Diagnosis
XLA diagnosis usually begins due to a history of recurrent infections, mostly in the respiratory tract, through childhood. This is due to humoral immunodeficiency. The diagnosis is probable when blood tests show the complete lack of circulating B cells (determined by the B cell marker CD19 and/or CD20), as well as low levels of all antibody classes, including IgG, IgA, IgM, IgE and IgD.When XLA is suspected, it is possible to do a Western Blot test to determine whether the Btk protein is being expressed. Results of a genetic blood test confirm the diagnosis and will identify the specific Btk mutation, however its cost prohibits its use in routine screening for all pregnancies. Women with an XLA patient in their family should seek genetic counseling before pregnancy. Although the symptoms of a XLA and other primary immune diseases (PID) include repeated and often severe infections, the average time for a diagnosis of a PID can be up to 10 years. Treatment
The most common treatment for XLA is an intravenous infusion of immunoglobulin (IVIg, human IgG antibodies) every week, for life. IVIg is a human product extracted and pooled from thousands of blood donations. IVIg does not cure XLA but increases the patients lifespan and quality of life, by generating passive immunity, and boosting the immune system. With treatment, the number and severity of infections is reduced. With IVIg, XLA patients may live a relatively healthy life. A patient should attempt reaching a state where his IgG blood count exceeds 800 mg/kg.
Bacillary angiomatosis (BA) is a form of angiomatosis associated with bacteria of the genus Bartonella. Symptoms
Cutaneous BA is characterised by the presence of lesions on or under the skin. Appearing in numbers from one to hundreds, these lesions may take several forms:
papules or nodules which are red, globular and non-blanching, with a vascular appearance
purplish nodules sufficiently similar to Kaposis sarcoma that a biopsy may be required to verify which of the two it is
a purplish lichenoid plaque
a subcutaneous nodule which may have ulceration, similar to a bacterial abscessWhile cutaneous BA is the most common form, it can also affect several other parts of the body, such as the brain, bone, bone marrow, lymph nodes, gastrointestinal tract, respiratory tract, spleen, and liver. Symptoms vary depending on which parts of the body are affected; for example, those whose livers are affected may have an enlarged liver and fever, while those with osseous BA  experience intense pain in the affected area. Presentation
BA is characterised by the proliferation of blood vessels, resulting in them forming tumour-like masses in the skin and other organs. Causes
It is caused by either Bartonella henselae or B. quintana. B.  henselae is most often transmitted through a cat scratch or bite, though ticks and fleas may also act as vectors. B. quintana is usually transmitted by lice.It can manifest in people with AIDS and rarely appears in those who are immunocompetent. Diagnosis
Diagnosis is based on a combination of clinical features and biopsy. Neutrophilic infiltrate.