Cherry angiomas are benign vascular tumors that typically appear as small, red moles on the skin. A doctor will tell you that they are not dangerous and that you can ignore them. They are common among older adults and are generally considered harmless. Despite their benign nature, their presence has been linked to various underlying factors, including potential infectious agents such as Bartonella. This article will explore that possibility in detail.
Understanding Cherry Angiomas
Cherry angiomas, also known as senile angiomas or Campbell de Morgan spots, are characterized by their bright red color and are composed of clusters of small blood vessels. They can vary in size and are most often found on the torso, arms, and face. The exact etiology of cherry angiomas remains unclear, but they are believed to result from the proliferation of endothelial cells, which line blood vessels. Factors such as genetics, liver dysfunction, toxin exposure, and environmental influences may contribute to their development[4][5].
Overview of Bartonella
Bartonella is a genus of Gram-negative bacteria that includes several species known to cause human diseases, such as Bartonella henselae and Bartonella quintana. These bacteria are typically transmitted through vectors like fleas and sand flies, and they can lead to a range of emerging infectious diseases collectively referred to as bartonellosis. Notably, Bartonella infections can manifest in various forms, including cat scratch disease and bacillary angiomatosis, particularly in immunocompromised individuals[1][2][4].
Mechanisms of Bartonella Infection
Bartonella employs several mechanisms to invade and manipulate host cells, particularly endothelial cells. These mechanisms include:
Invasion and Intracellular Survival: Bartonella utilizes a type IV secretion system to invade endothelial cells, establishing an intracellular niche that allows for prolonged survival[1][4].
Inhibition of Apoptosis: The bacteria can inhibit the programmed cell death of infected endothelial cells, promoting their persistence within the host[4].
Stimulation of Proliferation: Bartonella acts as a mitogen, stimulating the proliferation of endothelial cells, which could lead to the formation of vascular lesions[4].
Induction of Angiogenesis: By promoting new blood vessel formation, Bartonella increases the surface area for colonization and further infection[4].
Immune Evasion: The bacteria can alter their surface proteins to evade the host immune response, facilitating chronic infection[3][5].
Potential Link Between Bartonella and Cherry Angiomas
Recent studies suggest a possible association between Bartonella infection and the development of cherry angiomas or similar vascular lesions. While a direct causal relationship has not been definitively established, several observations warrant consideration:
– Increased Incidence in Infected Individuals: Some studies have indicated that cherry angiomas are more frequently observed in patients with Bartonella infections, particularly those with Lyme disease or bacillary angiomatosis[1][2].
– Serological Evidence: Research has shown a statistically significant prevalence of Bartonella antibodies in patients with pyogenic granulomas, which are similar to cherry angiomas, suggesting a potential link between these lesions and Bartonella infection[2].
– Histopathological Similarities: Bacillary angiomatosis, caused by Bartonella, presents with vascular lesions that can mimic cherry angiomas, particularly in immunocompromised patients[3][4].
Despite these connections, it is crucial to note that the primary causes of cherry angiomas are still attributed to factors such as genetic predisposition and environmental influences rather than direct infection with Bartonella. The current understanding highlights the need for further research to elucidate the relationship between Bartonella and cherry angiomas, particularly in exploring the mechanisms by which Bartonella may contribute to vascular proliferation.
Overview of Bartonella Diagnosis and Treatment
Bartonella infections, caused by various species of the *Bartonella* genus, present diagnostic challenges due to their diverse clinical manifestations and the difficulty in culturing the bacteria. Common species include *Bartonella henselae*, which causes cat scratch disease, *Bartonella quintana*, associated with trench fever, and *Bartonella bacilliformis*, linked to Carrion’s disease. Diagnosis typically involves serological testing, culture, or molecular techniques like PCR, with serology being the most cost-effective initial approach. However, serological tests may lack specificity, as many individuals can be seropositive without active disease. In symptomatic patients, diagnosis often relies on the exclusion of other conditions and the response to antibiotic therapy, particularly in cases involving immunocompromised individuals who are at higher risk for severe manifestations[22][24][26].
Treatment for Bartonella infections primarily consists of antibiotic therapy, tailored to the specific species and clinical presentation. For instance, azithromycin is often recommended for cat scratch disease due to its efficacy in reducing lymphadenopathy. In cases of more severe infections, such as endocarditis, a combination of antibiotics, including doxycycline and an aminoglycoside, may be necessary, with treatment duration typically ranging from three to six weeks. Patients with underlying immunosuppression may require extended therapy. The choice of antibiotics is influenced by the ability of the drug to penetrate the central nervous system or eye, particularly in cases of neurological involvement[24][25][26].
Other Theories About Cherry Angioma Causes
Cherry angiomas are benign skin lesions characterized by small, dilated blood vessels. While their exact molecular causes remain largely unknown, several theories have emerged regarding their development.
One prominent theory suggests that angiogenic factors play a significant role in the formation of cherry angiomas. A study indicated that increased levels of serum lipids, particularly total cholesterol, low-density lipoprotein (LDL), and triglycerides, were associated with the presence of cherry angiomas. This suggests that dyslipidemia may contribute to the production of angiogenic factors, which could trigger the abnormal proliferation of endothelial cells leading to the formation of these lesions[29][30].
Additionally, genetic predisposition is considered a potential underlying cause. The familial occurrence of cherry angiomas hints at a polygenic mode of inheritance, where genetic factors may influence the vascular system’s response to aging and other stimuli[28][29]. Furthermore, hormonal changes, particularly those associated with pregnancy and menopause, have been linked to increased incidences of cherry angiomas, indicating that hormonal fluctuations may also promote their development[28][30].
Lastly, chemical exposure, particularly to bromides, has been proposed as a contributing factor. Although evidence is still limited, prolonged exposure to bromides, found in various household products, may trigger the formation of cherry angiomas by influencing vascular growth mechanisms[27][28]. Overall, while the precise molecular pathways remain to be fully elucidated, these theories provide insight into the potential causes of cherry angiomas.
Pathogen Role Rexamined
Pathogens can influence angiogenesis, the formation of new blood vessels, through the release of angiogenic factors. Various types of pathogens, including bacteria, viruses, protozoa, and fungi, have been implicated in modulating the host’s angiogenic response. Here are some key points regarding the pathogens and their mechanisms:
Bacteria
– Bartonella henselae: This bacterium is known to induce angiogenesis, particularly in the context of cat scratch fever. It can manipulate host cells to promote blood vessel formation, which aids its survival and persistence in tissues[32].
– Other Bacterial Infections: Various bacterial infections can activate hypoxia-inducible factors (HIFs) that lead to the production of vascular endothelial growth factor (VEGF), a critical pro-angiogenic factor. This response is often a part of the host’s attempt to restore oxygen supply to infected tissues[32][34].
Viruses
– Certain viruses can also induce angiogenesis as part of their life cycle. For example, the Kaposi’s sarcoma-associated herpesvirus (KSHV) directly produces proteins that stimulate angiogenesis, contributing to the vascular lesions seen in Kaposi’s sarcoma[32].
Protozoa
– Plasmodium spp.: The malaria-causing protozoa can trigger angiogenic responses in the host. The mechanisms involve the release of factors that promote blood vessel growth, which is essential for the parasite’s lifecycle and survival within the human host[32].
Fungi
– Fungal infections have also been linked to angiogenesis. Certain fungi can induce host cells to release angiogenic factors, facilitating their own growth and dissemination within the host[32].
Mechanisms of Angiogenic Factor Release
The release of angiogenic factors by these pathogens often occurs through the following mechanisms:
– Hypoxia: Many pathogens create a hypoxic environment, which activates HIF-1α. This factor regulates the expression of various pro-angiogenic factors, including VEGF and fibroblast growth factor (FGF)[34][35].
– Cytokine Release: Infected cells and infiltrating immune cells (like neutrophils and macrophages) release cytokines that can enhance angiogenesis. For instance, neutrophils are significant sources of VEGF and other angiogenic factors during inflammation and infection[33][34].
– Direct Pathogen Products: Some pathogens produce their own angiogenic factors or modify host cell signaling pathways to promote angiogenesis, facilitating their survival and spread[32][35].
In summary, a variety of pathogens can induce angiogenic factors through different mechanisms, including direct stimulation of host cells and creating a conducive environment for blood vessel formation. Understanding these interactions can lead to the development of new therapeutic strategies targeting angiogenesis in infectious diseases.
Conclusion
While cherry angiomas are generally regarded as benign and harmless, emerging evidence suggests that infections with Bartonella may play a role in their development, particularly in certain populations. The mechanisms by which Bartonella interacts with endothelial cells—such as promoting proliferation and inhibiting apoptosis—could potentially contribute to the formation of these vascular lesions. However, more comprehensive research is necessary to clarify this association and establish any definitive causal links.
More Reading
[1] https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/085010037.pdf
[2] https://pubmed.ncbi.nlm.nih.gov/11907853/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10147494/
[4] https://dermnetnz.org/topics/bacillary-angiomatosis
[5] https://dermnetnz.org/topics/carrion-disease
[6] https://www.healingwell.com/community/default.aspx?f=30&m=4055850
[7] https://www.lymedisease.org/TheLymeTimes-V27-1/files/assets/common/downloads/page0032.pdf
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10147494/
[9] https://journals.sagepub.com/doi/pdf/10.1177/120347540100500601
[10] https://draxe.com/health/cherry-angioma/
[11] https://jrenhep.com/index.php/jrenhep/article/view/172/332
[12] https://www.natvetlab.com/PDF/newsletters/NVLNewsLtr-Spring-2016-Vol-15-No2.pdf
[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287964/
[14] https://pubmed.ncbi.nlm.nih.gov/10400104/
[15] https://rarediseases.org/rare-diseases/bartonellosis/
[16] https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1196700/full
[17] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1462-5822.2012.01806.x
[18] https://www.tandfonline.com/doi/full/10.1080/21505594.2024.2322961
[19] https://www.kirbylab.org/pathogenesis.html
[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3255967/
[21] https://en.wikipedia.org/wiki/Bartonella
[22] https://rarediseases.org/rare-diseases/bartonellosis/
[23] https://www.abcdcatsvets.org/guideline-for-feline-bartonellosis/
[24] https://bestpractice.bmj.com/topics/en-us/1152
[25] https://www.aafp.org/pubs/afp/issues/2011/0115/p152.html
[26] https://emedicine.medscape.com/article/213169-treatment
[27] https://www.medicalnewstoday.com/articles/312594
[28] https://welzo.com/blogs/health/cancerous-cherry-angioma
[29] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5971275/
[30] https://skincancer-specialists.com/blog/what-is-cherry-angioma-causes-symptoms/
[31] https://onlinelibrary.wiley.com/doi/10.1155/2018/4639248
[32] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831739/
[33] https://link.springer.com/article/10.1007/s00018-019-03351-7
[34] https://www.ncbi.nlm.nih.gov/books/NBK53377/
[35] https://www.nature.com/articles/s41392-023-01460-1
[36] https://geneglobe.qiagen.com/us/knowledge/pathways/organism-physiology-pathways/angiogenesis
