zithromax and Angiomatosis--Bacillary

Bacillary angiomatosis is an infectious disease caused by 2 gram-negative bacilli, Bartonella henselae and Bartonella quintana. This disease is characterized by vascular proliferations in the skin and/or visceral organs, and typically manifests in immunocompromised patients. However, we report a case of a 10-year-old immunocompetent female child with a questionable history of being scratched by a cat. Although initially diagnosed as a pyogenic granuloma, a diagnosis of bacillary angiomatosis was made based on histologic examination of the excised lesion demonstrating interstitial bacillary deposition on Warthin-Starry silver stain. The patient was successfully treated with 2 weeks of azithromycin after which all symptoms resolved.

Topics: Angiomatosis, Bacillary; Animals; Anti-Bacterial Agents; Azithromycin; Bartonella Infections; Cats; Child; Female; Humans

Bacillary angiomatosis is an unusual infectious disease, with angioproliferative lesions, typical of immunocompromised patients. It is caused by Bartonella quintana and Bartonella henselae, two infectious agents of the genus Bartonella, which trigger variable clinical manifestations, including cutaneous vascular and purpuric lesions, and regional lymphadenopathy, and even a systemic disease with visceral involvement. We report a 38-year-old HIV positive male presenting with a history of six months of cutaneous growing purple angiomatous lesions, located also in nasal fossae, rhi-nopharynx and larynx. The skin biopsy was compatible with bacillary angiomatosis. Polymerase chain reaction of a tissue sample showed homology with B. quintana strain Toulouse. The patient was treated with azithromycin and ciprofloxacin with a favorable evolution.

Topics: Adult; AIDS-Related Opportunistic Infections; Angiomatosis, Bacillary; Anti-Bacterial Agents; Azithromycin; Bartonella quintana; Biopsy; Ciprofloxacin; Humans; Male

Vasoproliferative retinal tumors are benign tumors of unknown origin often accompanied by vitreoretinal inflammation. A 21-year-old female patient presented with acute reduced unilateral visual acuity. A solid yellow vascularized lesion was present in the inferior temporal retina accompanied by localized retinal detachment and accumulation of hard exudations. The only finding was an increased Bartonella henselae titer. Persistence of uveitis and blurred vision led to therapy for Bartonella henselae with macrolide antibiotics and successful tumor regression was achieved by cryotherapy.

Topics: Angiomatosis, Bacillary; Anti-Bacterial Agents; Anti-Inflammatory Agents; Azithromycin; Bartonella henselae; Combined Modality Therapy; Cryosurgery; Drug Therapy, Combination; Female; Fluorescein Angiography; Follow-Up Studies; Humans; Immunoglobulin G; Ophthalmoscopes; Retinal Detachment; Retinal Diseases; Retinal Neovascularization; Ultrasonography; Uveitis, Intermediate; Young Adult

Using Bartonella henselae isolates from cats and a human, the activity of pradofloxacin was compared with those of enrofloxacin and azithromycin. By Etest and disc diffusion assay, pradofloxacin showed greater antimicrobial activity than did other antibiotics. We conclude that pradofloxacin may prove useful for the treatment of B. henselae infections.

Topics: Angiomatosis, Bacillary; Animals; Anti-Bacterial Agents; Azithromycin; Bartonella henselae; Cat Diseases; Cat-Scratch Disease; Cats; Enrofloxacin; Fluoroquinolones; Humans; Microbial Sensitivity Tests

A dog being treated with immunosuppressive doses of prednisone and azathioprine for pancytopenia of unknown origin, developed, over a 2-week period, multiple erythematous nodular lesions in the skin including footpads. Skin samples revealed lesions identical to those of human bacillary angiomatosis (BA). The nodules were composed of multifocal proliferations of capillaries, each lined by protuberant endothelial cells. The capillary clusters were separated by an oedematous connective tissue, lightly infiltrated with degenerate inflammatory cells, including neutrophils and macrophages. Tissue sections stained with Warthin-Starry silver stain revealed large numbers of positively stained bacilli in the stromal tissue, most heavily concentrated around the proliferating capillaries. Lesions of vascular degeneration and inflammation were evident. Bartonella vinsonii subsp. berkhoffii genotype 1 was independently amplified and sequenced from the blood and the skin tissue. The pathognomonic nature of the histological lesions, demonstration of compatible silver-stained bacilli in the tissue, and identification of B. vinsonii subsp. berkhoffii in the blood and tissue indicates that this is most likely the aetiologic agent responsible for the lesions. Antibiotic therapy was successful in resolving the nodules. It would appear that B. vinsonii subsp berkhoffii, like Bartonella henselae and Bartonella quintana, has the rare ability to induce angioproliferative lesions, most likely in association with immunosuppression. The demonstration of lesions identical to those of human BA in this dog is further evidence that the full range of clinical manifestations of human Bartonella infection occurs also in canines.

Topics: Angiomatosis, Bacillary; Animals; Anti-Bacterial Agents; Azathioprine; Azithromycin; Clindamycin; Dogs; Female; Immunocompromised Host; Immunosuppressive Agents; Pancytopenia; Prednisone

Bacillary angiomatosis is an unusual systemic vascular proliferation seen predominantly in patients with the acquired immunodeficiency syndrome. These vascular lesions are due to infection with a Bartonella species, most commonly B. henselae, but sometimes B. quintana. It is treatable and often curable, but without therapy may be life-threatening. Clinically, the disorder often resembles several different vascular disorders, particularly pyogenic granuloma and Kaposi's sarcoma. We now report a clinically typical patient with bacillary angiomatosis who was HIV seronegative, but who had idiopathic thrombocytopenic purpura, was status-post splenectomy and to whom long-term systemic prednisone had been administered.

Topics: Adult; Angiomatosis, Bacillary; Anti-Bacterial Agents; Azithromycin; Glucocorticoids; HIV Seronegativity; Humans; Male; Prednisolone; Purpura, Thrombocytopenic, Idiopathic; Skin

Topics: Adult; AIDS-Related Opportunistic Infections; Angiomatosis, Bacillary; Azithromycin; Humans; Male; Skin

A 28-year-old male with AIDS and a CD4 cell count of 100/mm3 presented with fever, hepatosplenomegaly, weight loss, and multiple, polypoid, angiomatous lesions on his face. It was determined by means of biopsy that the lesions were due to bacillary angiomatosis. The patient was treated with oral azithromycin (1 g daily as a single dose). Rapid resolution of the skin lesions was noted. After 1 week of therapy, diminution in the size of the liver and spleen was noted. The only significant side effect noted was diarrhea, which was controlled with symptomatic therapy.

Topics: Adult; AIDS-Related Opportunistic Infections; Angiomatosis, Bacillary; Azithromycin; Humans; Male