ΒΑΚΤΗΡΙΑΚΗ ΑΓΓΕΙΩΜΑΤΩΣΗ: ΑΙΤΙΟΠΑΘΟΓΕΝΕΤΙΚΗ, ΔΙΑΓΝΩΣΤΙΚΗ ΚΑΙ ΘΕΡΑΠΕΥΤΙΚΗ ΑΝΑΣΚΟΠΗΣΗ
Λέξεις-κλειδιά:
Βακτηριακή Αγγειωμάτωση, Bartonella Henselae,Περίληψη
Η βακτηριακή (ή επιθηλιοειδής) αγγειωμάτωση είναι σπάνια, δυνητικώς συστηματική αγγειογενής υπερπλασία, η οποία έχει περιγραφεί (στην πλειονότητα των περιπτώσεων) σε πάσχοντες ή φορείς του A.I.D.S. καθώς και σε άλλης αιτιολογίας καταστάσεις ανοσοκαταστολής. Οι δερματικές της βλάβες υποδύονται πυογόνο κοκκίωμα ή σάρκωμα Kaposi. Ο συνηθέστερα απομονούμενος και ταυτοποιούμενος μικροοργανισμός είναι η Bartonella Henselae. Σε λίγες περιπτώσεις έχει ενοχοποιηθεί η Bartonella Ouintana. Η ιστολογική μελέτη των δερματικών βλαβών αποτελεί τον συνηθέστερο και ασφαλέστερο τρόπο για να τεκμηριωθεί η ακριβής διάγνωση. Μικροσκοπικώς παρατηρείται λοβόμορφη αγγειακή υπερπλασία η οποία συγκροτείται από ποικίλης μορφολογίας "επιθηλιόμορφα" ενδοθηλιακά κύτταρα. Πέριξ των αγγείων αναπτύσσεται πολύμορφη κυτταρική διήθηση όπου επικρατούν τα ουδετερόφιλα πολυμορφοπύρηνα, στο κέντρο της οποίας διακρίνονται ηωσινόφιλα μορφώματα που αντιστοιχούν σε συσσωματώματα βακτηρίων και αναγνωρίζονται ευχερέστερα με χρώση Warthin Starry ή με ηλεκτρονική μικροσκόπηση μεταβίβασης. Η ερυθρομυκίνη αποτελεί τη θεραπεία επιλογής ενώ εξαιρετικά αποτελέσματα έχουν επιτευχθεί και με δοξυκυκλίνη. Ορισμένα άλλα αντιβιοτικά έχουν δοκιμασθεί με ικανοποιητική απάντηση, σε περιορισμένο αριθμό ασθενών.
Αναφορές
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