Angiomatosis bacilar

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Angiomatosis bacilar

Griselda Montes de Oca Sánchez,* Andrés Tirado Sánchez,* Denisse Vázquez González*

RESUMEN

La angiomatosis bacilar, una enfermedad infecciosa no contagiosa de humano a humano, es causada por Bartonella henselae y Bartonella quintana, que se adquiere por arañazo o mordida de gato; la angiomatosis bacilar generalmente afecta a individuos inmunodeprimidos por SIDA en etapa avanzada; en términos histológicos, las acumulaciones de bacterias se tiñen con tinción de Warthin-Starry; los pacientes con angiomatosis bacilar responden bien al tratamiento con eritromicina; existe riesgo de recidiva inmediata o mediata de las lesiones después de suspender la eritromicina, sobre todo, en pacientes inmunodeprimidos.

Palabras clave: angiomatosis bacilar, Bartonella henselae, Bartonella quintana, tinción de Warthin-Starry, eritromicina.

ABSTRACT

Bacillary angiomatosis is an infectious, not contagious disease among humans, is caused by Bartonella henselae and Bartonella quin-tana and acquired by scratch or bitten of cat, in humans mainly affects immunosuppresed individuals, especially with AIDS in advanced stages, Histopathologically the heaps of bacteria that dye well with Warthin-Starry's stain are observed. It responds to the treatment with erythromycin, but there is the risk of relapses of the injuries mediately or immediately after suspending the treatment, especially in immu-nosuppresed patients.

Key words: bacillary angiomatosis, Bartonella henselae, Bartonella quintana, Warthin-Starry stain, erythromycin.

* Servicio de Dermatología, Hospital General de México, México, DF.

Correspondencia: Dra. Griselda Montes de Oca Sánchez. Dr. Balmis 148, colonia Doctores, CP 06720, México, DF. Correo electrónico: [email protected]

Recibido: febrero, 2011. Aceptado: marzo, 2011.

Este artículo debe citarse como: Montes de Oca-Sánchez G, Tirado-Sánchez A, Vázquez-González D. Angiomatosis bacilar. Dermatol Rev Mex 2011;55(4):209-216.

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Reino Bacteria

Phylum Proteobacteria

Clase Alfaproteobacteria

Orden Rhizobiales Rickettsiales

Familia Bartonellaceae Rickettsiaceae

Género Bartonella Rickettsia

Figura 1. Clasificación de Bartonella y su relación con Rickettsia.

Cuadro 1. Especies más frecuentes de Bartonella y enfermedades asociadas

Especie Enfermedad Reservorio/vector

B. henselae Enfermedad por arañazo de gato

Gato/pulga del gato

Angiomatosis bacilar Gato/pulga del gato Endocarditis Gato/pulga del gato B. quintana Fiebre de las

trinche-ras o fiebre de las trincheras urbanas

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Fiebre de las trincheras con endocarditis

Humano/piojo del cuerpo

Angiomatosis bacilar Humano/piojo del cuerpo B. bacilliformis Fiebre de La Oroya Humano/flebótomo

Verruga peruana Humano/flebótomo

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Cuadro 2. Diagnóstico diferencial histológico entre angiomatosis bacilar y sarcoma de Kaposi

Característica Angiomatosis bacilar Sarcoma de Kaposi

Vasos sanguíneos Forma redondeada Forma aserrada

Células endoteliales Protruyen el vaso, abundantes No protruyen, moderadas

Infiltrado inflamatorio Neutrófilos Linfocitos, plasmocitos

Material granular eosinofílico Presente Ausente

Tinción de Warthin-Starry Bacilos presentes Bacilos ausentes

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Figura 5. Aspecto de la lesión después del tratamiento con eritromicina.

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CONCLUSIONES

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Figura 3. Tinción de H y E (cortesía de Cruz H).

Figura 4. Tinción de Warthin-Starry (cortesía de Cruz H).

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