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PubMed1994

[Rochalimaea henselae, Afipia felis and cat-scratch disease].

Several years ago, Rochalimaea henselae has emerged as an agent of bacillary angiomatosis, bacillary peliosis and recurrent septicaemia that generally occur in patients infected with human immunodeficiency virus. An aetiologic role in cat scratch disease is also suspected widely on the basis of a serologic survey. Its slow growth and its culture requirement explain that this pathogen, a gram-negative bacterium, could not be isolated until 1990. Moreover, blood and tissue samples request lysis and crushing for recovering by culture. The clinical, histological, microbiological and pathogenic aspects of these infections are described and discussed.

AIDS-Related Opportunistic Infections↗
PubMed2000

Parapharyngeal abscess due to cat-scratch disease.

The spectrum of illness attributed to cat-scratch disease (CSD) continues to expand. Although a common cause of cervical adenitis in children, CSD has not been associated as a cause of deep fascial space infections of the head and neck. We describe a child with extensive parapharyngeal adenitis and abscesses due to CSD confirmed by histological and serological evaluations.

Abscess↗
PubMed2000

Portal vein and bone involvement in disseminated cat-scratch disease: report of 2 cases.

Cat-scratch disease (CSD) is a common cause of regional lymphadenopathy. We describe 2 children with an unusual presentation of disseminated CSD, the first one presenting with persistent fever, multilocular abscesses in liver and spleen as well as osteolytic lesions in the lumbar spine and the second one with portal vein thrombosis and severe ascites.

Bone and Bones↗
PubMed2001

Circulating cytokines in patients with cat scratch disease.

Levels of circulating interleukin (IL)-2, IL-6, and IL-10, measured by enzyme-linked immunosorbent assay, were significantly higher in patients with cat scratch disease (CSD) than in healthy control subjects; no induction of IL-12 was observed, and levels of interferon-gamma and IL-4 were generally not detectable. This is the first report showing increased circulating cytokine levels in patients with CSD. The induction of these mediators can partly explain some clinical and pathological features of the disease.

Antibodies, Bacterial↗
PubMed2001

Probable atypical cat scratch disease presenting as isolated posterior pancreatic duodenal lymphadenitis and abdominal pain.

We report a case involving a 15-year-old girl with atypical, clinically unsuspected cat scratch disease (CSD) presenting as isolated posterior pancreatic duodenal lymphadenitis, fever, and abdominal pain. The serological, abdominal ultrasonographic, and CT findings, as well as clinical and epidemiological data, indicate that B. henselae was likely an etiologic agent of CSD in our patient.

Abdominal Pain↗
PubMed2001

Enzyme immunoassay for the diagnosis of cat-scratch disease defined by polymerase chain reaction.

Whole-cell immunofluorescent antibody (IFA) tests for detection of anti-Bartonella henselae immunoglobulin (Ig) G are commonly used to diagnose cat-scratch disease (CSD). The need to cultivate B. henselae in Vero cells for antigen preparation and the absence of routinely applied IFA assays for IgM constitute the major disadvantages of this form of test. We describe the results of an enzyme immunoassay (EIA) for IgM and IgG that used N-lauroyl-sarcosine-insoluble outer membrane antigens from agar-grown B. henselae performed in 84 patients with definite CSD (regional lymphadenitis, cat contact, and > or =1 confirmatory test: polymerase chain reaction, skin test, or B. henselae culture). Although this method has been used as a diagnostic tool in several case reports, it has not previously been evaluated in a large study of definitively proven CSD cases. Results of this study indicate that the EIA described herein can play an important role in the serodiagnosis of CSD, although improvement of the sensitivity, particularly that of the IgM, would be desirable.

Adolescent↗
PubMed2002

Role of cat-scratch disease in lymphadenopathy in the head and neck.

Bartonella henselae is the causative agent of cat-scratch disease (CSD), which usually manifests as acute regional lymphadenopathy. The causes of cervical lymphadenopathy, with special regard to CSD, were investigated in a study of 454 patients who presented with unclear masses in the head and neck from January 1997 through January 2001. Sixty-one patients (13.4%) experienced CSD; 54 (11.9%) had primary lymphadenopathy due to other infectious agents, and 41 (9.0%) had lymphadenopathy that occurred in association with primary infections of other organs. For 171 patients (37.7%), the cause of the cervical lymph node enlargement could not be found. B. henselae DNA was detected in extirpated lymph nodes only during the first 6 weeks of lymphadenopathy, which indicates that the results of polymerase chain reaction strongly depend on the duration of illness. CSD should be included in the differential diagnosis of adenopathy in the otorhinolaryngologic patient population, to avoid unnecessary treatment.

Anti-Bacterial Agents↗
PubMed2003

Long-term serological analysis and clinical follow-up of patients with cat scratch disease.

A highly specific enzyme immunoassay (EIA) was recently described for use in the diagnosis of cat scratch disease (CSD). However, data regarding EIA antibody kinetics or its correlation with long-term clinical follow-up data are lacking. The association between antibody kinetics, clinical spectrum, and disease duration were studied in 98 patients with CSD. The median duration of follow-up was 35.3 weeks (range, 2-211.3 weeks). Results of EIA testing for detection of anti-Bartonella henselae immunoglobulin M (IgM) antibodies (detected in 53% of the patients) remained positive for < or =3 months. Therefore, the presence of IgM indicated acute infection. Titers of immunoglobulin G (IgG) also decreased over time; 25% of the patients remained seropositive for >1 year after the onset of CSD. Onset of CSD in patients with an IgG titer with an optical density of > or =1.0 occurred within the prior 12 months. No association was found between antibody titers or their kinetics and the clinical manifestations or duration of disease. EIA allows for the identification of atypical manifestations of CSD that were unrecognized before the use of serological assays. Complete recovery from these manifestations may take months. Results of this study provide additional data supporting the utility of EIA in the serodiagnosis of CSD.

Adolescent↗
PubMed2005

Cat-scratch disease (ocular bartonellosis) presenting as bilateral recurrent iridocyclitis.

An otherwise healthy 9-year-old girl presented with bilateral recurrent anterior uveitis. Thirteen months later, the diagnosis of cat-scratch disease (ocular bartonellosis) was suspected when neuroretinitis appeared. Confirmation was based on serological test results positive for Bartonella henselae. Antibiotic treatment completely cured the disease, and there have been no further manifestations during a follow-up period of 6 years.

Anti-Bacterial Agents↗
PubMed2005

Cat-scratch disease in elderly patients.

BACKGROUND: Cat-scratch disease (CSD) is mostly contracted by children and young adults. To our knowledge, CSD in elderly patients has never been characterized, and it may be underrecognized in this age group. METHODS: The study population included all patients with CSD diagnosed at our reference laboratory during 1991-2002. Demographic, clinical, and laboratory data for patients with CSD aged >or=60 years (elderly group) were compared with data for patients with CSD aged <60 years (nonelderly group). RESULTS: There were 846 immunocompetent patients with CSD included in this study. Fifty-two patients (6%) were >or=60 years old. Lymphadenopathy was less common in elderly patients than in nonelderly patients (76.5% vs. 94.4%; P<.001), and general malaise was more frequent in elderly patients (70.8% vs. 51.4%; P=.009). Atypical CSD was more common in elderly patients than in nonelderly patients (32.7% vs. 13.6%), including endocarditis (odds ratio [OR], 61.6; P<.001), encephalitis (OR, 6.3; P=.013), and fever of unknown origin (OR, 7.3; P<.001). The time period from onset of symptoms to diagnosis was >6 weeks for 29.5% of elderly patients versus 13.3% of nonelderly patients (P=.003). CONCLUSIONS: CSD affects elderly persons as well as nonelderly persons, but clinical features differ between the patient groups. Atypical CSD, including endocarditis, is more frequent in elderly than in nonelderly patients. Conversely, lymphadenitis, the hallmark of typical CSD, is often absent in elderly patients. Lack of awareness among clinicians may delay the diagnosis of CSD in elderly persons and result in unnecessary and often invasive diagnostic procedures.

Adolescent↗
PubMed1998

Chest-wall abscess due to cat-scratch disease (CSD) in an adult with antibodies to Bartonella clarridgeiae: case report and review of the thoracopulmonary manifestations of CSD.

We describe a patient who presented with a massive chest-wall abscess after a severe debilitating illness that lasted 3 months. Steroid therapy, administered for 4 weeks, masked the slow development of an extensive axillary and chest-wall abscess. After multiple negative tests, the patient's prolonged illness was diagnosed as cat-scratch disease (CSD). An indirect fluorescent antibody test revealed that two convalescent serum samples were positive for IgG to Bartonella clarridgeiae, but no other Bartonella species. We also review 12 cases of severe chest and pulmonary disease due to CSD that were reported in the English-language literature. Thoracopulmonary findings associated with CSD, pathogenic mechanisms of bartonella infections, diagnostic criteria, and management of CSD are presented.

Abscess↗
PubMed1999

Vertebral osteomyelitis associated with cat-scratch disease.

We describe a patient with vertebral osteomyelitis and paravertebral soft-tissue collections associated with cat-scratch disease (CSD). Diagnosis was established on the basis of histologic examination and serological and polymerase chain reaction (PCR) tests. Treatment consisted of administration of antibiotics, and although skeletal lesions were persistently evident on radiography the patient showed complete clinical recovery. In addition, 15 cases of documented osteomyelitis associated with CSD are reviewed.

Cat-Scratch Disease↗
PubMed1994

Morphologically variable bacilli of cat scratch disease are identified by immunocytochemical labeling with antibodies to Rochalimaea henselae.

The identification of the causative organisms of cat scratch disease (CSD) has been elusive. The demonstration of Warthin-Starry stain-positive pleomorphic bacilli in lymph nodes of patients with CSD and recent serologic and epidemiologic data suggest an etiologic role of Rochalimaea henselae in CSD. The authors studied lymph node biopsy specimens of 46 patients with illnesses clinically consistent with CSD and found pleomorphic bacilli in 15 (33%). The organisms were labeled by polyclonal rabbit antibodies induced by outer surface proteins of R henselae. This finding further supports the possibility of an important role of R henselae in the pathogenesis of CSD.

Adolescent↗
PubMed1987

Ultrastructural observations in cat scratch disease.

Because the causative bacterium of cat scratch disease has not been definitively cultured or fully characterized, the authors have studied its ultrastructure in lymph node biopsies from two patients using glutaraldehyde-fixed tissue. In both specimens, the organisms were invariably extracellular, forming small groups within bundles of collagen fibrils. Their appearance was similar in necrotic and viable regions of the nodes, although in the latter sites they could not be identified by light microscopic examination with the Warthin-Starry stain. The bacteria were pleomorphic rods, and, despite faint gram-negative staining, their walls were consistently thick and homogeneous.

Adolescent↗
PubMed1989

Cat-scratch disease in a patient with AIDS.

A case of cat-scratch disease (CSD) in a patient with acquired immunodeficiency syndrome (AIDS) is reported. The lymph node pathologic characteristics were altered from those usually seen with CSD, showing clusters of vacuolated macrophages admixed with pycnotic nuclear debris instead of the usual suppurative granulomas. Evidence for the diagnosis was provided by Warthin-Starry stain and electron microscopic demonstration of the presumed CSD bacillus. Empiric treatment with antibiotics brought about clinical improvement. This case demonstrates the altered lymph node pathologic characteristics with CSD that may occur in a patient with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Systemic cat scratch disease: report of 23 patients with prolonged or recurrent severe bacterial infection.

Over a seven-year period, we identified 23 patients who had prolonged or recurrent, severe, systemic, cat-scratch disease (CSD). Compared with the usual, benign course in 1,038 patients with typical CSD, the course in these 23 patients included prolonged (two or more weeks) morbidity (fever, malaise, fatigue, myalgia, arthralgia, skin eruptions, weight loss, and splenomegaly). Five patients with systemic CSD had either neuroretinitis, pleurisy, arthralgia or arthritis, splenic abscesses, and mediastinal masses or enlarged nodes of the head of the pancreas. Recurrent CSD in two of three adults was confirmed by finding typical CSD bacilli in lymph nodes removed during separate episodes. The majority of patients were adult males, and all patients recovered completely without sequelae. Histopathologic studies of five skin and 18 lymph node biopsy specimens were diagnostic. CSD bacilli were detected in lymph nodes from 15 patients and in the primary skin lesions of four patients. CSD bacilli were found in both skin and lymph nodes of three patients.

Adolescent↗
PubMed1990

Cat-scratch disease presenting as abdominal visceral granulomas.

Three cases of atypical, clinically unsuspected cat-scratch disease (CSD), diagnosed by demonstration of the CSD bacillus in an abdominal visceral organ, are presented. In two cases CSD bacilli were demonstrated for the first time in splenic granulomas in a child and in an adult with acquired immunodeficiency syndrome (AIDS)-related complex. In both cases, there was granulomatous hepatitis as well as splenitis. In the third case, the CSD bacillus was present in hepatic granulomas in an adult with granulomatous hepatitis. In all cases, granulomatous inflammation with suppuration in the viscera was identical to that previously described for lymph nodes in CSD. All patients eventually recovered completely. Clinical awareness of the broad spectrum of CSD should avoid the cost and morbidity of prolonged hospitalization, medications, and invasive surgery for a disease that is self-limited and not clearly responsive to antibiotics and that can usually be diagnosed by noninvasive means.

Adult↗