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PubMed1990

[Cat-scratch disease].

Cat scratch disease is a self-limited but chronic lymphadenitis which has acquired new interest by the description of a responsible pathogen, an intracellularly located gram-negative rod. Due to its low pathogenicity for laboratory animals, the definite proof for causality is still lacking. Severe systemic courses, mainly in immune suppressed patients, can however be identified more positively by detection of this pathogen. A routine diagnostic test is likely to be developed in the near future and therapeutic guidelines for the minority of severe, progressive forms may be drawn up.

Cat-Scratch Disease↗
PubMed1999

Unusual eruption as a presenting symptom of cat scratch disease.

Cat scratch disease (CSD) is a common infectious cause of subacute regional lymphadenopathy. Bartonella henselae is the principal etiologic agent. About 10% of CSD patients experience atypical manifestations, including rashes. The most common cutaneous manifestation of CSD is a papule at the inoculation site. We report a case of CSD presenting with an eruption on the upper trunk, reminiscent of Sweet's syndrome, accompanied by lymphadenopathy, arthralgia, and fever. Response to systemic corticosteroids was remarkable. Histopathologic findings refuted the diagnosis of Sweet's syndrome. Identification of anti-B henselae antibodies and B henselae DNA in the affected lymph node confirmed the diagnosis of CSD. This is a first report of extensive papuloedematous eruption as a cutaneous manifestation of CSD. Accurate diagnosis is possible due to the availability of serological tests and DNA amplification techniques.

Adult↗
PubMed2001

Unsuspected extralymphocutaneous dissemination in febrile cat scratch disease.

Cat scratch disease (CSD) commonly manifests as regional self-limited lymphadenitis. However, dissemination of the infection to distant multiple sites may occur even in immunocompetent patients. We report a series of 11 children with fever and extralymphocutaneous manifestations of CSD, in order to highlight potential multiorgan involvement in patients with febrile CSD. To be eligible for enrollment, patients had to present with involvement of sites other than regional lymph nodes. The diagnosis was based on suggestive clinical criteria, histological findings and positive serology. The utilization of ultrasound imaging revealed hepatic lesions in 3 children and splenic lesions in 8 children, whereas osteolytic lesions were observed in 4 children by bone scan. Hepatic or splenic involvement was not suggested by clinical signs or biochemical investigation in 2/3 and 6/8 children, respectively. Bone involvement was supported either by relative symptoms or signs. Our findings indicate that, in the presence of fever, extralymphocutaneous manifestations have to be anticipated in patients with clinically suspected CSD. The systematic use of imaging modalities in patients with serologically documented Bartonella henselae infection could contribute to a better understanding of the clinical spectrum of CSD.

Adolescent↗
PubMed1994

Rochalimaea henselae organisms possess an elevated capacity of binding to peripheral blood lymphocytes from patients with cat scratch disease.

Cat scratch disease (CSD) is a clinical condition whose aetiological agent, according to recent findings, is of bacterial origin. Two Gram-negative bacteria are invoked as causative agents of CSD, namely Afipia felis and Rochalimaea henselae. In this paper, five patients with suspected CSD were studied in terms of binding capacity of A. felis and R. henselae to their own peripheral blood lymphocytes (PBL). This parameter was correlated with serum antibody titres to both A. felis and R. henselae, as determined by an indirect fluorescence assay (IFA). Results demonstrate that in four out of five cases binding of R. henselae to PBL was higher than that observed with A. felis. In two cases serum antibody titres to both bacteria were lower or absent, while in the other two patients serum antibody titres to R. henselae were significantly high. In one case only, characterized by elevated titres of serum antibodies to A. felis, values of cytoadherence exhibited by this bacterium were similar to those observed with R. henselae. The results suggest that bacterial binding to lymphocytes may represent an additional parameter to support diagnosis of CSD.

Adolescent↗
PubMed2001

[Splenic abscess and cat-scratch disease].

Cat-scratch disease is caused by a Gram-negative bacillus known as Bartonella henselae. This disease is usually benign and causes regional adenitis that does not require treatment. However, some patients develop more serious atypical forms of the disease including prolonged systemic illness with hepatic and splenic abscesses.A 14-year-old girl was admitted to hospital with a 12-day history of persistent high fever and abdominal pain. Ultrasonography and computerized tomography of the abdomen revealed splenic abscesses. These findings, together with an antecedent of cat exposure, led to the suspicion of cat-scratch disease, which was confirmed by serology. The girl was treated with intramuscular ceftriaxone and clinical evolution was favorable. Splenic cat-scratch disease is infrequent. Cat-scratch disease sometimes presents as fever of unknown origin and consequently this disease should be considered in the differential diagnosis of prolonged fever. Although evolution is usually favorable, antibiotic therapy is recommended in systemic manifestations of cat-scratch disease.

Abscess↗
PubMed1992

Oculoglandular syndrome. Cat-scratch disease without the cat scratch.

Oculoglandular syndrome and swelling of the parotid gland are unusual manifestations of cat-scratch disease. Although exposure to cats is considered an important part of the patient history, an actual cat scratch is not required to establish the diagnosis. Oral fluoroquinolones show promise in the treatment of the infection.

Adult↗
PubMed1987

Cat-scratch disease.

Cat-scratch disease is a self-limited disease associated with contact with cats that causes regional lymphadenopathy in children and young adults. Recently identification of the probable causative organism, a gram-negative, non-acid-fast coccobacillus, has been achieved through special staining techniques from skin inoculation sites and involved lymph tissue. Differential diagnosis includes a variety of other infectious diseases and neoplasms. Diagnosis of cat-scratch disease can be made by presence of typical clinical findings, history of exposure to cats, results of skin testing to cat-scratch antigen, and in some circumstances, biopsy or fine-needle aspiration from skin inoculation site or involved lymph nodes. Future developments awaiting culture of the suspected bacterium include a vaccine for prevention, rapid diagnostic methods, and antimicrobial testing.

Cat-Scratch Disease↗
PubMed2000

Cervical lymphadenitis and cat scratch disease (CSD): an overlooked disease?

Cat Scratch Disease (CSD) is a benign disease characterized by regional lymphadenopathy affecting most frequently the head and neck region in children and young adults. In the present paper, the authors describe four cases of CSD focusing on clinical history, diagnostic management and therapy. The main germ responsible for this lymph node disease is Bartonella henselae. Diagnosis is based on history, serology and histological findings. Clinical evolution is generally favorable despite the fact that complications occur in about 5% to 13% of patients including encephalitis, hepatitis and Parinaud's oculoglandular syndrome. Antibiotic treatment is only considered for highly symptomatic patients. Surgical excision of the lymphadenopathy is useful to establish the diagnosis when serology is not available and/or when the adenopathy become fluctuating. The authors emphasize the increasing incidence of patients with CSD in the ENT population and the algorithm for CSD disease affecting the cervical lymph nodes.

Adolescent↗
PubMed2000

Cat-scratch disease.

Cat-scratch disease (CSD) was first described by Debré in 1950, yet the causative bacterial agent of CSD remained obscure until 1992, when Bartonella (formerly Rochalimaea) henselae was implicated in CSD by serological and microbiologic studies. Bartonella henselae had initially been linked to bacillary angiomatosis (BA), a vascular proliferative disease most commonly associated with long-standing human immunodeficiency virus infection or other significant immunosuppression. Bartonella henselae has also been associated with bacillary peliosis, relapsing bacteraemia and endocarditis in humans. Cats are healthy carriers of B. henselae, and can be bacteraemic for months or years. Cat-to-cat transmission of the organism by the cat flea, with no direct contact transmission, has been demonstrated. Two new Bartonella species have been identified in the cat reservoir, namely: B. clarridgeiae and B. koehlerae. The role of these species in the aetiology of CSD still needs to be confirmed by isolation or DNA identification from lesions in humans. The author discusses the present state of knowledge on the aetiology, clinical features and epidemiological characteristics of CSD/BA, in addition to diagnosis, treatment and prevention.

Animals↗
PubMed2002

Unilateral neuroretinitis and periparillary serous retinal detachment in cat-scratch disease.

Cat-scratch disease is a self-limited infection characterized by subacute regional lymphadenitis, which is usually preceded by a history of being scratched by a cat infected with the Bartonella species. Neuroretinitis, retinochoroiditis, isolated papillitis and peripapillary angiomatosis are features of posterior segment involvement. However, vision loss is very rare. We report a patient with cat-scratch disease associated with unilateral neuroretinitis and peripapillary serous retinal detachment, and discuss its fluorescein and indocyanine green angiographic features.

Adolescent↗
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↗
PubMed1996

Imaging manifestations of cat-scratch disease.

Cat-scratch disease affects an estimated 22,000 people in the United States each year, more than half of whom are children or adolescents [1]. It is caused by Bartonella henselae, a gram-negative bacillus usually introduced by the scratch of a cat [2]. In the past, diagnosis was made if three of the following four criteria were met: (1) history of cat exposure with inoculation, (2) positive skin test: (3) absent laboratory and histopathologic evidence of other diseases, and (4) biopsy findings of granulomatous inflammation [3]. Recent identification of the causative organism has led to new diagnostic tests, including serum assays for B. henselae antibodies [4]. Although response of the disease to antibiotics is poor, spontaneous recovery generally occurs within months to years [3].

Adolescent↗
PubMed1989

Antibiotic therapy for cat-scratch disease?

Cat-scratch disease is usually a benign, self-limited disease that causes regional lymphadenopathy. Occasionally, it may present with systemic symptoms and have a prolonged course. To date, antibiotic therapy has not been proved to be of value. We describe three patients with cat-scratch disease who were treated successfully with gentamicin sulfate. Two patients had extensive hepatic involvement, and one patient had regional lymphadenopathy. All three patients responded within 48 hours to intravenous gentamicin. Extensive follow-up has shown no recurrence of symptoms. These cases suggest that gentamicin may be efficacious in shortening the course of cat-scratch disease. Prospective, randomized trials should be performed to confirm these results.

Cat-Scratch Disease↗
PubMed2000

[Familial parinaud oculo-glandular syndrome in cat-scratch disease].

Cat-scratch disease is manifested by subacute, regional lymphadenitis and occurs mainly in children. The causative agent is a pleomorphic, gram-negative bacillus, Bartonella henselae carried by asymptomatic cats. Parinaud oculoglandular syndrome is the most common ocular manifestation of this disease. It is characterized by unilateral conjunctivitis with polypoid granuloma, usually of the palpebral conjunctiva, and preauricular lymphadenopathy. The diagnosis is supported by a history of exposure to cats and is confirmed by positive serologic tests or positive PCR assay. The occurrence of more than 1 case of Parinaud syndrome in a family is rare. We describe 2 sisters with Parinaud oculoglandular syndrome, proven by serologic tests. They reported that they used to cuddle with their cats, among them a kitten. Because of the refractory conjunctivitis and signs of imminent periorbital cellulitis, they were treated with oral tetracycline with apparently good responses. We recommend asking about contacts with cats in any atypical conjunctivitis accompanied by regional lymphadenopathy, especially in young patients. Systemic antibiotics should be given when there is any suspicion of significant ocular involvement, if the patient is immunosuppressed, or if there are systemic manifestations of cat-scratch disease.

Adolescent↗
PubMed2001

An unusual presentation of cat-scratch disease.

Cat-scratch disease (CSD) is a relatively common entity, particularly in children. The most common sites of involvement are the axillary lymph nodes, followed by cervical, pre-auricular and submandibular lymph nodes. We present a case of cat-scratch disease in which the initial clinical features were indistinguishable from those of acute bacterial tonsillitis with jugulodigastric lymphadenopathy. This previously unreported apparent mode of presentation is discussed with reference to the current understanding of the disease.

Acute Disease↗
PubMed1993

Multiorgan involvement in systemic cat-scratch disease.

Cat-scratch disease is considered in the differential diagnosis of benign regional lymphadenopathy. We describe a case of cat-scratch disease in a 12-year-old boy with multiple bony, hepatic and splenic lesions which resolved with chemotherapy. The present case with simultaneous multiorgan involvement supports the view of a systemic nature of the disease.

Abscess↗