Bacillary angiomatosis is skin infection caused by the gram-negative bacteria Bartonella henselae or B. quintana. Diagnosis is based on histopathology of the skin lesions, cultures, and polymerase chain reaction (PCR) analysis. Treatment is with antibiotics.
(See also Overview of Bartonella Infections.)
Bacillary angiomatosis is an infection that occurs only in immunocompromised people (eg, patients with advanced HIV disease, with a solid organ transplant, or who are receiving chemotherapy).
Infection with Bartonella quintana is spread by lice; infection with Bartonella henselae is probably spread by fleas from household cats.
Symptoms and Signs of Bacillary Angiomatosis
Bacillary angiomatosis is characterized by protuberant, purple to bright red, berrylike lesions on the skin, often surrounded by a collar of scale. Lesions bleed profusely if traumatized. They may resemble Kaposi sarcoma or pyogenic granulomas.
Disease may spread throughout the reticuloendothelial system, causing bacillary peliosis (peliosis hepatis due to Bartonella bacteria), particularly in patients with AIDS/advanced HIV disease. Other internal organs (eg, lung, brain, bones, spleen) also may be involved.
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Diagnosis of Bacillary Angiomatosis
Histopathology of skin lesions, cultures, and PCR analysis
Diagnosis of bacillary angiomatosis relies on histopathology of the skin lesions, cultures, and PCR analysis. The laboratory should be notified that Bartonella is suspected because special stains and prolonged incubation are necessary.
Treatment of Bacillary Angiomatosis
Antibiotics
Treatment of bacillary angiomatosis is with erythromycin or doxycycline, continued for at least 3 months (1).
For severe infections, rifampin can be combined with doxycycline. Azithromycin, clarithromycin, and fluoroquinolones are alternatives.
Treatment reference
1. Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D. Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemother. 2004;48(6):1921-1933. doi:10.1128/AAC.48.6.1921-1933.2004
