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Rotundo S, Tassone MT, Marascio N, Morrone HL, Gigliotti S, Quirino A, Russo A, Matera G, Trecarichi EM, Torti C. A systematic review on antibiotic therapy of cutaneous bacillary angiomatosis not related to major immunocompromising conditions: from pathogenesis to treatment. BMC Infect Dis 2024; 24:380. [PMID: 38589795 PMCID: PMC11000314 DOI: 10.1186/s12879-024-09253-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/25/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Cutaneous bacillary angiomatosis (cBA) is a vascular proliferative disorder due to Bartonella spp. that mostly affects people living with HIV (PLWH), transplanted patients and those taking immunosuppressive drugs. Since cBA is mostly related to these major immunocompromising conditions (i.e., T-cell count impairment), it is considered rare in relatively immunocompetent patients and could be underdiagnosed in them. Moreover, antimicrobial treatment in this population has not been previously investigated. METHODS We searched the databases PubMed, Google Scholar, Scopus, OpenAIRE and ScienceDirect by screening articles whose title included the keywords "bacillary" AND "angiomatosis" and included case reports about patients not suffering from major immunocompromising conditions to provide insights about antibiotic treatments and their duration. RESULTS Twenty-two cases of cBA not related to major immunocompromising conditions were retrieved. Antibiotic treatment duration was shorter in patients with single cBA lesion than in patients with multiple lesions, including in most cases macrolides and tetracyclines. CONCLUSIONS cBA is an emerging manifestation of Bartonella spp. infection in people not suffering from major immunocompromising conditions. Until evidence-based guidelines are available, molecular tests together with severity and extension of the disease can be useful to personalize the type of treatment and its duration.
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Affiliation(s)
- Salvatore Rotundo
- Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Catanzaro, Italy
| | - Maria Teresa Tassone
- Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Catanzaro, Italy
| | - Nadia Marascio
- Dipartimento di Scienze della Vita, Unità Operativa Complessa di Microbiologica Clinica, Università "Magna Graecia", Catanzaro, Italy
| | - Helen Linda Morrone
- Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Catanzaro, Italy
| | - Simona Gigliotti
- Dipartimento di Scienze della Vita, Unità Operativa Complessa di Microbiologica Clinica, Università "Magna Graecia", Catanzaro, Italy
| | - Angela Quirino
- Dipartimento di Scienze della Vita, Unità Operativa Complessa di Microbiologica Clinica, Università "Magna Graecia", Catanzaro, Italy
| | - Alessandro Russo
- Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Catanzaro, Italy
- Unità Operativa Complessa di Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria "R. Dulbecco", Catanzaro, Italy
| | - Giovanni Matera
- Dipartimento di Scienze della Vita, Unità Operativa Complessa di Microbiologica Clinica, Università "Magna Graecia", Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Dipartimento di Scienze Mediche e Chirurgiche, Università "Magna Graecia", Catanzaro, Italy
- Unità Operativa Complessa di Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria "R. Dulbecco", Catanzaro, Italy
| | - Carlo Torti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy.
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Álvarez-Fernández A, Maggi R, Martín-Valls GE, Baxarias M, Breitschwerdt EB, Solano-Gallego L. Prospective serological and molecular cross-sectional study focusing on Bartonella and other blood-borne organisms in cats from Catalonia (Spain). Parasit Vectors 2022; 15:6. [PMID: 34983610 PMCID: PMC8729136 DOI: 10.1186/s13071-021-05105-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background There is limited clinical or epidemiological knowledge regarding Bartonella infection in cats, and no serological studies have compared the presence of antibodies against different Bartonella species. Moreover, there are limited feline Bartonella studies investigating co-infections with other vector-borne pathogens and the associated risk factors. Therefore, the objective of this study was to investigate Bartonella spp. infections and co-infections with other pathogens in cats from Barcelona (Spain) based on serological and/or molecular techniques and to determine associated risk factors. Methods We studied colony and owned cats (n = 135). Sera were tested for Bartonella henselae-, Bartonella quintana-, and Bartonella koehlerae-specific antibodies using endpoint in-house immunofluorescence antibody assays. Bartonella real-time PCR (qPCR) and conventional PCR (cPCR) were performed. In addition, cPCR followed by DNA sequencing was performed for other pathogenic organisms (Anaplasma, Babesia, Cytauxzoon, Ehrlichia, Hepatozoon, hemotropic Mycoplasma, and Theileria spp.). Results From 135 cats studied, 80.7% were seroreactive against at least one Bartonella species. Bartonella quintana, B. koehlerae, and B. henselae seroreactivity was 67.4, 77.0, and 80.7%, respectively. Substantial to almost perfect serological agreement was found between the three Bartonella species. Colony cats were more likely to be Bartonella spp.-seroreactive than owned cats. Moreover, cats aged ≤ 2 years were more likely to be Bartonella spp.-seroreactive. Bartonella spp. DNA was detected in the blood of 11.9% (n = 16) of cats. Cats were infected with B. henselae (n = 12), B. clarridgeiae (n = 3), and B. koehlerae (n = 1). Mycoplasma spp. DNA was amplified from 14% (n = 19) of cat blood specimens. Cats were infected with Mycoplasma haemofelis (n = 8), Candidatus M. haemominutum (n = 6), Candidatus Mycoplasma turicensis (n = 4), and Mycoplasma wenyonii (n = 1). Anaplasma, Babesia, Cytauxzoon, Ehrlichia spp., Hepatozoon, and Theileria spp. DNA was not amplified from any blood sample. Of the 16 Bartonella spp.-infected cats based on PCR results, six (37%) were co-infected with Mycoplasma spp. Conclusions Bartonella spp. and hemoplasma infections are prevalent in cats from the Barcelona area, whereas infection with Anaplasma spp., Babesia, Cytauxzoon, Ehrlichia spp., Hepatozoon, and Theileria infections were not detected. Co-infection with hemotropic Mycoplasma appears to be common in Bartonella-infected cats. To our knowledge, this study is the first to document M. wenyonii is infection in cats. Graphical Abstract ![]()
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Affiliation(s)
- Alejandra Álvarez-Fernández
- Department of Animal Medicine and Surgery, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Valles, Spain
| | - Ricardo Maggi
- Department of Clinical Sciences and the Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University (NCSU), Raleigh, NC, USA
| | - Gerard Eduard Martín-Valls
- Department of Animal Health and Anatomy, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Valles, Spain
| | - Marta Baxarias
- Department of Animal Medicine and Surgery, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Valles, Spain
| | - Edward Bealmear Breitschwerdt
- Department of Clinical Sciences and the Intracellular Pathogens Research Laboratory, Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University (NCSU), Raleigh, NC, USA
| | - Laia Solano-Gallego
- Department of Animal Medicine and Surgery, Facultat de Veterinària, Universitat Autònoma de Barcelona, Cerdanyola del Valles, Spain.
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3
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James S, Thozhuthumparambil KP. Cat scratch disease sepsis in an immunocompromised patient. BMJ Case Rep 2021; 14:14/7/e239932. [PMID: 34257108 DOI: 10.1136/bcr-2020-239932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
As a greater number of households have pets, the likelihood of zoonotic infections can rise too. Although in most healthy individuals these infections are self-limiting, they are more serious and can lead to adverse outcomes in the immunocompromised. There is minimal information available for the immunocompromised patient who are pet owners or on pet handling. We report a case of cat scratch disease-related sepsis in an immunocompromised patient. This case illustrates the need for a detailed history, including a pet history, in immunocompromised patients presenting with fever of unknown origin and the need for UK-based information for the immunocompromised on pet care and risks associated with having a pet.
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Affiliation(s)
- Sunil James
- Acute Medical Unit, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Balaban M, Ioana Nedelcu R, Balmes G, Adela Todorovic T, Brinzea A, Nichita L, Gabriela Popp C, Theodor Andrei R, Andrada Zurac S, Adriana Ion D, Turcu G. Bacillary angiomatosis triggered by severe trauma in a healthy Caucasian patient: A case report. Exp Ther Med 2019; 20:56-60. [PMID: 32508994 DOI: 10.3892/etm.2019.8260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/21/2019] [Indexed: 11/05/2022] Open
Abstract
Bacillary angiomatosis represents a cutaneous and systemic infection caused by Bartonella species, typically described in the past in HIV-positive patients or associated with immunodeficiencies. More recent case reports had brought into attention the probability that this entity may manifest in otherwise healthy individuals, triggered by trauma and skin burns. The physiopathology of this neoproliferative process is based on the production of angiogenetic molecules, such as vascular endothelial growth factor (VEGF) and IL-8. In case of an inadequate treatment, the evolution can be fatal, with a systemic dissemination of the abscesses within the gastro-intestinal tract, respiratory tract, brain and bones. The appropriate therapy is with oral erythromycin and doxycycline, but several treatments such as cephalosporins, penicillins, macrolides, aminoglycosides, rifampin, dapsone, ciprofloxacin, have been tried with favorable results. Herein we present the case of a Caucasian patient, seronegative for HIV, who developed multiple vascular papules and nodules on the face, after a severe trauma and which healed after an adequate antibiotic therapy with oral clarithromycin.
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Affiliation(s)
- Mihaela Balaban
- Department of Dermatology, Derma 360° Clinic, Bucharest 011273, Romania.,Department of Biochemistry, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
| | - Roxana Ioana Nedelcu
- Department of Dermatology, Derma 360° Clinic, Bucharest 011273, Romania.,Department of Pathophysiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020105, Romania
| | - Gabriela Balmes
- Department of Dermatology, Colentina Clinical Hospital, Bucharest 020125, Romania
| | | | - Alice Brinzea
- Department of Pathophysiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020105, Romania.,Department of Ambulatory, National Institute for Infectious Diseases Prof. Dr. Matei Balș, Bucharest 020105, Romania
| | - Luciana Nichita
- Department of Pathology, Colentina Clinical Hospital, Bucharest 020125, Romania
| | | | | | | | - Daniela Adriana Ion
- Department of Pathophysiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020105, Romania
| | - Gabriela Turcu
- Department of Dermatology, Derma 360° Clinic, Bucharest 011273, Romania.,Department of Dermatology, Colentina Clinical Hospital, Bucharest 020125, Romania.,Department of Dermatology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
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Abstract
This article describes the various non-neoplastic lymphadenopathies that occur in patients infected with the human immunodeficiency virus (HIV), before or during the stage of acquired immunodeficiency syndrome (AIDS). The stages that develop during the HIV infection include: primary infection (acute infection, spread of the virus, development of host immune response, and acute retroviral syndrome), chronic infection or clinical latency, and finally, the AIDS stage. Non-neoplastic lymphadenopathies can occur at any of these phases of the infection and are due to multiple causes that can be divided into infectious causes (bacterial, fungal, parasitic, viral), and reactive causes (persistent generalized lymphadenopathy and a variety of situations that they also occur in immunocompetent people such as Castleman's disease and Kikuchi-Fujimoto's disease, among others). The general, histological and immunophenotypic characteristics of these pathologies are described.
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Affiliation(s)
- Carlos Barrionuevo-Cornejo
- Department of Pathology, Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru.
| | - Daniela Dueñas-Hancco
- Department of Pathology, Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
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Pultorak E, Linder K, Maggi R, Balakrishnan N, Breitschwerdt E. Prevalence of Bartonella spp. in Canine Cutaneous Histiocytoma. J Comp Pathol 2015; 153:14-21. [DOI: 10.1016/j.jcpa.2015.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 03/31/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
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Bartonella infection in immunocompromised hosts: immunology of vascular infection and vasoproliferation. Clin Dev Immunol 2011; 2012:612809. [PMID: 22162717 PMCID: PMC3227422 DOI: 10.1155/2012/612809] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 09/27/2011] [Accepted: 09/29/2011] [Indexed: 01/07/2023]
Abstract
Most infections by genus Bartonella in immunocompromised patients are caused by B. henselae and B. quintana. Unlike immunocompetent hosts who usually develop milder diseases such as cat scratch disease and trench fever, immunocompromised patients, including those living with HIV/AIDS and posttransplant patients, are more likely to develop different and severe life-threatening disease. This paper will discuss Bartonella's manifestations in immunosuppressed patients and will examine Bartonella's interaction with the immune system including its mechanisms of establishing infection and immune escape. Gaps in current understanding of the immunology of Bartonella infection in immunocompromised hosts will be highlighted.
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Abstract
Cutaneous lesions occur in up to 25% of patients with chronic lymphocytic leukemia (CLL). These can be caused by either cutaneous seeding by leukemic cells (leukemia cutis, LC) and other malignant diseases or nonmalignant disorders. Skin infiltration with B-lymphocyte CLL manifests as solitary, grouped, or generalized papules, plaques, nodules, or large tumors. Prognosis in CLL patients with LC is rather good and many authors claim that it does not significantly affect patients' survival. However, prognosis is poor in patients in whom LC shows blastic transformation (Richter's syndrome) and when leukemic infiltrations in the skin appear after the diagnosis of CLL. Secondary cutaneous malignancies are also frequent complications in patients with CLL. A higher risk was seen in skin cancer, for which eightfold higher occurrence has been stated. There are some suggestions that alkylating agents and purine analogs may be associated with an increased incidence of secondary malignancies in CLL. Nonspecific, secondary cutaneous lesions are frequently observed in CLL patients. The most common secondary cutaneous changes seen in CLL are those of infectious or hemorrhagic origin. Other secondary lesions present as vasculitis, purpura, generalized pruritus, exfoliative erythroderma, and paraneoplastic pemphigus. An exaggerated reaction to an insect bite and insect bite-like reactions have been also observed.
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MESH Headings
- Diagnosis, Differential
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemic Infiltration
- Male
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/pathology
- Pemphigoid, Bullous/diagnosis
- Pemphigus/diagnosis
- Prognosis
- Skin/pathology
- Skin Diseases/diagnosis
- Skin Diseases/metabolism
- Skin Diseases/microbiology
- Skin Neoplasms/complications
- Skin Neoplasms/diagnosis
- Skin Neoplasms/secondary
- Syndrome
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Affiliation(s)
- Ewa Robak
- Department of Dermatology and Venereology, Medical University of Lodz, Poland
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Lange D, Oeder C, Waltermann K, Mueller A, Oehme A, Rohrberg R, Marsch W, Fischer M. Bacillary angiomatosis. J Dtsch Dermatol Ges 2009; 7:767-69. [PMID: 19298547 DOI: 10.1111/j.1610-0387.2009.07055.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An infection with Bartonella henselae transmitted from domestic cats to humans by scratching normally leads to cat-scratch disease. When the human host has severe immunosuppression or HIV infection, the potentially life-threatening disease bacillary angiomatosis can develop. A 79-year-old man presented with livid-erythematous, angioma-like skin lesions. We considered a cutaneous infiltrate from his known chronic lymphocytic leukemia, Merkel cell carcinoma, cutaneous metastases of internal tumors, cutaneous sarcoidosis, mycobacterial infection and even atypical herpes simplex infection. The correct diagnosis was proven histologically and by PCR. Because of increasing numbers of immunosuppressed and HIV-positive patients, as well as an infection rate of 13% for B. henselae in domestic cats in Germany, one must be alert to the presence of bacillary angiomatosis.
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Affiliation(s)
- Danica Lange
- Department of Dermatology and Venereology, University of Halle-Wittenberg, Halle (Saale), Germany.
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Pons I, Sanfeliu I, Nogueras MM, Sala M, Cervantes M, Amengual MJ, Segura F. Seroprevalence of Bartonella spp. infection in HIV patients in Catalonia, Spain. BMC Infect Dis 2008; 8:58. [PMID: 18452613 PMCID: PMC2390557 DOI: 10.1186/1471-2334-8-58] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 05/01/2008] [Indexed: 11/20/2022] Open
Abstract
Background Although the first clinical descriptions of Bartonella infection were associated with immunocompromised patient with bacillary angiomatosis, we currently know that this organism is directly involved in diseases affecting a large number of patients, regardless of their immune status. Cat scratch disease, hepatic peliosis, and some cases of bacteraemia and endocarditis, are directly caused by some species of the genus Bartonella. The purpose of this study was to determinate the prevalence of IgG antibodies against Bartonella henselae and B. quintana in HIV patients and to identify the epidemiological factors involved. Methods Serum samples were collected from HIV patients treated at Hospital de Sabadell. Antibodies to B. henselae and B. quintana from 340 patients were examined by indirect immunofluorescence assay (IFA). Significance levels for univariate statistical test were determined by the Mann-Whitney U test and χ2 test. Results Of 340 patients, 82 were women and 258 men, with a median age of 42.21 ± 10.35 years (range 16–86 years). Seventy-six (22.3%) patients reacted with one or more Bartonella antigens. Of all the factors concerning the seroprevalence rate being studied (age, sex, intravenous drugs use, alcohol consumption, CD4 levels, AIDS, HCV, HBV, residential area), only age was statistically significant. Conclusion A high percentage of HIV patients presents antibodies to Bartonella and is increasing with age.
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Affiliation(s)
- Immaculada Pons
- Infectious Diseases Program, Hospital de Sabadell Institut Universitari Parc Taulí UAB, Sabadell, Spain.
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