Infectiologic differential diagnosis of chronic Lyme disease and so ...

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A particular characteristic of Bartonella is the induction of vascularized tumors or
granulomas, which occur in the region of the skin (bacillary angiomatosa), in the liver
(peliosis hepatis) or in the spleen (peliosis splenitis) [97 - 99]. In this context, these
vascular tumors or granulomas exhibit a pathological sprouting of capillaries as well
as enlarged and hyperproliferative vascular endothelial cells [100]. Bartonellosis is
obviously accompanied by a stimulation of blood vessel formation. This corresponds
to the observation that bartonellosis, in addition to angiomatosis, also results in
different other skin manifestations in which an increased vessel formation is
observed [101]. In addition, the determination of VEGF (vascular endothelial growth
factor) in blood could be of diagnostic importance [101].
In all pathogenetic relevant bartonellae (B. quintana, B. henselae, B. bacilliformis),
this effect on endothelial cells and the induction of angiogenesis has been
demonstrated. In the process, the vascular proliferation was primarily traced back to
three factors [102 - 108]:
- Elevated endothelial cell proliferation
- Inhibition of the apoptosis of endothelial cells
- Increased secretion of vasculoproliferative cytokines
All these studies support the idea that VEGF (vascular endothelial growth factor)
plays a significant role in Bartonella-induced endothelial cell proliferation [108].