A K Forrestel1, A Naujokas2, J N Martin3, T A Maurer4, T H McCalmont2, M O Laker-Opwonya5, G Mulyowa6, N Busakhala7, Erin H Amerson8. 1. Yale University School of Medicine, New Haven, CT, USA. 2. Department of Pathology, University of California, San Francisco, San Francisco, CA, USA. 3. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA. 4. Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA. 5. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA Infectious Diseases Institute, Kampala, Uganda. 6. Skin Clinic, Mbarara University of Science and Technology, Mbarara, Uganda. 7. Moi University School of Medicine, Eldoret, Kenya. 8. Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA amersone@derm.ucsf.edu.
Abstract
BACKGROUND: Bacillary angiomatosis (BA) is a rare manifestation of infection caused by Bartonella species, which leads to vasoproliferative lesions of skin and other organs. Bacillary angiomatosis affects individuals with advanced HIV disease or other immunocompromised individuals. In sub-Saharan Africa, despite the high prevalence of HIV infection and documentation of the causative Bartonella species in humans, mammalian hosts, and arthropod vectors, BA has only rarely been described. METHODS: Three adult patients from Uganda and Kenya with deep purple dome-shaped papules or nodules of the skin underwent punch biopsies for histopathologic diagnosis. The biopsies of all 3 patients were sent to a local pathologist as well as to a dermatopathologist at the University of California, San Francisco. RESULTS: All 3 patients were clinically suspected to have Kaposi's sarcoma (KS), and local pathologists had interpreted the lesions as KS in 2 of the cases and nonspecific inflammation in the third. Histologic examination by dermatopathologists in the United States revealed nodular dermal proliferations of irregular capillaries lined by spindled to epithelioid endothelial cells. The surrounding stroma contained a mixed inflammatory infiltrate with lymphocytes, eosinophils, and neutrophils. Extracellular deposits of pale amphophilic granular material were noted in the surrounding stroma. A Warthin-Starry stain highlighted clumps of bacilli, confirming the diagnosis of BA. CONCLUSIONS: These 3 cases, to our knowledge, are the first reports of BA in East Africa in the biomedical literature. Each had been originally incorrectly diagnosed as KS. We speculate BA is underdiagnosed and underreported in resource-poor regions, such as sub-Saharan Africa, that have high endemic rates of HIV infection.
BACKGROUND:Bacillary angiomatosis (BA) is a rare manifestation of infection caused by Bartonella species, which leads to vasoproliferative lesions of skin and other organs. Bacillary angiomatosis affects individuals with advanced HIV disease or other immunocompromised individuals. In sub-Saharan Africa, despite the high prevalence of HIV infection and documentation of the causative Bartonella species in humans, mammalian hosts, and arthropod vectors, BA has only rarely been described. METHODS: Three adult patients from Uganda and Kenya with deep purple dome-shaped papules or nodules of the skin underwent punch biopsies for histopathologic diagnosis. The biopsies of all 3patients were sent to a local pathologist as well as to a dermatopathologist at the University of California, San Francisco. RESULTS:All 3patients were clinically suspected to have Kaposi's sarcoma (KS), and local pathologists had interpreted the lesions as KS in 2 of the cases and nonspecific inflammation in the third. Histologic examination by dermatopathologists in the United States revealed nodular dermal proliferations of irregular capillaries lined by spindled to epithelioid endothelial cells. The surrounding stroma contained a mixed inflammatory infiltrate with lymphocytes, eosinophils, and neutrophils. Extracellular deposits of pale amphophilic granular material were noted in the surrounding stroma. A Warthin-Starry stain highlighted clumps of bacilli, confirming the diagnosis of BA. CONCLUSIONS: These 3 cases, to our knowledge, are the first reports of BA in East Africa in the biomedical literature. Each had been originally incorrectly diagnosed as KS. We speculate BA is underdiagnosed and underreported in resource-poor regions, such as sub-Saharan Africa, that have high endemic rates of HIV infection.
Authors: J C Mohle-Boetani; J E Koehler; T G Berger; P E LeBoit; C A Kemper; A L Reingold; B D Plikaytis; J D Wenger; J W Tappero Journal: Clin Infect Dis Date: 1996-05 Impact factor: 9.079
Authors: Miriam O Laker-Oketta; Megan Wenger; Aggrey Semeere; Barbara Castelnuovo; Andrew Kambugu; Robert Lukande; F Chite Asirwa; Naftali Busakhala; Nathan Buziba; Lameck Diero; Kara Wools-Kaloustian; Robert Matthew Strother; Mwebesa Bwana; Winnie Muyindike; Erin Amerson; Edward Mbidde; Toby Maurer; Jeffrey Martin Journal: Oncology Date: 2015-02-27 Impact factor: 2.935