The Agent of Bacillary Angiomatosis: An Approach to the Identification of Uncultured Pathogens
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BACKGROUND: Bacillary angiomatosis is an infectious disease causing proliferation of small blood vessels in the skin and visceral organs of patients with human immunodeficiency virus infection and other immunocompromised hosts. The agent is often visualized in tissue sections of lesions with Warthin-Starry staining, but the bacillus has not been successfully cultured or identified. This bacillus may also cause cat scratch disease. METHODS: In attempting to identify this organism, we used the polymerase chain reaction. We used oligonucleotide primers complementary to the 16S ribosomal RNA genes of eubacteria to amplify 16S ribosomal gene fragments directly from tissue samples of bacillary angiomatosis. The DNA sequence of these fragments was determined and analyzed for phylogenetic relatedness to other known organisms. Normal tissues were studied in parallel. RESULTS: Tissue from three unrelated patients with bacillary angiomatosis yielded a unique 16S gene sequence. A sequence obtained from a fourth patient with bacillary angiomatosis differed from the sequence found in the other three patients at only 4 of 241 base positions. No related 16S gene fragment was detected in the normal tissues. These 16S sequences associated with bacillary angiomatosis belong to a previously uncharacterized microorganism, most closely related to Rochalimaea quintana. CONCLUSIONS: The cause of bacillary angiomatosis is a previously uncharacterized rickettsia-like organism, closely related to R. quintana. This method for the identification of an uncultured pathogen may be applicable to other infectious diseases of unknown cause.
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Microbiological studies suggest intrauterine infection might account for 25-40% of preterm births, and this might be a minimum estimate because intrauterine infection is difficult to detect with conventional culture techniques.
“Microbiological studies suggest that intrauterine infection might account for 25–40% of preterm births;67 however, 25–40% might be a minimum estimate because intrauterine infection is difficult to detect with conventional culture techniques.69”
From Epidemiology and causes of preterm birth (2008) · cites this paper as [69]
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Self-citation
- Authors
- Relman, D. A., Loutit, J. S., Schmidt, T. M., Falkow, S., & Tompkins, L. S.
- Affiliations
- Stanford Medicine (US)
- Indiana University Bloomington (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1990-12-06
- Volume
- 323
- Issue
- 23
- Pages
- 1573-1580
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC13632802
- OpenAlex
- W3136726370
- Cited by
- 901
- References
- 54
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 8 · 2023: 6 · 2022: 9 · 2021: 9 · 2020: 11 · 2019: 10 · 2018: 5 · 2017: 12 · 2016: 19 · 2015: 24 · 2014: 31 · 2013: 12 · 2012: 22
- FWCI
- 44.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion)
- Funders
- National Institutes of Health (5r01ai023796-08)
- National Institute of Allergy and Infectious Diseases (R01AI026195, AI-26195, AI-23796)
- Topics
- Life Sciences › Immunology and Microbiology › Parasitology › Bartonella species infections research
- Life Sciences › Immunology and Microbiology › Parasitology › Vector-borne infectious diseases
- Life Sciences › Immunology and Microbiology › Microbiology › Microbial infections and disease research
- Keywords
- bacillary angiomatosis, Rochalimaea quintana, Rickettsia-like organisms, cat scratch disease, HIV infection, immunocompromised patients, Warthin-Starry stain, phylogenetic relatedness
- MeSH terms
- Acquired Immunodeficiency Syndrome, Adult, Angiomatosis, Bacterial Infections, Base Sequence, Cat-Scratch Disease, Female, Gene Amplification, Humans, Immunosuppression Therapy, Male, Middle Aged, Molecular Sequence Data, Opportunistic Infections, Rickettsiaceae, Rickettsiaceae Infections, RNA, Ribosomal, 16S, HIV Infections, Polymerase Chain Reaction
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