Bacillary angiomatosis in immunocompromised patients

OBJECTIVES: To report seven cases of bacillary angiomatosis; to evaluate the most useful diagnostic tools; to analyse the clinical and epidemiological features associated with Bartonella quintana or Bartonella henselae infections. DESIGN: Clinical, diagnostic and epidemiological evaluation of 37 speciated bacillary angiomatosis cases in the literature, including the seven patients in our study. METHODS: Pathological examination of tissue samples, including Warthin-Starry staining and immunohistology; titre of antibodies to Bartonella sp.; detection of Bartonella sp. in blood and biopsy materials by culture or PCR; and statistical analysis of clinical and epidemiological features associated with B. quintana or B. henselae bacillary angiomatosis cases. RESULTS: Seven immunocompromised patients (six with AIDS and one patient with acute leukaemia) had bacillary angiomatosis confirmed by histology. B. quintana was cultured in three patients, whereas B. henselae DNA was amplified by PCR in the remaining four patients. Serum from only one patient reacted with Bartonella antigens. Amongst the 14 B. quintana and 23 B. henselae bacillary angiomatosis cases now reported in the literature, lymphadenopathies were significantly more frequent in B. henselae-infected patients, and neurological disorders of the central nervous system in B. quintana-infected patients. Risk factors were contact with cats, and homelessness or poor socioeconomic status in B. henselae and B. quintana bacillary angiomatosis cases, respectively. CONCLUSIONS: Although diagnosis of bacillary angiomatosis often remains solely based upon histology, culture or PCR-based methods are useful for the detection of Bartonella sp., and allow identification of the species involved, which is necessary to further characterize clinical and epidemiological features associated with B. quintana or B. henselae infections.     

Bartonella-associated infections

Bartonella-associated infections occur in immunocompetent and immunocompromised patients. The spectrum of diseases caused by Bartonella species has expanded and now includes cat-scratch disease, bacillary angiomatosis, bacillary peliosis, bacteremia, endocarditis, and trench fever. Most Bartonella-associated infections that occur in North America and Europe are caused by B. henselae or B. quintana. The domestic cat serves as the major reservoir for B. henselae; the reservoir for the modern day B. quintana infection remains unknown. Methods used to diagnose Bartonella-associated infections include histopathologic analysis of biopsy specimens, culture of tissue samples, blood culture, and serology. Available data on treatment of Bartonella-associated infections remain relatively sparse but would suggest that erythromycin or doxycycline provide the best responses.     

Molecular epidemiology of bartonella infections in patients with bacillary angiomatosis-peliosis

BACKGROUND: Bacillary angiomatosis and bacillary peliosis are vascular proliferative manifestations of infection with species of the genus bartonella that occur predominantly in patients infected with the human immunodeficiency virus. Two species, B. henselae and B. quintana, have been associated with bacillary angiomatosis, but culture and speciation are difficult, and there has been little systematic evaluation of the species-specific disease characteristics. We studied 49 patients seen over eight years who were infected with bartonella species identified by molecular techniques and who had clinical lesions consistent with bacillary angiomatosis-peliosis. METHODS: In this case-control study, a standardized questionnaire about exposures was administered to patients with bacillary angiomatosis-peliosis and to 96 matched controls. The infecting bartonella species were determined by molecular techniques. RESULTS: Of the 49 patients with bacillary angiomatosis-peliosis, 26 (53 percent) were infected with B. henselae and 23 (47 percent) with B. quintana. Subcutaneous and lytic bone lesions were strongly associated with B. quintana, whereas peliosis hepatis was associated exclusively with B. henselae. Patients with B. henselae infection were identified throughout the study period and were epidemiologically linked to cat and flea exposure (P< or =0.004), whereas those with B. quintana were clustered and were characterized by low income (P=0.003), homelessness (P = 0.004), and exposure to lice (P= 0.03). Prior treatment with macrolide antibiotics appeared to be protective against infection with either species. CONCLUSIONS: B. henselae and B. quintana, the organisms that cause bacillary angiomatosis-peliosis, are associated with different epidemiologic risk factors and with predilections for involvement of different organs.     

Detecting chaos in HRV signals in human cardiac transplant recipients

Infections with organisms of the genus Bartonella, for many years important only in South and Central America, have assumed significance in developing countries, especially in conjunction with the advent of the pandemic of the human immunodeficiency virus infection. New molecular and culture techniques have determined that these organisms cause new diseases such as bacillary angiomatosis as well as diseases the etiology of which have been unknown such as cat scratch disease. In this article, the microbiology, pathogenesis, histopathology and clinical manifestations of diseases caused by these organisms are discussed.     

Concordance of common movement disorders among familial cases

A 51-year-old human immunodeficiency virus (HIV)-positive male patient (CDC stage 3C) had had a painful nodule on his external ankle joint for 10 months. A biopsy suggested bacillary angiomatosis, but Kaposi's sarcoma could not be excluded. Rods were detectable in lesional skin by a Warthin-Starry stain. A 298 base pair (bp) gene fragment specific for Bartonella species was amplified from lesional skin and direct nucleotide sequence analysis of the amplification product clearly identified Bartonella quintana. Kaposi's sarcoma-associated herpes virus specific DNA was not amplifiable by polymerase chain reaction (PCR) in our patient, suggesting that the lesion represented bacillary angiomatosis alone, despite clinical and histopathological features which suggested the coexistence of bacillary angiomatosis and Kaposi's sarcoma. The lesion regressed after erythromycin was prescribed. However, 4 and 9 weeks after initiation of therapy, PCR still yielded a positive result in material obtained by a swab. After complete healing, following 12 weeks of antibiotic therapy, PCR became consistently negative. The optimal length of antibiotic treatment in HIV-positive patients with bacillary angiomatosis is not yet known and inadequate therapy may be followed by disseminated disease and a fatal outcome. PCR-based monitoring of the success of treatment is valuable for determining the duration of treatment resulting in a cure.     

Cat-scratch disease and bacillary angiomatosis

Cat-scratch disease (CSD) was first described by Debré in 1950, yet the causative bacterial agent of CSD remained obscure until 1992, when Bartonella (formerly Rochalimaea) henselae was implicated in CSD by serological and microbiological studies. B. henselae had initially been linked to bacillary angiomatosis (BA), a vascular proliferative disease most commonly associated with long-standing human immunodeficiency virus (HIV) infection or other significant immunosuppression. B. henselae has also been associated with bacillary peliosis, relapsing bacteraemia and endocarditis in humans. Cats are healthy carriers of B. henselae, and can be bacteraemic for months or years. It has recently been demonstrated that B. henselae can be transmitted from cat to cat by the cat flea, but not by direct contact between animals. The author discusses the present state of knowledge on the aetiology, clinical features and epidemiological characteristics of cat-scratch disease and bacillary angiomatosis.     

The bacterial DNA content of mouse organs in the Cornell model of dormant tuberculosis

SETTING: The Cornell model of murine tuberculosis has proved useful for demonstrating and studying dormancy. However, it has not previously been used to investigate the molecular aspects of dormancy. OBJECTIVE: To obtain a profile of the amount of Mycobacterium tuberculosis DNA at various stages of the Cornell model. DESIGN: BALB/C mice were infected intravenously with 2.7 x 10(6) cfu M tuberculosis strain H37Rv; they were left for two weeks, treated for 14 weeks with isoniazid and pyrazinamide and left untreated for a further 14 weeks. Spleens and lungs at start of treatment and at 8, 12, 14, 18, 24 and 28 weeks thereafter were examined by culture, and DNA in tissue homogenates was quantitated by polymerase chain reaction (PCR) and dot blot hybridisation. RESULTS: Culture and quantitative PCR estimated initial bacillary content at about 10(7) per organ. Thereafter, organ cultures rapidly declined and were usually negative between 14 and 28 weeks. However, during this period quantitative PCR consistently estimated about 5.5 log10 bacilli equivalents in spleens and lungs. Dot blot hybridisation sensitive to about 10 ng bacillary DNA was usually positive pretreatment and occasionally during and after treatment, hence confirming the PCR results. CONCLUSIONS: There is persistence of significant quantities of M. tuberculosis DNA throughout the various stages of the model. This may represent dead bacilli, free DNA or dormant forms.     

A phenomenological study of ethical decision-making experiences among senior intensive care nurses and doctors concerning withdrawal of treatment

Substantial evidence has recently accumulated showing domestic cats to be the principal reservoirs of Bartonella henselae, the aetiological agent of human diseases including cat-scratch disease, bacillary angiomatosis, bacillary peliosis and a febrile bacteraemia syndrome. To determine the prevalence of antibodies reactive with Bartonella henselae in cats from southern Africa, indirect fluorescent antibody assays were carried out on feline sera from South Africa and Zimbabwe. Overall, 23% (39/171) of cats had antibody titres > or = 1/64, with cats from Zimbabwe (24%; 28/119) having higher seroprevalences than those from South Africa (21%; 11/52) although this difference was not statistically significant. The implications of these findings for veterinarians in southern Africa are discussed.     

Quantitative bacillary response to treatment in HIV-associated pulmonary tuberculosis

A group of 122 patients with culture-proven pulmonary tuberculosis were recruited to examine the concentrations of Mycobacterium tuberculosis in sputum and the relationship to HIV-1 antibody status. They were followed for up to 28 days from the start of antituberculous chemotherapy to assess the early bacillary response to two chemotherapeutic regimens. Of 67 treated with streptomycin, thiacetazone, and isoniazid 17 were HIV positive, and subsequently 55, of whom 20 were HIV positive, were treated with streptomycin, rifampin, isoniazid, and pyrazinamide. The mean initial concentration of M. tuberculosis in the sputum of the HIV-negative patients was significantly higher than in HIV-positive patients (6.95 and 6.34 log colony-forming units respectively; p = 0.019). The HIV-positive patients had less radiologic evidence of disease and significantly fewer zones of lung affected with cavities. The response to treatment was similar, but with HIV-positive patients more likely to become culture negative by 28 days. The differences that exist between HIV-positive and HIV-negative patients are minor, and standard regimens are at least as effective in HIV-positive patients in the first month of treatment.     

A data-reduction process for long-term EEGs. Feature extraction through digital processing in a multiresolution framework

The ability of Mycobacterium avium subsp. paratuberculosis to survive in bovine monocytes was studied using radiometric (BACTEC) culture, standard plate counting and microscopic counting of acid-fast stained monocyte monolayers. Results of microscopic counts sharply contrasted with results of viable counts determined both by plate counting and radiometric counting. We observed an early phase (the first 6 d after in vitro infection) of intracellular bacillary growth, followed by a later phase of mycobacteriostasis or killing (up to 12 d after in vitro infection) in monocytes from non-infected cows. The data suggest that multiplication and death of M. avium subsp. paratuberculosis occur simultaneously in bovine monocytes infected in vitro. Using the BACTEC method, we compared the ability of bovine monocytes from normal cows and cows infected with M. avium subsp. paratuberculosis and showing evidence of a strong Thl-like cellular immune response to ingest and inhibit the intracellular growth of M. avium subsp. paratuberculosis. There was a trend toward greater phagocytosis and faster killing of Mycobacterium avium subsp. paratuberculosis by monocytes from the infected, immune responder cows. However, the observed numbers of viable M. avium subsp. paratuberculosis at each time after monocyte infection were not significantly different between normal and infected cows.     

Dynamics of submerged growth of Mycobacterium tuberculosis under aerobic and microaerophilic conditions

When Mycobacterium tuberculosis is grown in detergent-containing medium under continous agitation, multiplication is known to follow a logarithmic mode. When the cultures are not continuously shaken, but only agitated a few times a week to resuspend the bacilli and permit turbidity to be measured, the net increase suggests an arithmetic growth mode. It is shown here that a single pulse of aeration of an unshaken submerged culture of M. tuberculosis causes an almost instantaneous acceleration of growth, followed rapidly by a cessation of growth. Whether or not the bacilli will subsequently resume growth depends on the bacillary population density of the cuture at the time of application of the pulse of aeration. If the bacilli are permitted to grow in the depths of Dubos Tween Albumin broth without any agitation, they exhibit net arithmetic growth and attain a maximal population density greater than is seen in cultures exposed to occasional pulses of aeration. By the use of isotopically labeled cells, it has been shown that replication occurs ar a logarithmic rate amoung the small proportion of the bacilli that remain suspended in nonagitated cultures. This replication is balanced by settling of cells, resulting in a net appearance of arithmetic multiplication. The cells that have settled into the sediment replicate at a very slow rate, if at all, but do retain their viability for 4 weeks or longer. This suggests a possible analogy to quiescent tubercle bacilli in vivo.     

Bacillary generalized angiomatosis in HIV infection

A unique case of generalized bacillary angiomatosis (BA) in a patient who died of HIV infection is described. Apart from widely spread skin lesions there were also manifestations in the brain, lungs, heart, esophagus and intestine. Gram-negative bacteria were found in the histological sections. Oval and roundish bacteria with a predominantly perivascular location were found electron microscopically in the archives material.     

Bacillary angiomatosis of the spleen

Bacillary angiomatosis is a recently described vasoproliferative lesion associated with infection by a newly characterized rickettsial organism, Rochalimaea henselae. Most previous reports have described skin lesions in immunocompromised patients infected with human immunodeficiency virus. This is the first case report detailing the features of bacillary angiomatosis of the spleen occurring in a patient undergoing cytotoxic chemotherapy for disseminated ovarian carcinoma.     

The TDA Internet survey

Analyzing the main indices of tuberculosis epidemiology among the convicts showed that there is 1 steady-state upward trend of its morbidity, mortality, bacillary forms. The latters are characterized by the extent of tuberculosis and its severity, which is suggestive of a large infection reservoir among the convicts. This is due to deteriorating macro- and microsocial factors, so this situation should be considered to be extremely explosive both for the convicts and for the general population of the country.     

Resistance to antibiotics of Shigella strains isolated in Somalia

The resistance to antibiotics of 240 Shigella strains isolated in Somalia from 1973 to 1976 was studied. Many strains, particularly those of Shigella dysenteriae type 1, were found to be resistant to more than one drug. In view of their resistance to ampicillin, chloramphenicol, streptomycin, tetracycline, and sulfonamides, it is suggested that polymyxin B or M sulfate - which have proved to be effective in vivo - should be used for the treatment of clinically typical cases of bacillary dysentery.     

Studies on the rod-coccus life cycle of Rhodococcus equi

In the present study all 19 Rhodococcus equi cultures isolated from horses and 19 of 22 R. equi cultures isolated from human patients displayed a rod-coccus life cycle after cultivation under defined growth conditions. A bacillary growth could be observed after cultivation of the bacteria in fluid media for 4 h at 37 degrees C, a coccoid morphology after cultivation of the bacteria for 24 h either on sheep blood agar plates or in fluid media. The different morphological features did not significantly influence the typability of the bacteria or the expression of surface proteins including 15-17 kDa virulence proteins. Studies on further surface characteristics revealed a relation between haemagglutinating properties, the surface hydrophobicity and adherence properties of the bacteria to HeLa cells. These properties seemed to be influenced by the cultivation conditions but not by the different morphological forms of the bacteria. A haemagglutination reaction, a hydrophobic surface and an enhanced adherence to HeLa cells could be observed with coccoid bacteria after cultivation in fluid media for 24 h at 37 degrees C but not with coccoid bacteria harvested from sheep blood agar plates or with bacillary bacteria after 4 h growth in fluid media. This difference might possibly be caused by the degree of encapsulation of the bacteria after various cultivation conditions and a subsequent masking effect of the hydrophilic polysaccharide capsule of R. equi.     

Homology in natural cryptic plasmids of Bacillus subtilis

Peculiarities of DNA homology in a number of cryptic plasmids isolated from soil bacillary strains and related or identical to Bacillus subtilis were studied. Fragments generated after digestion of one of these plasmids, p1414, were employed as a probe for blot hybridization with identical fragments of other plasmids. The data obtained suggest that nearly all the studied plasmids possess a common homology site that occupies a significant plasmid portion. Regions of detectable and weak homology were located throughout this site. Moreover, plasmid p1414 was shown to carry a large site that lacks homology with plasmids belonging to two groups. Eventually, one of these plasmids demonstrates complete lack of homology with the remaining plasmids.     

The manganese superoxide dismutase from the penicillin producer Penicillium chrysogenum

A survey was conducted to clarify the tuberculosis (TB) situation among the homeless during the period from 1991 to 1995 in Nagoya city, using 5,222 registration cards of TB cases registered at one of Nagoya City's 16 Health Centers. Out of 5,222 TB cases, there were 269 homeless cases (267 male and 2 female). Ninety-seven percent of them were pulmonary TB cases. The incidence and prevalence rates of TB per 100,000 among the homeless were estimated at around 1,500 and around 2,400, respectively, around 20 times higher than those of the non-homeless male over the 19 years of age. A decrease in the incidence rate of TB cases among the homeless was not seen, although the rate among the non-homeless decreased gradually. The percentage of infectious (bacillary and/or cavitary) tuberculous cases among the homeless was higher than in the non-homeless. In the infectious cases, the percentage of smear-positive bacillary cases or far advanced cavitary cases was 52.1% or 9.4% among the homeless compared to 48.1% or 2.6% among the non-homeless, respectively. The detection rate by chest X-ray examination of the homeless was 3.9%.     

Plasma exchange in children with hemolytic-uremic syndrome at risk of poor outcome

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.