Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil; Laboratory of Applied Research in Dermatology and Bartonella Infection, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil.
Department of Clinical Medicine, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil; Laboratory of Applied Research in Dermatology and Bartonella Infection, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil.
An Bras Dermatol. 2023 Jul-Aug;98(4):472-479. doi: 10.1016/j.abd.2022.07.007. Epub 2023 Mar 25.
Livedoid vasculopathy (LV) manifests as ulcers and atrophic white scars on the lower extremities. The main known etiopathogenesis is hypercoagulability with thrombus formation, followed by inflammation. Thrombophilia, collagen and myeloproliferative diseases may induce LV, but the idiopathic (primary) form predominates. Bartonella spp. may cause intra-endothelial infection and skin manifestations caused by these bacteria may be diverse, including leukocytoclastic vasculitis and ulcers.
The aim of this study was to investigate the presence of bacteremia by Bartonella spp. in patients with difficult-to-control chronic ulcers diagnosed as primary LV.
Questionnaires and molecular tests (conventional PCR, nested PCR and real-time PCR) were applied and liquid and solid cultures were performed in the blood samples and blood clot of 16 LV patients and 32 healthy volunteers.
Bartonella henselae DNA was detected in 25% of LV patients and in 12.5% of control subjects but failed to reach statistically significant differences (p = 0.413).
Due to the rarity of primary LV, the number of patients studied was small and there was greater exposure of the control group to risk factors for Bartonella spp.
Although there was no statistically significant difference between the groups, the DNA of B. henselae was detected in one of every four patients, which reinforces the need to investigate Bartonella spp. in patients with primary LV.
皮肤白细胞碎裂性血管炎（LV）表现为下肢溃疡和萎缩性白色瘢痕。主要已知的发病机制是血栓形成伴高凝状态，继以炎症。血栓形成倾向、胶原和骨髓增殖性疾病可诱发 LV，但特发性（原发性）形式更为常见。巴尔通体属可能引起内皮内感染，这些细菌引起的皮肤表现可能多种多样，包括白细胞碎裂性血管炎和溃疡。
本研究旨在调查难以控制的慢性溃疡患者中是否存在原发性 LV 相关的巴尔通体属菌血症。
对 16 名 LV 患者和 32 名健康志愿者的血液样本和血凝块进行了问卷调查和分子检测（常规 PCR、巢式 PCR 和实时 PCR）以及液体和固体培养。
LV 患者中有 25%检测到亨氏巴尔通体 DNA，对照组中有 12.5%检测到，但未达到统计学显著差异（p=0.413）。
由于原发性 LV 罕见，研究的患者数量较少，且对照组接触巴尔通体属菌的风险因素更多。
尽管组间无统计学差异，但每 4 名患者中就有 1 名检测到亨氏巴尔通体 DNA，这进一步证实了有必要对原发性 LV 患者进行巴尔通体属菌的检测。
