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PubMed2001

Cat-scratch disease neuroretinitis diagnosed by a polymerase chain reaction approach.

PURPOSE: To assess the value of polymerase chain reaction in the diagnosis of cat-scratch disease neuroretinitis without conclusive serology. METHODS: Interventional case report. A 13-year-old girl developed a right neuroretinitis 2 months after a cat scratch. Despite the lack of accompanying features, an infection by Bartonella henselae was suspected and a systemic check-up was performed. RESULTS: Serologic results excluded other proposed origins but were insufficient in making the diagnosis because of low B. henselae specific IgG level in serum. A polymerase chain reaction analysis for B. henselae DNA in a small axillary lymphadenopathy aspirate enabled us to achieve a definitive diagnosis of cat-scratch disease. CONCLUSION: Polymerase chain reaction is a valuable method of diagnosing cat-scratch disease when serology is considered negative or borderline.

Adolescent↗

PubMed1998

Cat-scratch disease simulating Histiocytosis X.

Cat-scratch disease is a self-limited condition commonly causing a benign chronic lymphadenopathy in children. Osteolytic lesions are a rare complication, but have been previously reported. We report a case of a solitary osteolytic lesion of the skull whose clinical, radiographic and pathological features were initially interpreted as being consistent with Histiocytosis X. Subsequently, positive serological titers for Bartonella, a history of a cat-scratch antecedent to the onset of clinical symptoms and review of the original histopathology confirmed the diagnosis of cat-scratch disease. We reviewed the English language literature on osteolytic lesions associated with cat-scratch disease and compare the current case with those previously reported.

Antibodies, Bacterial↗

PubMed1988

Granulomatous hepatitis associated with cat scratch disease.

In three patients with cat scratch disease the liver was affected. All three had high fever (39 degrees C) for more than 3 weeks. Two of them had no peripheral adenopathy. Computed tomography of the abdomen revealed focal hepatic defects in two patients and periportal and periaortic adenopathy in the third. At laparotomy, there were nodules on the liver surfaces of all patients and histological examination revealed necrotising granulomata. The Warthin-Starry silver stain showed organisms consistent in appearance with the cat scratch bacillus in the liver and a periaortic lymph node of one patient, in the liver of the second patient, and in the axillary lymph node of the third. In all three patients the clinical findings and radiological abnormalities improved without specific therapy. A review of the surgical pathology files of Washington University revealed only two other cases of granulomatous hepatitis in children over a 6-year period. These findings indicate that cat scratch disease should now be included in the differential diagnosis of granulomatous hepatitis, at least in children. The absence of peripheral adenopathy in two of the three patients with granulomatous hepatitis suggests that the clinical spectrum of cat scratch disease may be broader than previously appreciated.

Cat-Scratch Disease↗

PubMed1993

Detection of Rochalimaea henselae in cat-scratch disease skin test antigens.

One of the diagnostic criteria for cat-scratch disease is a positive delayed-type hypersensitivity skin test reaction to an antigen prepared from purulent material aspirated from a cat-scratch disease-involved lymph node. Polymerase chain reaction coupled with DNA sequence analysis was used to identify organisms found in these skin test antigen preparations that may be responsible for eliciting this response. Two independent sources of cat-scratch disease skin test antigens yielded DNA sequences characteristic of the newly described rickettsia, Rochalimaea henselae. These results coupled with previous serologic data strongly suggest that R. henselae plays a central role in the etiology of cat-scratch disease.

Antigens, Bacterial↗

PubMed1999

Cat-scratch disease causing status epilepticus in children.

Status epilepticus from cat-scratch encephalopathy is often recalcitrant to usual therapies, causing treatment to focus on critical care management of the patient that may require aggressive interventions, such as continuous pentobarbital administration. We describe two children whose initial clinical presentation of cat-scratch disease was status epilepticus with normal cerebrospinal fluid studies. A history of cat exposure (specifically, kitten and/or fleas), regional lymphadenopathy, and a papule or inoculation site should be sought, but are not essential for diagnosis. The presumptive diagnosis of cat-scratch disease can be made by serology alone even in the absence of classic diagnostic criteria. Our two cases and other reports in the literature show a favorable prognosis in most cases, despite the occurrence of status epilepticus. The diagnosis of cat-scratch disease should be strongly considered in all children with unexplained status epilepticus or encephalopathy and serologic testing for Bartonella henselae should be done.

Cat-Scratch Disease↗

PubMed1996

Will the real agent of cat-scratch disease please stand up?

Cat-scratch disease has been recognized since 1889 in association with the oculoglandular syndrome of Parinaud. The epidemiologic association with cats was first made in 1931 and further substantiated throughout the years, refining the interaction predominantly to kittens. Putative infectious agents have included numerous species of bacteria, chlamydiae, and viruses. The cultivation of Afipia spp. in the late 1980s appeared to answer the mystery of the identity of the agent. However, even more recent analysis, which has combined traditional microbiology, molecular methods, and additional epidemiology, has demonstrated that Bartonella (Rochalimaea) henselae is the definitive agent of cat-scratch disease. Our understanding of the pathogenesis of cat-scratch disease and other diseases caused by Bartonella species is incomplete and the spectrum of diseases continues to emerge. We review historic and modern efforts to understand the etiology of cat-scratch disease and related syndromes.

Adult↗

PubMed2001

Possible role of high-dose corticosteroids in the treatment of cat-scratch disease encephalopathy.

Approximately 2% of the estimated 24,000 patients in the United States who contract cat-scratch disease annually develop neurologic complications. Between 1989 and 1999, 36 patients were admitted to our hospital with cat-scratch disease; 25% had neurologic complications, and the majority experienced lengthy hospital stays. We describe a case of cat-scratch disease encephalopathy in a 4-year-old girl who responded to high-dose corticosteroid therapy. Further studies are warranted to determine if corticosteroid therapy shortens the duration of symptoms, lessens the severity of disease, and ultimately improves the outcome for patients with cat-scratch disease encephalopathy.

Bartonella henselae↗

PubMed2006

[Cat-scratch disease. Review of eight adult patients hospitalized for fever or adenopathy].

BACKGROUND: Cat-scratch disease is common among children. Among adults the disease is less often considered in the differential diagnosis of enlarged lymph nodes and fever. AIM: To report the clinical and laboratory features of eight patients with cat-scratch disease. MATERIAL AND METHODS: Review of the medical records of eight patients (aged 22 to 57 years, six males) with a serological diagnosis of cat-scratch disease (an IgG titer over 1:256, by immunofluorescence). RESULTS: Only five patients recalled having had contact with cats. Seven had fever and weight loss. Six had excessive sweating and five had chills. Seven had painfully enlarged lymph nodes mainly in submandibular and axillary regions. All had an increased C reactive protein and six had elevated erythrocyte sedimentation rate. Five had leukocytosis and four an elevated serum lactate dehydrogenase. The disease subsided in all, even in one patient that did not receive antimicrobials. CONCLUSIONS: Cat-scratch disease should be considered in the differential diagnosis of adult patients with lymph adenitis and fever.

Adult↗

PubMed1988

Cutaneous vascular lesions and disseminated cat-scratch disease in patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex.

Cutaneous lesions develop frequently in patients infected with human immunodeficiency virus (HIV). We describe the clinical features of four patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex who developed angiomatous nodules involving skin and bone, 2 of whom were scratched by a cat. Some of these lesions were clinically indistinguishable from Kaposi sarcoma. When examined with Warthin-Starry staining and electron microscopy, these nodules were noted to contain numerous clumps of a bacterium. Immunoperoxidase staining with an antiserum raised against the cat-scratch disease bacillus stained these organisms in all patients. Cat-scratch disease is usually a self-limited infection, but complicated or prolonged infections have been described in both normal and immunocompromised hosts. In our patients infected with HIV, manifestations of systemic cat-scratch disease included angiomatous nodules, severe systemic symptoms of fever, chills, night sweats and weight loss, elevated erythrocyte sedimentation rate, and decreased hematocrit. Cutaneous lesions involved the face, trunk, and extremities and numbered 2 to greater than 60; osseous lesions involved the fibula, radius, femur, and tibia, and were present in two of four patients. Treatment with x-ray therapy, intralesional vinblastine, penicillin, dicloxacillin, cephradine, and nafcillin had no effect on any lesions; however, treatment with erythromycin, doxycycline, or antimycobacterial antibiotics resulted in complete and rapid resolution of the cutaneous and osseous lesions, and the accompanying signs and symptoms of systemic infection. In patients with AIDS or AIDS-related complex, angiomatous nodules should be carefully evaluated for the presence of this organism, which can be treated and cured with antibiotic agents.

AIDS-Related Complex↗

PubMed2004

[Cat-scratch disease of the parotid gland].

Cat-scratch disease is a mild disease associated with regional lymph node enlargement. We present a case of cat-scratch disease of the parotid gland in 10-year-old girl. She presented with painful parotid mass, after unsuccessful treatment with antibiotics. Computed tomography showed tumour like lesions in parotid gland. Subtotal parotidectomy with facial nerve preservation was performed as neoplastic disease was suspected. Histopathology examination of the sample revealed typical changes for cat-scratch disease. History of continuous contacts with cats was confirmed by the parents. Cat-scratch disease should be taken into account in differential diagnosis of parotid masses, especially in children.

Cat-Scratch Disease↗

PubMed2006

[Cat scratch disease--course, diagnosis].

Cat scratch disease is an infection which often causes regional lymphadenopathy. Bartenolloses present a growing health problem both in human and veterinary medicine. They may be etiological fevers of unknown etiology, endocarditis, pneumonia, meningitis. The mildest clinical form is the cat scratch disease which proceeds as a mild regional lymphadenopathy. It is caused by Bartonellosis henselae. Animals, especially cats, are the sourse of infections. Lymphadenitis may remain for many weeks and requires differentiation from other causes of regional lymphadenopathy. Three typical cases of the disease are presented. All sick persons had contact with cats. In none case a primary change was observed. In the case no 1 the possibility of occurrence of the disease was not considered and it was diagnosed only after histopathological examination of lymphnodes. In the two other cases diagnoses were established on the basis of serological examination after a few days of admittance for hospital treatment. Cat scratch disease is rarely diagnosed in Poland probably due to insufficient knowledge of the clinical form of this disease. Swollen lymph nodes together with patient contact with a cat or other animals established during a detailed interviewing, raise suspicion of CSD. Denial by a patient of the primary change does not rule out diagnosis. When regional lymphadenopathy of cat scratch disease is taken into consideration in differential diagnosis and serological tests are carried out, it may be possible in many cases to eliminate any further diagnostics burdening a sick person.

Adolescent↗

PubMed1989

Culture-proved disseminated cat-scratch disease in acquired immunodeficiency syndrome.

A male homosexual (positive for the human immunodeficiency virus) with a recent cat scratch developed fever, epitrochlear and axillary lymphadenopathy, and retinitis. Subsequently, he developed skin (epitheloid hemangioma) and mucosal lesions (Kaposi's sarcoma), multiple liver abscesses, and pleural effusion. Warthin-Starry stains and/or electron micrographs of lymph nodes and skin lesions demonstrated bacilli characteristic of those associated with cat-scratch disease. Cultures of lymph node, pleural fluid, and liver abscess specimens yielded organisms believed to be the causative agent of cat-scratch disease. We believe that disseminated cat-scratch disease may become an indicator of opportunistic infection signaling acquired immunodeficiency syndrome in a patient who is positive for the human immunodeficiency virus.

Acquired Immunodeficiency Syndrome↗

PubMed1986

Optic neuritis in cat scratch disease.

A patient with optic neuritis is described whose associated lymphadenopathy, cat exposure, and positive cat scratch antigen skin test suggested the diagnosis of cat scratch disease. Optic neuritis and other neurologic abnormalities, especially encephalopathy, may be associated with, or the presenting manifestation of, cat scratch disease. To our knowledge, this is the fourth case of cat scratch disease-related optic neuritis to be reported.

Adolescent↗

PubMed1986

Life-threatening cat-scratch disease in an immunocompromised host.

We describe a renal allograft recipient with cat-scratch disease in whom refractory hypotension, severe metabolic acidosis, pulmonary infiltrates, and encephalopathy developed. The patient first presented with a history of cat bites and scratches, fever, headache, and arthralgias. Four weeks later, the clinical presentation of septic shock suddenly developed in the patient. Cat-scratch disease was documented clinically and by finding delicate pleomorphic bacilli in Warthin-Starry silver stains of biopsy specimens taken from the primary inoculation site and regional lymph node. The administration of intravenous sulfamethoxazole and trimethoprim, erythromycin lactobionate, and tobramycin sulfate therapy correlated with recovery. Although cat-scratch disease is usually a benign, self-limited illness, this article illustrates its systemic nature, its potential for devastating complications in the immunocompromised host, and its possible response to vigorous antibiotic therapy.

Adult↗

PubMed1996

[Cat-scratch disease and other infections caused by Bartonella species].

Bartonella henselae, the causative agent of cat-scratch disease, was identified recently by DNA amplification techniques. Several other Bartonellae (most of which were called Rochalimaea before) cause disease in humans: B. bacilliformis (Carrion's disease), B. elizabethae (endocarditis) and B. quintana (bacillary angiomatosis and peliosis, chronic bacteraemia and endocarditis, trench fever). B. henselae is transmitted to humans by scratch or bite of a bacteraemic, but asymptomatic, cat, which event may be followed by regional lymphadenitis (classical cat-scratch disease), bacillary angiomatosis or peliosis of liver and spleen (in immune compromised, e.g. HIV-infected individuals) or chronic bacteraemia and endocarditis (in elderly individuals). The incidence in the Netherlands of cat-scratch disease is > 2/100,000/year. If a Bartonella infection is suspected, specific immuno-assays and polymerase chain reaction assay may be applied for diagnosis. Culture of the organism is difficult. Macrolides and tetracyclines have been shown to be effective in treatment of disseminated infections. The natural (self-limiting) course of regional lymphadenitis however is not affected by antibiotic treatment.

Aged↗

PubMed1996

[Cat scratch disease. Atypical forms].

First described by Robert Debré in 1950, cat scratch disease, usually observed in children and young adults (80% of the case occur in subjects under 18), is the principal cause of chronic benign lymph node enlargement. The Centers for Disease Control at Atlanta currently recognize Afipia felis and Rochalimaea henselae as the causal agents of cat scratch disease. Cats transmit the disease to humans by skin scratches or by licking open wounds. The bacilli can also be transmitted by dogs, monkeys, squirels or inert objects. The contaminating cats are usually young. There is no interhuman transmission. There are several uncommon manifestations of cat scratch disease which may misguide diagnosis. In atypical forms, the positive diagnosis of this benign disease can only be confirmed by serology or molecular biology techniques. In order to reduce the duration of the disease, antibiotic treatment is recommended in forms with systemic involvement and in atypical forms although there has been no proof of efficacy.

Cat-Scratch Disease↗

PubMed1996

[Bartonella henselae infection in immunocompetent patients: cat scratch disease].

BACKGROUND: Cat scratch disease, whose etiologic agent is Bartonella henselae, is a benign disease in immunocompetent subjects, characterized by lymphadenopathy of prolonged course and occasional involvement of other organs such as liver, spleen, central nervous system, eye and lung. In immunocompromised patients, the infection is bacteremic and disseminated. AIM: To report Chilean cases of cat scratch disease. PATIENTS AND METHODS: Ten children (seven male, aged between 6 and 13 years old) with histologically or serologically confirmed cat scratch disease are reported. RESULTS: Lymphadenopathy location was pre auricular in four cases, axillary in two, inguinal in two and epitrochlear in two. Three children had fever over 39 degrees C and two had a parinaud syndrome. Nine children had a history of cat scratch and one of a cat byte. Six had an erythrocyte sedimentation rate over 40. Lymph node ultrasound examination was a useful diagnostic tool. Two patients had splenic granulomas. Lymph node biopsies were obtained in four cases, showing a suppurative granulomatous lymphadenitis in all and a positive Warthin-Starry stain in two. Serology, done in patients without histological confirmation was positive with titles ranging from 1:64 to 1:8192. All patients had a satisfactory outcome with regression of lymphadenopathy. CONCLUSIONS: Infections by Bartonella hemselae occur in the Chilean population and must be considered in the differential diagnosis of regional lymph node enlargement.

Adolescent↗

PubMed1998

[Cutaneous vasculitis disclosing cat-scratch disease].

BACKGROUND: We describe a case of cat-scratch disease ingnaugurated by vascular purpura and discuss the role of the causal agent, Bartonella henselae. CASE REPORT: A 49-year-old woman presented vascular purpura without fever. Skin biopsy demonstrated leukocytoclasic vasculitis. She owned a cat and a had a scratch scar on the back of her left hand. A few days later, two inflammatory epitrochlear lymph nodes suppurated. Catscratch disease was confirmed by serology and PRC analysis of pus aspirated from the nodes. The purpura resolved spontaneously in three weeks. Left axillary adenopathy developed and suppurated. In spite of four antibiotics, the nodes subsided only ten months later, leaving scars. DISCUSSION: Two arguments favor Bartonella henselae as the causal agent in this cutaneous vasculitis. The simultaneous onset of the two diseases and the absence of another cause of vasculitis. This patient did not have Bartonella henselae endocarditis which could have explained this vasculitis. Only one case of hypersensitivity vasculitis has been described during cat-scratch disease. The exceptional feature of this association is perhaps the result of the unawareness of moderate or asymptomatic cat-scratch disease. Bartonella henselae was possibility caused hypersensitivity vasculitis.

Bartonella henselae↗