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Jordan W. Tappero, MD, MPH; Janet Mohle-Boetani, MD; Jane E. Koehler, MD; B. Swaminathan, PhD; Timothy G. Berger, MD; Philip E. LeBoit, MD; Laura L. Smith, MD; Jay D. Wenger, MD; Robert W. Pinner, MD; Carol A. Kemper, MD; Arthur L. Reingold, MD

JAMA. 1993;269(6):770-775.

Abstract
Objective.
—To determine environmental risk factors for bacillary angiomatosis-bacillary peliosis (BAP), and to confirm infection with Rochalimaea species.

Design.
—Case-control study.

Setting.
—Community and university hospitals and clinics.

Patients.
—Case patients (N=48) had biopsy-confirmed BAP. Controls (N=94) were matched to patients by institution and by human immunodeficiency virus (HIV) serological status.

Main Outcome Measures.
—Clinical information was obtained from medical records. Subjects were queried about environmental exposures. Univariate odds ratios (ORs) with 95% confidence intervals (Cls) were determined. Bivariate analyses were performed on variables associated with disease by univariate analysis. DNA from 22 available case-patient tissues and from 22 control tissues was amplified with the polymerase chain reaction (PCR) using primers designed to detect Rochalimaea species.

Results.
—We identified five HIV-negative, immunocompetent case patients; one HIV-negative, immunodeficient case patient; and 42 HIV-positive case patients. There were no significant differences between case patients and controls by race, sex, age, or risk factors for HIV infection. Owning a cat (OR, 2.8; CI, 1.4 to 5.8) and history of a recent cat lick (OR, 1.95; CI, 1.0 to 3.8), cat scratch (OR, 3.7; CI, 1.7 to 8.0), or cat bite (OR, 3.9; CI, 1.8 to 8.9) were associated with disease in the univariate analysis. In bivariate analyses, only the variables representing traumatic contact with a cat (bite or scratch) remained associated with disease. No other environmental exposure was associated with disease. The PCR amplified a DNA fragment of the size expected for Rochalimaea species in all 22 case-patient tissue specimens.

Conclusions.
—These data suggest that BAP is a new zoonosis associated with both traumatic exposure to cats and infection with Rochalimaea species or a closely related organism.

(JAMA. 1993;269:770-775)

Author Affiliations
From the Departments of Dermatology (Drs Tappero, Berger, LeBoit, and Smith), Medicine and Laboratory Medicine (Dr Koehler), and Pathology (Dr LeBoit), University of California, San Francisco; the Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases (Drs Tappero, Mohle-Boetani, Swaminathan, Pinner, and Wenger), and the Mycotic Diseases Branch, DBMD, CID (Dr Pinner), Centers for Disease Control and Prevention, Atlanta, Ga; the Divisions of Infectious Diseases, Stanford (Calif) University Medical Center, and the Santa Clara Valley Medical Center, San Jose, Calif (Dr Kemper); and The School of Public Health, Epidemiology Program, University of California, Berkeley (Dr Reingold).

Footnotes
Reprint requests to Meningitis and Special Pathogens Branch, Centers for Disease Control and Prevention, Mail Stop C09,1600 Clifton Rd, Atlanta, GA 30333 (Dr Tappero).

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