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PubMed2003

B-mode sonographic criteria for differential diagnosis of cervicofacial lymphadenopathy in cat-scratch disease and toxoplasmosis.

BACKGROUND: Our purpose was to evaluate different sonographic parameters of cervicofacial lymphadenopathy caused by cat-scratch disease (CSD) and toxoplasmosis. METHODS: By use of high-resolution B-mode sonography a total of 552 lymph nodes in the head and neck were detected between January 1997 and December 2001. There were 71 patients (422 lymph nodes) with CSD and 19 patients (130 lymph nodes) with toxoplasmosis. Sonographic variables, including 20 sonomorphologic features along with age and gender, were analyzed with multivariate logistic regression. RESULTS: Heterogenous lymph nodes were more often found in CSD (p =.003), and nonsharp nodal borders showed a significant association with CSD (p =.0005). Multivariate analysis identified sharpness of borders (p =.0001), S/L ratio (p =.0006), and type of lymphadenopathy (acute, abscessed, chronic) (p =.0006) as most significant for differentiating between CSD and toxoplasmosis. CONCLUSIONS: These results provide significant and useful criteria for ultrasonographic differentiation between CSD and toxoplasmosis.

Adolescent↗

PubMed1986

Cat scratch disease: evidence for a bacterial etiology. A retrospective analysis using the Warthin-Starry stain.

97 cases of acute necrotizing granulomatous lymphadenitis (so called "reticulozytärabszedierende Lymphadenitis") were examined retrospectively with the Warthin-Starry stain, in order to detect bacteria in patients with cat-scratch disease (CSD). 27 patients with CSD were found and among those, bacteria were demonstrated in 4. The organisms were pleomorphic rods of about 3 micron length and occurred in clumps within foci of fresh necrosis. We found the organisms in a much lower percentage than has been described in the literature. The reasons may be that many of our patients had antimicrobial treatment prior to the biopsy and that step-sectioning of the specimen may be necessary in order to detect fresh lesions. Our findings seem to confirm the observation that CSD may have a bacterial aetiology.

Bacteria↗

PubMed1988

Cat scratch disease. An epidemiological and ultrastructural study of lymphadenitis caused by Warthin-Starry positive bacteria.

The aetiological agent of cat scratch disease (CSD) has been unknown for more than 30 years. Recently, a micro-organism clearly shown with Warthin-Starry silver (W-S) stain was found and thought to be a possible cause of the disease. In this study, 32 cases of regional lymphadenopathy histologically compatible with CSD and 20 contrasting cases of lymphadenopathy were examined retrospectively with W-S stain. W-S positive pleomorphic organisms were clearly demonstrated in 20 of the 32 suspected cases of CSD, but in none of the other cases. The onset of disease in these 20 cases with W-S positive organisms occurred between July and January. This seasonal variation in the onset of disease was highly significant (P less than 0.005) and was not due to a single epidemic. Moreover, some characteristic morphological features of the organism were found by electron microscopic observations. Ultrastructurally, the organism was a bacterium showing a chain-like arrangement, septal formation, branching and clubbed ends.

Abscess↗

PubMed1991

Atypical large plasma cells in lymph node granulomas in cat-scratch disease.

A histological variant of plasma cells found in the granulomas of cat-scratch disease (CSD) lymphadenitis is reported. Though the lesion shows the typical features of suppurative granulomatous lymphadenitis, many atypical giant cells which have abundant basophilic cytoplasm and bizarre nuclei with occasional multinucleated forms are noted among epithelioid histiocytes. The diagnosis of CSD lymphadenitis was confirmed by comparing clinical; histopathological, and histochemical (Warthin-Starry silver impregnation stain) studies on lymph node sections from five cases with features typical of the disease. Histochemical (methyl green-pyronine stain) and immunohistochemical examination provided several lines of evidence indicating that the atypical giant cells in our case were plasmacytic and confirmed that its proliferation was reactive, not neoplastic. Multinucleated giant cells were also occasionally present in the other five cases, but they had histological and immunohistochemical features of Langhans' type giant cells. We stress the importance of distinguishing such atypical large plasma cells from neoplastic cells.

Adolescent↗

PubMed1995

Serology to Bartonella (Rochalimaea) henselae may replace traditional diagnostic criteria for cat-scratch disease.

Bartonella (Rochalimaea) henselae has been identified as causative agent of cat-scratch disease (CSD). Employing an indirect fluorescence antibody test we found that 20 (100%) out of 20 children with suspected CSD had serum titres to B. henselae of > or = 512. By contrast, in all but one of the controls (n = 332) including subjects exposed to the same cats, patients with diseases other than CSD, and blood donors the antibody titres were < or = 256 (P < 0.001). However, significant regional differences in seroprevalence were noted. CONCLUSION. Serology to B. henselae may supplant traditional criteria for the diagnosis of CSD and prevent patients from unnecessary surgery.

Adolescent↗

PubMed1991

Granulomatous hepatitis in cat-scratch disease. Ultrasound and CT observations.

A male two year old was admitted to the hospital with a one month history of fever. The physical examination was unrevealing. Abdominal ultrasound revealed multiple, circumscribed regions of low attenuation in the liver and a parapancreatic mass. Laparotomy and biopsy revealed multiple nodules in the liver. The histopathologic findings indicated the child had cat-scratch disease, which resolved with administration of gentamycin sulfate.

Cat-Scratch Disease↗

PubMed1989

Cat-scratch disease with reversible encephalopathy.

A case of cat-scratch disease (CSD) complicated by reversible encephalopathy is presented. Neurological complications of CSD are uncommon. Laboratory and radiological examinations were negative. There was complete recovery.

Cat-Scratch Disease↗

PubMed2001

Serodiagnosis of cat scratch disease: response to Bartonella henselae in children and a review of diagnostic methods.

In this study, sera from 116 children without clinical evidence of cat scratch disease (CSD) and sera from 19 children with CSD were investigated by two different immunofluorescent assays (test A and test B) to evaluate the seroprevalence of Bartonella henselae antibodies in this population. Antibodies against Bartonella henselae were found in noninfected children only in low titers: 13% and 3.5% of serum samples were positive by test A and test B, respectively. IgG titers as determined by test A ranged from 1:64 to 1:256, whereas test B did not yield titers >1:64. Of the 19 children with CSD, 7 (37%) and 5 (26%) had low antibody titers (1:64-1:256) on admission by test A and test B, respectively. In such cases, IgM antibodies against Bartonella henselae and/or a titer increase in the following weeks are required to prove suspected CSD. The results indicate that the seroprevalence of Bartonella henselae antibodies in children without evidence of CSD is low, and that the results may differ depending on the tests being used. Low antibody titers, however, were found not only in healthy children but also among patients with CSD, which could be indicative of the beginning or of the end of an illness. Currently, only few data are available concerning the seroprevalence of antibodies to Bartonella spp. among children. Although children are often affected by CSD, the specificity of most tests has been evaluated by investigating blood donors, who are usually adults. Several different serological tests are used for the diagnosis of CSD, including the immunofluorescence assay, the enzyme-linked immunosorbent assay, and Western blot (WB) analysis. The sensitivities of different IFAs range from 14 to 100%, depending on the antigen used, the cut-off chosen, and the test procedures. The current diagnostic value of different serological tests for diagnosis of CSD is reviewed.

Adolescent↗

PubMed2002

Cat-scratch disease osteomyelitis.

We report on a patient who presented with osteomyelitis of a rib and adjacent abscess as a rare and atypical manifestation of cat-scratch disease. Radiographic findings showed an osteolytic lesion with adjacent mass. Biopsy, serology and polymerase chain reaction technique are essential for the final diagnosis. Prognosis is excellent with full recovery.

Adult↗

PubMedDate not supplied

Hepatic and splenic involvement in cat-scratch disease: imaging features.

Hepatosplenic involvement in cat-scratch disease, probably underdiagnosed, is characterized by multinodular lesions throughout the liver and spleen. Radiologic features of ultrasound, computed tomography, and magnetic resonance imaging are not specific. The key of the diagnosis relies on a history of cat or kitten contact. A specific serological test can confirm the diagnosis without invasive procedures such as biopsy.

Cat-Scratch Disease↗

PubMed1998

[Reactive arthritis after cat bit: a rare manifestation of cat scratch disease--case report and overview].

Cat scratch disease (CSD) is a rarely recognized infectious disease in Germany. Only a few years ago the causative agent, Bartonella henselae, could be isolated. The typical clinical manifestations of CSD consist of skin changes at the inoculation site and a benign lymphadenopathy; other manifestations are rare. We report the case of a 47 year old woman, who developed a reactive spondylarthropathy with synovitis of finger joints, polyarthralgias of large- and medium-sized joints, and inflammatory spinal pain after a cat bite. The rheumatic manifestations resolved after 10 months by treatment with non-steroidal antirheumatic drugs. Only a few cases of rheumatic manifestations associated with CSD have been described in the literature. Because the prevalence of Bartonella henselae infection of cats is high in Europe, rheumatic manifestations might be more frequent. Diagnosis of CSD is now improved by the development of serological tests. We provide an overview of the clinical manifestations and the diagnostic criteria.

Animals↗

PubMed1998

IgM to Bartonella henselae in cat-scratch disease and during acute Epstein-Barr virus infection.

The diagnostic value of IgM to Bartonella henselae was evaluated in 20 children with cat-scratch disease (CSD) and controls consisting of 20 blood donors and 20 children with enlarged lymph nodes without CSD by two indirect immunofluorescence assays (IFA). One was based on B. henselae cocultivated with Vero cells (host cell-associated IFA), and the other on B. henselae grown on agar (host cell-free IFA). With the host cell-associated IFA, 18 of 20 children with CSD revealed IgM, whereas only 14 did so with the host cell-free IFA. Sera of two blood donors as well as sera from three children with enlarged lymph nodes without CSD showed also positive IgM to cell-associated B. henselae. This study reveals that the IFA applied had sensitivities of 70-90% and specificities of 87.5-100% for detecting IgM to B. henselae. Additionally, 20 patients with IgM to Epstein-Barr virus (EBV) capsid antigen were tested for IgM to B. henselae. Sera of 16 and 9 of these patients revealed IgM to B. henselae with the host cell-associated and the host cell-free IFA, respectively. Using Western blot these sera were demonstrated to react against linearized proteins of Vero cells and of B. henselae. Thus, since acute EBV infection may substantially reduce the specificity of B. henselae-specific IgM tests, we conclude that diagnosis of CSD should be confirmed by a significant IgG titer to B. henselae or by detection of this pathogen.

Animals↗

PubMed2002

Cat scratch disease: analysis of 130 seropositive cases.

To clarify the clinical manifestations of cat scratch disease (CSD), we evaluated a total of 130 seropositive patients with CSD. The patients' ages ranged from 1 to 68 years; 103 (79.2%) were under 18 years of age. CSD occurred predominantly in the fall and winter months. Regional lymphadenopathy was noted in 110 (84.6%) of the cases, and the most common sites were the neck (33%), axillary (27%), and inguinal (18%) regions. One hundred of the patients (77%) had general symptoms, such as fever, headache, and malaise. The clinical manifestations of CSD showed a wide spectrum from typical or classical CSD, with regional lymphadenopathy, to atypical or systemic CSD. Of the 130 cases, 103 (79.2%) were typical CSD and 27 (20.8%) were atypical CSD. Atypical cases of CSD were commonly reported as fever of unknown origin (37.0%), neuroretinitis (22.2%), encephalopathy (14.8%), hepatosplenic granuloma (11.1%), and Parinaud's oculoglandular syndrome (7.4%). Fever of unknown origin or prolonged fever lasting more than 14 days was evident in 27 (20.8%) of the 130 cases in this study. Eleven of the 27 cases lacked lymphadenopathy. Our findings suggest that CSD is not a rare disease in Japan. The indirect fluorescent antibody (IFA) test to detect Bartonella species may provide a prompt diagnosis of CSD and facilitate appropriate therapy.

Adolescent↗

PubMedDate not supplied

Pattern visual evoked potentials in eyes with disc swelling due to cat scratch disease-associated neuroretinitis.

PURPOSE: To evaluate optic nerve function by pattern visual evoked potentials (VEPs) in eyes with optic disc swelling due to neuroretinitis associated with cat scratch disease (CSD). METHODS: Four eyes of four patients with marked optic disc swelling resembling optic neuritis but diagnosed serologically as CSD received systemic steroid treatment. VEPs elicited by black and white checkerboard stimuli created on a TV monitor were recorded before the treatment. RESULTS: The visual acuity (VA) in the affected eyes was decreased to 20/50 in two eyes and finger counting in two eyes at their initial visits. Ophthalmoscopic examination revealed neuroretinitis characterized by severe optic disc swelling, chorioretinal exudates, and macular edema in all eyes. Anti-Bartonella henselae serum antibody was markedly elevated in all patients confirming the diagnosis of CSD. The P100 of the transient VEPs was only mildly reduced without a delay in the implicit times in three eyes and only slightly delayed in the other eye. The steady-state VEPs were mildly reduced in two eyes and phase-reversed in other two eyes. The VA fully recovered after systemic steroid treatment in all patients. CONCLUSIONS: Although all examined patients showed marked swelling of the optic disc and visual decrease, the pattern VEPs were not affected as severely as in idiopathic optic neuritis. However, the degree of change of the pattern VEPs varied among patients.

Adult↗

PubMedDate not supplied

Visceral manifestation of cat scratch disease in children. A consequence of altered immunological state?

A 12-year-old girl with a 2-month history of fever and abdominal pain was admitted to our hospital. Ultrasound and CT scans of the abdomen showed multiple hypoechoic lesions of liver and spleen. Screening for zoonosis revealed high positive titers to Bartonella henselae. T-cell deficiency was demonstrated and remained almost unchanged during a follow-up of 11 months. A review of the literature shows that disseminated visceral affection is a rare presentation of cat scratch disease (CSD) in childhood and adolescence. Further immunological investigations are needed in more patients with CSD to confirm whether an altered immunological state may be responsible for the atypical visceral manifestation of CSD.

Animals↗

PubMed1992

Serological response to "Rochalimaea henselae" antigen in suspected cat-scratch disease.

There are no generally accepted diagnostic tests for cat-scratch disease (CSD), the cause of which is unknown. During the development of an indirect fluorescence antibody (IFA) test for detection of antibodies to "Rochalimaea henselae", sera from patients with CSD were found to have high titres to R henselae antigens. Further tests with this assay showed that 36 (88%) of 41 patients with suspected CSD had serum titres of 64 or more to R henselae antigen, that there was a low prevalence (3%) of substantial titres to R henselae in healthy controls (n = 107), and that the immune responses to R henselae antigens were specific. These data suggest that the R henselae IFA test, or other serological assays based on R henselae, may be useful for diagnosis of CSD.

Antigens, Bacterial↗

PubMed1991

The current status of cat-scratch disease: an update.

Cat-scratch disease (CSD) is a benign inoculative lymphoreticulosis, first described in independent reports by Pierre Mollaret [1] and Robert Debre in 1950 [2]. The disease usually self-limited, with spontaneous resolution occurring after several weeks, appears to be related to the presence of an identified gram-negative bacteria.

Acquired Immunodeficiency Syndrome↗

PubMed1990

Cat scratch disease in the parotid gland presenting with facial paralysis.

Facial paralysis due to cat scratch disease (CSD) has not been described previously. A case is reported where this self limiting benign condition presented in a child with a parotid lump and a lower motor neurone facial paralysis affecting the marginal mandibular branch of the facial nerve simulating a malignant tumour of the parotid gland. This case demonstrates a highly unusual presentation of CSD.

Cat-Scratch Disease↗