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Isolation in endothelial cell cultures of chlamydia trachomatis LGV (Serovar L2) from a lymph node of a patient with suspected cat scratch disease.

An inguinal lymph node, removed from a 21-year-old Romanian man suspected of having cat scratch disease, was sent to our laboratory for Bartonella culture. Lymph node specimens were inoculated on blood-enriched agar and in an endothelial cell culture system using the centrifugation shell vial technique. Bacteria were grown in cell monolayers and detected as positive with an anti-Bartonella henselae rabbit serum. However, such bacteria were identified as Chlamydia trachomatis biovar LGV serovar L2 by PCR sequencing techniques. Pathological examination of tissue biopsies was compatible with either lymphogranuloma venereum or cat scratch disease. The shell vial system is suitable for isolation of intracellular pathogens responsible for chronic lymphadenopathies, including C. trachomatis, Bartonella species, Francisella tularensis, and mycobacteria. However, care should be taken when identifying Chlamydia spp. and Bartonella spp. using polyclonal antibodies, since species of both genera have common antigens which are responsible for cross-reactions.

Adult↗

Improved culture from lymph nodes of patients with cat scratch disease and genotypic characterization of Bartonella henselae isolates in Australia.

Over a 4-year period we detected Bartonella henselae isolates in 104 of 297 specimens (35.1%) from Australian patients clinically suspected of having cat scratch disease by amplification of a fragment of the htrA gene. We isolated 17 B. henselae strains (20.5%) from the 83 PCR-positive human specimens available for culture. Our culture method was based on prolonged incubation in a moist atmosphere of blood agar to which hemin was added. We obtained more B. henselae isolates than the number of all other isolates from lymph nodes reported in the literature. In order to identify and study the genetic variation of Australian B. henselae isolates, we determined the sequence of a fragment of the pap31 gene from our 17 human isolates and also from 8 Australian cat isolates. Thirteen of the human B. henselae isolates belonged to the Houston genotype, variant Houston-1 (76.5%), and four belonged to the Marseille genotype, variant CAL-1 (23.5%). In contrast, seven cat isolates were classified as B. henselae Marseille, variant CAL-1 (87.5%), and one was classified as B. henselae Houston, variant Houston-1 (12.5%). Our study describes an efficient culture method for the diagnosis of cat scratch disease and contributes to the description of the genotypic distribution of B. henselae in Australia.

Australia↗

Cat scratch disease presenting as orbital abscess and osteomyelitis.

Ocular manifestations of cat scratch disease are uncommon. The diagnosis is usually made on the basis of increasing Bartonella henselae serum antibody titers. We report a child presenting with orbital abscess and osteomyelitis who was diagnosed with hepatosplenic cat scratch disease by detection of B. henselae DNA in the orbital abscess fluid.

Abscess↗

Osteolysis in cat-scratch fever.

The osteolysis associated with cat-scratch fever resembles more ominous conditions. The combination of osteolysis and unilateral regional adenopathy in a child or adolescent should suggest cat-scratch disease.

Adolescent↗

Cat scratch disease and glomerulonephritis.

Cat scratch disease is a generally benign, self-limited disease characterized by fever and regional lymphadenitis. Systemic complications are rare and most frequently affect the central nervous system, bone, liver or spleen. We report the first case of glomerulonephritis associated with cat scratch disease which resolved spontaneously concurrent with the resolution of lymphadenitis and constitutional symptoms. Immunopathologic and ultrastructural studies suggest a form of immune-mediated postinfectious glomerulonephritis.

Adolescent↗

Cat-scratch disease associated with pleural effusions and encephalopathy in a child.

Cat-scratch disease has been associated with a variety of systemic manifestations. We present a case of cat-scratch disease associated with bilateral pleural effusions and encephalopathy in a child. The particular combination of findings reported here may be more ubiquitous than formerly suspected and widen the clinical description of this condition.

Biopsy↗

Cat-scratch disease.

Cat-scratch disease has been reported with increasing frequency since its initial description in 1931. It is now recognized as being so prevalent that it probably represents the most common cause of unilateral lymphadenopathy in children, once nonspecific viral diseases and cutaneous infections have been excluded. The cardinal feature of the disease is a subacute regional granulomatous lymphadenitis. Because of its relatively mild natural course, most cases are treated on an outpatient basis. Forty-four children, representing the more seriously ill portion of the disease spectrum, were treated at Texas Children's Hospital from 1972 to 1984 and constitute the data base for this article. Most patients were symptomatic for nearly 1 month prior to admission, typically complaining of low-grade fever and regional lymphadenopathy. The two most common sites of lymph node involvement were the axilla (54%) and the neck (46%). Although there is, at this time, no specifically recommended treatment, 80% of patients received antibiotics and 70% underwent a surgical procedure--usually total nodal excision. Nodal excision was followed by rapid resolution of symptoms. Because cat-scratch disease is benign, surgery should be reserved for severe cases with signs of significant suppuration. Generally, symptomatic relief can be afforded by warm soaks and analgesics and recovery over the course of several weeks is uneventful.

Adolescent↗

Cat scratch disease (bartonellosis) mimicking an SLE flare.

Only recently Bartonella species have been recognized as important human pathogens. Cat scratch disease (CSD), caused by infection with Bartonella henselae, shows a steady increase in the number of cases throughout the world. We report a case of an 18-year-old woman with systemic lupus erythematosus (SLE) who presented with ongoing fever, arthralgias and loss of weight which did not respond to increasing doses of corticosteroids. After exclusion of common infections a photograph of her cat in combination with scratch marks on her arms finally led to the suspicion of CSD. This tentative diagnosis was confirmed serologically. Under clarithromycin treatment the patient rapidly responded and her temperature dropped within 2 days.

Adolescent↗

Cerebral arteritis in cat-scratch disease.

Acute right hemiplegia and transient expressive aphasia occurred in a 7-year-old girl a few days after nonspecific constitutional symptoms and the appearance of a large right submandibular lymph node. Biopsy of this node and lack of other evident cause suggested a diagnosis of cat-scratch disease. Carotid arteriography showed a localized arteritis of the supraclinoid part of the left internal carotid artery and the left middle cerebral artery, involving also some lenticulostriate vessels. Computerized tomography demonstrated infarction in the left internal capsule. The size of this infarct and the angiographic abnormalities improved 6 weeks after onset, and coincided with clinical recovery. Cat-scratch disease may have caused the localized arteritis.

Arteritis↗

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↗

Cat-scratch disease: historic, clinical, and pathologic perspectives.

Cat-scratch disease (CSD) initially was described in 1931, but the etiologic agent (Bartonella henselae) was not elucidated until decades later. This disease is the most common cause of chronic lymphadenopathy among children and adolescents, characteristically manifesting as subacute regional lymphadenitis with an associated inoculation site due to a cat scratch or bite, often accompanied by fever. The hallmark histologic lesion is granulomatous inflammation with a central stellate microabscess. Numerous atypical manifestations of CSD have been described, and these often lack the characteristic superficial lymphadenopathy and inoculation site papule. These atypical forms may be misdiagnosed initially as other infectious processes or neoplasms. We present a review of the history and epidemiologic features of CSD, describe common and unusual clinicopathologic manifestations, and discuss current diagnostic modalities.

Animals↗

Cat-scratch disease: considerations for dentistry.

BACKGROUND: Cat-scratch disease, or CSD, results from inoculation of the gram-negative bacillus Bartonella henselae via a cat's scratch. A regional lymphadenitis, which usually is cervical, develops and may progress to suppuration. It is necessary to differentiate CSD from other lymphadenopathies. CASE DESCRIPTION: A patient who had close contact with a cat subsequently developed a localized, suppurative cervical lymphadenitis. As B. henselae was identified in 1992, the authors were able to confirm the existence of CSD serologically. Surgical drainage resulted in a successful resolution of the disease process. CLINICAL IMPLICATIONS: As patients with CSD may be seen in the dental office, an awareness of its symptomatology can prevent unnecessary dental intervention and facilitate early treatment.

Antibodies, Bacterial↗

Cat scratch disease.

Cat scratch disease developed on a 40-year-old wife was reported. Umbilicated papules closely resembling those in herpetic skin infection development on the areas which had been scratched by a cat a week ago. Obtained findings in the present case led us to a speculation that this disease was caused by herpes virus. 72 cases of this disease have been reported in Japan, and they were reviewed in the present paper.

Adolescent↗

Cat-scratch disease and bacillary angiomatosis.

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 microbiological studies. B. henselae had initially been linked to bacillary angiomatosis (BA), a vascular proliferative disease most commonly associated with long-standing human immunodeficiency virus (HIV) infection or other significant immunosuppression. B. 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. It has recently been demonstrated that B. henselae can be transmitted from cat to cat by the cat flea, but not by direct contact between animals. The author discusses the present state of knowledge on the aetiology, clinical features and epidemiological characteristics of cat-scratch disease and bacillary angiomatosis.

Angiomatosis, Bacillary↗

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↗

Detection of bartonella henselae DNA by polymerase chain reaction in a patient with cat scratch disease: a case report.

We report a case of cat scratch disease caused by Bartonella henselae in Korea. A 25-yr-old woman developed left cervical lymphadenopathy with history of contact with a dog. The cervical lymphadenopathy persisted for 1 month and resolved gradually and spontaneously. Serologic test was not done during the acute stage of the disease. Immunofluorescent antibody test performed during the convalescent stage was positive for B. henselae. To confirm B. henselae infection, polymerase chain reaction (PCR) analysis using aspirates of cervical lymph node was performed and the presence of B. henselae DNA was demonstrated. This is the first reported case of cat scratch disease in Korea confirmed by PCR for B. henselae DNA.

Adult↗

[Serous macular detachment as an atypical sign in cat scratch disease].

CASE REPORT: A 58-year-old woman presented with 0.1 visual acuity in the left eye associated with a serous retinal detachment of the macula as the only ocular manifestation of cat scratch disease. This diagnosis was made by serum antibody titers and the clinical course. DISCUSSION: Although uncommon, cat scratch disease should be considered in patients with a serous detachment in the macula region of the retina.

Animals↗