Peliosis hepatis can be associated with peliosis of the spleen, as well as bacillary angiomatosis of the skin in HIV patients. Trench fever
Trench fever, also known as five-day fever or quintan fever, is the initial manifestation of B. quintana infection. Clinical manifestations range from asymptomatic infection to severe illness. Classical presentations include a febrile illness of acute onset, headache, dizziness, and shin pain. Chronic infection manifestations include attacks of fever and aching in some cases and persistent bacteremia in soldiers and homeless people. Microbiology
Members of the genus Bartonella are facultative intracellular bacteria, alpha 2 subgroup Pseudomonadota. The genus comprises:

Pathophysiology
In mammals, each Bartonella species is highly adapted to its reservoir host as the result of intracellular parasitism and can persist in the bloodstream of the host. Intraerythrocytic parasitism is only observed in the acute phase of Carrions disease. Bartonella species also have a tropism for endothelial cells, observed in the chronic phase of Carrions disease (also known as verruga Peruana) and bacillary angiomatosis. Pathological response can vary with the immune status of the host. Infection with B. henselae can result in a focal suppurative reaction (CSD in immunocompetent patients), a multifocal angioproliferative response (bacillary angiomatosis in immunocompromised patients), endocarditis, or meningitis. Diagnosis
There are several methods used for diagnosing Bartonella infection including microscopy, serology, and PCR. Microscopy of blood smears is used to diagnose Carrións disease (B. bacilliformis), however for other Bartonella species, microscopy and silver staining are insensitive, not highly specific, and cannot differentiate species. The CDC does not recommend lymph node aspiration for diagnostic purposes.
Estropipate, also known as piperazine estrone sulfate and sold under the brand names Harmogen, Improvera, Ogen, Ortho-Est, and Sulestrex among others, is an estrogen medication which is used mainly in menopausal hormone therapy in the treatment of menopausal symptoms. It is a salt of estrone sulfate and piperazine, and is transformed into estrone and estradiol in the body. It is taken by mouth. Medical uses
Estropipate is used to:
Alleviate symptoms of menopause as menopausal hormone therapy
Treat some types of infertility
Treat some conditions leading to underdevelopment of female sexual characteristics
Treat vaginal atrophy
Treat some types of breast cancer (particularly in men and postmenopausal women)
Treat prostate cancer
Prevent osteoporosis

Available forms
Estropipate is available in the form of 0.75, 1.5, 3, and 6 mg oral tablets. Pharmacology
Pharmacodynamics
Estropipate is a prodrug of estrone and estradiol. Hence, it is an estrogen, or an agonist of the estrogen receptors. Pharmacokinetics
Estropipate is hydrolyzed into estrone in the body. Estrone can then be transformed into estradiol by 17β-hydroxysteroid dehydrogenase. Chemistry
History
Estropipate was introduced for medical use by Abbott in 1968. It was approved by the FDA in the United States in 1991. Society and culture
Generic names
Estropipate is the generic name of the drug and its INN, USAN, and BAN. Brand names
Estropipate is or has been marketed under the brand names Genoral, Harmogen, Improvera, Ogen, Ortho-Est, and Sulestrex among others. Availability
Estropipate appears to remain available only in the United States. In the past, estropipate has also been marketed in Canada, the United Kingdom, Ireland, Switzerland, Australia, South Africa, Mexico, and Indonesia. == References ==