of the leading bacillary angiomatosis treatments that ease your day-to-day life

Antibiotic Therapy

Antibiotic Therapy is effective in eliminating complications. This treatment option, with erythromycin or doxycycline for a minimum of 3 to 4 months, helps minimize the impact of the disease. If the case is more severe, intravenous antibiotics might be required.

Antiretroviral therapy (ART)

For patients with HIV, initiation or optimization of ART should restore immune function, thus decreasing the chance of recurrent infections.

Surgical Intervention

Rarely, if lesions are deemed large or obstructive, surgical removal may be warranted but would be otherwise avoided because the lesions will likely resolve with antibiotics alone.

Pain and Symptom Management

Occasionally, very painful skin or bone involvement requires analgesics and supportive therapy.

Ways to Prevent Bacillary Angiomatosis

Avoid Cat Scratches and Bites

Avoiding cat scratches and bites is a crucial measure to prevent complications. Bartonella henselae is present in cats, especially kittens, and can do all the damage. Hence, it is highly recommended that individuals with weak immune systems stay away from and avoid interacting aggressively with cats, which can lead to scratches or bites.

Control Flea and Louse Infestations

Use flea control treatment on pets and avoid contact with body lice, thereby reducing transmission of the bacteria.

Use Protective Equipment

Those who work with animals should wear gloves and observe hygienic behaviour when dealing with stray cats or cleaning litter boxes.

Early HIV Therapy

Immunocompromised people, especially those with HIV, will need regular medical checkups and adherence to ART to keep their immune systems strong.

Conclusion

Bacillary angiomatosis is a rare but severe bacterial infection, primarily in immunocompromised patients. It is caused by organisms of the Bartonella species. It gives vascular skin and mucosa lesions but may also take bones, liver, spleen, and lymph nodes. It is similar to Kaposi's sarcoma but with fundamental differences in bacillary angiomatosis histology, aetiology and treatment.

Diagnosis is rather timely and made by performing blood tests, biopsies and imaging studies. The good news, however, is that bacillary angiomatosis is highly treatable with antibiotics, and any measures, such as eliminating flea infestations and improving immune status, could prevent infection.

Bacillary angiomatosis: a complete guide to severe disease