PROCAARE: RELATED EPIDEMICS--Bacillary angiomatosis

[Albert Shaw <ashaw@usa.healthnet.org>]

KEYWORDS: BACILLARY ANGIOMATOSIS/BACILLARY PELIOSIS/BARTONELLA/
SAN FRANCISCO USA
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Reference: Mohle-Boetani, J.C., Koehler, J.E., Berger, T.G., LeBoit, 
P.E., Kemper, C.A., Reingold, A.L., Plikaytis, B.D., Wenger, J.D., 
Tappero, J.W. (1996).  Bacillary angiomatosis and bacillary peliosis in 
patients infected with human immunodeficiency virus: clinical 
characteristics in a case-control study.  
J. Infect. Dis. 22: 794-800.

In this case-control study, 42 patients with biopsy-proven bacillary 
angiomatosis or bacillary peliosis (BAP) were compared to 84 matched 
controls.  Participants were recruited from the San Francisco Bay area.  

31% of the patients with BAP presented with cutaneous vascular lesions, 
24% with subcutaneous nodules or masses, 21% with asymmetric 
lymphadenopathy (without cutaneous or subcutaneous findings), and 24% 
with fever and abdominal complaints (nausea, vomiting, anorexia, or 
abdominal pain) without lymphadenopathy, subcutaneous masses or vascular 
lesions.  Overall, fever, anorexia, lymphadenopathy, hepatomegaly, and 
splenomegaly were significantly more frequent among case patients than 
controls.\

The median CD4 count among BAP patients was 21/mm3, compared to 186/mm3 
for controls (p<0.001).  Anemia was significantly more frequent in the 
BAP group, and the median serum alkaline phosphatase (192U/L) was 
significantly higher among those with BAP than controls (91U/L, 
p<0.001).  In multivariate analysis, a CD4 count below 200/mm3 (odds 
ratio 10.7, 95% confidence interval (CI) 2.5-45.3), hematocrit below 36% 
(odds ratio 22.5, CI 5-102.5), and serum alkaline phosphatase greater 
than 153U/L (odds ratio 19.5, CI 4.3-83.6) were associated with bacillary 
angiomatosis or bacillary peliosis after controlling for zidovudine use.

This study emphasizes that BAP is most frequent in severely 
immunocompromised patients, as manifested by CD4 count.  Interestingly, 
45% of cases presented without cutaneous vascular lesions of subcutaneous 
masses, presumably resulting in significant diagnostic delays (median 
time between medical evaluation and diagnosis 4 weeks (range, 1 day to 24 
months).