Koehler J E, Sanchez M A, Garrido C S, Whitfeld M J, Chen F M, Berger T G, Rodriguez-Barradas M C, LeBoit P E, Tappero J W
Department of Medicine, University of California, San Francisco 94143-0654, USA.
N Engl J Med. 1997 Dec 25;337(26):1876-83. doi: 10.1056/NEJM199712253372603.
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.
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.
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.
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.
杆菌性血管瘤病和杆菌性紫癜是巴尔通体属细菌感染引起的血管增殖性表现，主要发生于感染人类免疫缺陷病毒的患者。亨氏巴尔通体和五日热巴尔通体这两个菌种与杆菌性血管瘤病有关，但培养和菌种鉴定困难，且对特定菌种的疾病特征几乎没有系统评价。我们研究了8年间诊治的49例感染巴尔通体菌种的患者，这些患者通过分子技术鉴定感染菌种，且有符合杆菌性血管瘤病 - 紫癜的临床病变。
在这项病例对照研究中，对患有杆菌性血管瘤病 - 紫癜的患者和96名匹配对照者进行了关于暴露情况的标准化问卷调查。通过分子技术确定感染的巴尔通体菌种。
49例患有杆菌性血管瘤病 - 紫癜的患者中，26例（53%）感染亨氏巴尔通体，23例（47%）感染五日热巴尔通体。皮下和溶解性骨病变与五日热巴尔通体密切相关，而肝紫癜仅与亨氏巴尔通体有关。在整个研究期间均发现有感染亨氏巴尔通体的患者，且在流行病学上与接触猫和跳蚤有关（P≤0.004），而感染五日热巴尔通体的患者呈聚集性，其特征为低收入（P = 0.003）、无家可归（P = 0.004）和接触虱子（P = 0.03）。先前使用大环内酯类抗生素治疗似乎对这两种菌种的感染均有保护作用。
引起杆菌性血管瘤病 - 紫癜的亨氏巴尔通体和五日热巴尔通体与不同流行病学危险因素相关，且对不同器官受累有不同偏好。
