Skin diseases associated with Bartonella infection: Facts and controversies
Introduction
The bacteria family Bartonellaceae, genus Bartonella has expanded during the past century from the recognition of the single Bartonella bacilliformis to 19 recognized species and subspecies (Table 1). Ten of these microorganisms, including B bacilliformis, B henselae, B quintana, B elizabethae, B clarridgeiae, and B vinsonii arupensis, have been found to be responsible for human infections.1, 2, 3 The growing knowledge in this field of pathology and new insights provided by molecular biology suggest that the number of recognized Bartonella spp and human diseases caused by them are likely continue to increase in the coming years.4
Bartonella spp are gram-negative bacteria that appear as small, curved, and pleomorphic rods. A characteristic feature of these microorganisms is their adherence to and invasion of erythrocytes. This phenomenon depends on the erythrocyte species of origin. Another unique facet of infection with Bartonella spp is their ability to promote angiogenesis, presumably by causing endothelial cell proliferation and migration.5, 6, 7, 8, 9, 10Bartonella spp are often cultivable, but this procedure is highly fastidious. The currently available methods for analyzing their genetic and protein compositions allow precise molecular characterization.4, 11 The spectrum of clinical illnesses varies with the nature of the Bartonella spp pathogen. In addition, the clinical features can be surprisingly variable among patients infected with the same species.12, 13
This contribution focuses on the cutaneous manifestations of bartonelloses, emphasizing some controversial topics about angiomatous skin lesions.
Section snippets
Past and ongoing controversies
The group of bartonelloses encompasses diseases without any single typical sign in common. The bacteria are hardly seen at standard microscopic inspection, and microbiologic culture is quite difficult to perform with confidence. In addition, a given Bartonella spp can cause different clinical diseases, depending on the host, geography, and climatic conditions controlling the presence of specific animal reservoirs and vectors. Socioeconomic status and war conditions also influence the nature and
Cat scratch disease
Cat scratch disease (CSD) is the most common Bartonella infection worldwide.1 In patients with history of a cat scratch, a bite of a cat's flea (Ctenocephalides felis), or a tick bite,14 the disease typically presents as a prominent swelling of lymph nodes draining from the arms (cervical, axillary, or epitrochlear). This presentation is preceded by an erythematous papule at the inoculation site.15, 16, 17 The cutaneous lesion develops 7 to 15 days after inoculation and usually evolves through
Trench fever
In the past century, trench fever has been one of the most widespread bartonellosis. Transmitted by the human body louse (Pediculus humanus), the disease became rare after World War II but surged again during the last decades in poor, homeless, alcoholic men living in urban areas.49, 50, 51 This disease, caused by B quintana, follows a cyclic clinical evolution associating relapsing fever, malaise, chills, anorexia, sweating, headache, conjunctivitis, severe myalgias, and arthralgias. About 80%
Bacillary angiomatosis
The first case of bacillary angiomatosis (BA) was associated with AIDS.52B henselae and B quintana were identified in the cutaneous lesions and blood of affected individuals using culture and polymerase chain reaction amplification of specific gene sequences.53 AIDS-associated BA was most frequently seen when the CD4 lymphocyte counts decreased to fewer than 100 cells/mm.54, 55, 56 BA was also reported in immunocompromised cardiac and renal transplant patients,57 in patients receiving
Verruga peruana, Carrion disease, and Oroya fever
B bacilliformis, the etiologic agent of verruga peruana, was the first identified member of the Bartonella genus. The disease presents as an eruptive angiomatous disease of the skin that typically develops 2 months after an acute phase of bacteriemia known as Oroya fever or Carrion disease. In addition to the regular presentation of the angiomatous lesions,72, 74, 75, 76, 77, 78, 79 atypical aspects have been identified.80 There is some histologic similarity between verruga peruana and BA that
Miscellaneous bartonelloses
Quite recently, Bartonella spp have been implicated in a variety of disorders.83, 84, 85, 86 Among them, Kikuchi disease, some granulomatous disorders, and Henoch-Schönlein purpura have been considered in the field of dermatology. They await confirmation by other observations.
Skin and the immune system in bartonelloses
The skin-restricted features of verruga peruana and the predominant skin manifestations in BA, together with the immunologic impaired status found in both diseases, make it attractive to suggest a common pathobiologic pathway.3 The skin might be a target of specific microorganisms responsible for angiomatous diseases in the setting of impaired immune function. The statement that Bartonella-associated vascular lesions may represent angiogenic responses calls for further research.5 The ability of
Conclusions
Bartonella spp infections are responsible for a series of distinct clinical presentations, including vascular growths in the skin. The cellular and molecular components of BA and verruga peruana lesions should be scrutinized. Some analogy among these diseases could provide evidence for common biologic mechanisms. Further research must seek the identification of the whole spectrum of the pathogens, in particular, the Bartonella spp responsible for vascular tumors.
References (86)
- et al.
Bartonella as emerging pathogens
Trends Microbiol
(1999) - et al.
Bartonellosis: new and old
Infect Dis Clin North Am
(2000) - et al.
Live Bartonella henselae enhances endothelial cell proliferation without contact
Microb Pathog
(1999) - et al.
Skin angiogenesis; biologic basis for pathological processes
Clin Dermatol
(1999) - et al.
Bartonellosis: light and shadows in diagnostic and therapeutic issues
Clin Microbiol Infect
(2005) - et al.
Cat scratch disease: analysis of 130 seropositive cases
J Infect Chemother
(2002) Cat scratch disease in Japan
J Infect Chemother
(2002)- et al.
Bartonella-associated infections
Infect Dis Clin North Am
(1998) - et al.
Erythema nodosum and adenopathy in a 15-year-old boy: uncommon signs of cat scratch disease
Arch Pediatr
(2005) - et al.
Analysis of data in 30 patients with cat scratch disease without lymphadenopathy
J Infect Chemother
(2006)
Cat scratch disease during etanercept therapy
Joint Bone Spine
Rapid detection and differentiation of Bartonella spp. by a single-run real-time PCR
Mol Cell Probes
Epidemiology of Bartonella infection in domestic cats in France
Vet Microbiol
Serologic response to “Rochalimacea henselae” antigen in suspected cat scratch disease
Lancet
Visceral bacillary epithelioid angiomatosis: possible manifestations of disseminated cat scratch disease in the immunocompromised host: a report of two cases
Am J Med
Bacillary angiomatosis in a child undergoing chemotherapy
J Pediat
Bacillary angiomatosis: a newly characterized pseudoneoplastic, infectious, cutaneous, vascular disorder
J Am Acad Dermatol
Bartonella henselae, B quintana, and B bacilliformis: historical pathogens of emerging significance
Microb Infect
Skin manifestations of Bartonella infections
Int J Dermatol
Discovery of new infectious diseases—Bartonella species
N Engl J Med
Bartonella bacilliformis stimulates endothelial cells in vitro and is angiogenic in vivo
Am J Pathol
Rochalimaea species stimulate human endothelial cell proliferation and migration in vitro
J Lab Clin Med
Autocrine role for interleukin-8 in Bartonella henselae-induced angiogenesis
Infect Immun
Bartonella-induced endothelial cell proliferation is mediated by release of calcium from intracellular stores
DNA Cell Biol
Molecular method for Bartonella species identification in clinical and environmental samples
J Clin Microbiol
Bartonella infections: diagnostic and management issues
Curr Opin Infect Dis
Detection of Rickettsia rickettsii and Bartonella henselae in Rhipicephalus sanguineus ticks from California
J Med Entomol
Cat scratch disease
Rev Med Liège
Cat-scratch disease: epidemiology, aetiology and treatment
Br J Biomed
Cat scratch disease presenting as orbital abscess and osteomyelitis
J Clin Microbiol
An unusual cutaneous presentation of cat-scratch disease
Clin Exp Dermatol
Familial occurrence of cat-scratch disease, with varying clinical expression
Scand J Infect Dis
Adult systemic cat scratch disease associated with therapy for hepatitis C
BMC Infect Dis
Cat-scratch disease relapse in a kidney transplant recipient
Pediatr Transplant
Role of cat-scratch disease in lymphadenopathy in the head and neck
Clin Infect Dis
Cat scratch disease with lymphadenitis, vertebral osteomyelitis, and spleen abscesses
Ann NY Acad Sci
A case of fatal disseminated Bartonella henselae infection (cat-scratch disease) with encephalitis
Arch Pathol Lab Med
Rickettsial and Bartonella infections
Detection by immunofluorescence assay of Bartonella henselae in lymph nodes from patients with cat scratch disease
Clin Diagn Lab Immunol
Syndrome of Rochalimaea henselae adenitis suggesting cat scratch disease
Ann Intern Med
Predominance of two Bartonella henselae variants among cat-scratch disease patients in the Netherlands
J Clin Microbiol
Bartonella spp. as emerging human pathogens
Clin Microbiol Rev
The role of the host immune response in pathogenesis of Bartonella henselae
DNA Cell Biol
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2019, Anais Brasileiros de DermatologiaCitation Excerpt :Bartonella spp. are not included in guidelines for the screening of cryptogenic hepatitis and it is possible that part of the 40% of de novo hepatitis cases that occur after liver transplants are related to infection by these bacteria.56 Often identified as the clinical expression of atypical CSD, non-classic forms of the disease should be considered separately, sch asmorbilliform exanthem, urticaria, erythema marginatum, granuloma annulare, leukocytoclastic vasculitis.32,41 Fig. 4 shows a case of annular granuloma in a 52-year-old woman who reported a lesion similar to the image at the site of a cat scratch on her left forearm seven years earlier.
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