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PubMedDate not supplied

[Cat-scratch disease caused by Bartonella quintana in an infant: an unusual presentation].

This case study reports a typical clinical course of cat-scratch disease (CSD) in an infant without epidemiological data and presenting bilateral submandibular lymphadenopathy. The authors describe clinical course, ultrasound images, diagnosis and prognosis. Polymerase chain reaction (PCR) detected and identified B. quintana in lymph node samples. B. henselae currently thought to be the causative agent of CSD was not detected. The PCR assays for B. quintana and B. henselae should be available for the investigation of lymphadenopathy, even if the infant has not had either cat or dog contact.

Bartonella quintana↗
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↗
PubMed1990

Epithelioid angiomatosis or cat scratch disease with splenic and hepatic abnormalities in AIDS: case report and review of the literature.

Cat scratch disease (CSD) in the setting of HIV infection is associated with lesions of epithelioid angiomatosis but not with granulomatous lesions seen in the normal host. We report a case of CSD in a patient with AIDS and Kaposi's sarcoma with epithelioid angioma of skin, thrombocytopenia, and abnormalities of liver, spleen, lymph node, and pleura that responded to antimicrobial therapy. We also review reported cases of epithelioid angiomatosis in HIV infections. 12 of these resolved, including 3 without antimicrobial therapy; 18 demonstrated pleomorphic organisms with Warthin-Starry silver stain. Six involved visceral or bony as well as skin lesions. CSD should be considered in the setting of HIV infection with skin nodules even in the presence of biopsy-proven Kaposi's sarcoma. CSD may in these patients be responsible for a variety of disseminated lesions which respond to antimicrobial therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Evaluation of serological response to Bartonella henselae, Bartonella quintana and Afipia felis antigens in 64 patients with suspected cat-scratch disease.

The serological response to Bartonella henselae, B. quintana, and Afipia felis was assessed by an indirect fluorescence antibody test (IFAT) in 64 patients with suspected cat-scratch disease (CSD) recruited from the Bordeaux area in France. Blood samples were collected from 57 patients with chronic lymphadenopathy who underwent lymph-node biopsy with suggestive histopathologic features of CSD, and from an additional 7 patients with suspected CSD who underwent surgical incision and drainage because of lymph-node tenderness. Of the patients, 31 were male and 33 female, with a median age of 27 years (range 2-89). 69.8% reported cat and/or dog contact. Of the 26/64 (40.6%) patients, serum samples were positive at a titer of 1:100 or more for immunoglobulin G (IgG) antibodies (17 only to B. henselae, 1 only to B. quintana, 3 only to Afipia felis, and 5 to both B. henselae and B. quintana). IgM or IgA antibodies were also detected in 10 patients with IgG antibodies to B. henselae. 11 (17.2%) of the 64 patient serum samples were positive at a low titer of 1:50. These data suggested that serological response assessed by standard IFAT is not enough to confirm a CSD diagnosis.

Adolescent↗
PubMedDate not supplied

Cat scratch disease and acquired immunodeficiency disease: diagnosis by transmission electron microscopy.

A 33-year-old, homosexual, cat-owning, African-American man with human immunodeficiency virus infection by positive serologic tests and acquired immunodeficiency syndrome by CD4 lymphocyte count alone (39 cells/mL) presented with a one-year history of intermittent fever, weight loss, and generalized lymphadenopathy. A malignant lymphoma was suspected clinically. Light microscopic study of a left inguinal lymph node biopsy specimen revealed effacement of the lymph node architecture by a diffuse infiltrate of large, atypical reticulum cells, loose, patchy granulomatous inflammation, diffuse hyaline fibrosis, diffusely proliferated blood vessels, and multifocal degeneration and necrosis. Lymph follicles were absent and lymphocytes were moderately depleted. Microorganisms were not seen in lymph node sections stained with special histochemical stains (including the Warthin-Starry stain). These light microscopic changes were considered suggestive of a malignant lymphoma, especially Hodgkin's disease. The diagnosis of cat scratch disease (CSD) became apparent only after transmission electron microscopic study of the lymph node revealed clusters of small, pleomorphic bacteria in degenerated collagenous tissue and in blood vessel walls. This case illustrates the value of transmission electron microscopy in making the diagnosis of CSD, especially when light microscopic changes are superimposed on those of late human immunodeficiency virus infection of the lymph node.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

An analysis of lymph node DNA for possible bacterial agents of cat-scratch disease.

Recent investigations have implicated Afipia felis and Rochalimaea henselae as possible agents of cat-scratch disease (CSD). We studied lymph nodes with necrotizing granulomas characteristic of CSD for A. felis and R. henselae DNA so that the relationship of these organisms to lymph nodes with necrotizing granulomas of unknown etiology might be better defined. We examined formalin-fixed, paraffin-embedded lymph node biopsies with necrotizing granulomas suggestive of CSD from 28 children obtained over the last 10 years. None had identifiable bacteria, fungi, or acid-fast organisms on routine staining. Pleomorphic bacillary structures consistent with the CSD bacillus were seen with the Steiner stain in 17 cases. We performed the polymerase chain reaction (PCR) on the extracted lymph node DNA with DNA primers for these organisms after demonstrating the presence of amplifiable DNA with c-K-Ras primers. R. henselae was identified in two samples. A. felis DNA was found in just one specimen. These putative CSD bacteria are infrequently associated with necrotizing granulomas using standard PCR techniques. It is possible that some of the patients did not have clinical CSD. The preservation of DNA or numbers of bacteria in the extracted sections may be inadequate for demonstration by DNA amplification methods. These bacilli may be responsible for a small proportion of these characteristic lesions of unknown etiology, or the typical CSD histology, including the presence of pleomorphic bacillary structures, may be nonspecific.

Bartonella↗
PubMedDate not supplied

Unraveling mysteries associated with cat-scratch disease, bacillary angiomatosis, and related syndromes.

The search for the infectious agents responsible for cat-scratch disease, bacillary angiomatosis, and related syndromes has a long and often circuitous history. Recognition of the etiologic agents and a new understanding of the fundamental features of the epidemiology and natural history of modern day Bartonella (formerly Rochalimaea)-associated diseases culminate a multipartite story that combines clinical medicine, traditional microbiology, and novel technological approaches to solve a long-standing enigma.

AIDS-Related Opportunistic Infections↗
PubMed2006

Lymph node biopsy specimens and diagnosis of cat-scratch disease.

We report microbiologic analysis of 786 lymph node biopsy specimens from patients with suspected cat-scratch disease (CSD). The specimens were examined by standard, cell culture, and molecular methods. Infectious agents were found in samples from 391 (49.7%) of 786 patients. The most commonly identified infectious agent was Bartonella henselae (245 patients, 31.2%), the agent of CSD. Mycobacteriosis was diagnosed in 54 patients (6.9%) by culture and retrospectively confirmed by using a specific real-time PCR assay. Neoplasm was diagnosed in 181 specimens suitable for histologic analysis (26.0%) from 47 patients. Moreover, 13 patients with confirmed Bartonella infections had concurrent mycobacteriosis (10 cases) or neoplasm (3 cases). A diagnosis of CSD does not eliminate a diagnosis of mycobacteriosis or neoplasm. Histologic analysis of lymph node biopsy specimens should be routinely performed because some patients might have a concurrent malignant disease or mycobacteriosis.

Adolescent↗
PubMed1999

Cat scratch disease diagnosed by polymerase chain reaction in a patient with suspected tuberculous lymphadenitis.

We present a patient diagnosed as having tuberculous lymphadenitis after lymph node biopsy and referred for tuberculous therapy. On review, because of recent cat exposure, she was tested for cat scratch disease (CSD), but serological tests for Bartonella henselae were negative. However, the diagnosis of CSD was confirmed, and tuberculosis excluded, by polymerase chain reaction techniques. This case serves as a reminder that CSD may mimic tuberculosis histologically and that sensitive molecular diagnostic tests are available.

Adult↗
PubMed2003

Rapid polymerase chain reaction-based confirmation of cat scratch disease and Bartonella henselae infection.

CONTEXT: Cat scratch disease (CSD) commonly occurs secondary to Bartonella henselae infection, and the diagnosis has traditionally been made by microscopic findings, the identification of organisms by cytochemistry, and clinical history. However, cytochemical analysis tends to be very difficult to interpret, and histology alone may be insufficient to establish a definitive diagnosis of CSD. OBJECTIVE: To demonstrate the presence of B henselae in tissue suspected of involvement by CSD, using a novel polymerase chain reaction (PCR) assay. DESIGN: Isolates of B henselae (American Tissue Culture Collection 49793) and Afipia felis (American Tissue Culture Collection 49714) were cultured on blood agar and buffered charcoal yeast extract agar, respectively. DNA was isolated from these organisms and from formalin-fixed, paraffin-embedded tissue sections with involvement by CSD (8 patients). Negative controls included water, human placental tissue, and lymph node specimens from 6 patients with reactive lymphoid hyperplasia and from 2 patients with granulomatous lymphadenitis. A primer complementary to B henselae citrate synthase gltA gene sequence was designed to perform a seminested PCR amplification. For restriction fragment length polymorphism analysis, PCR products were digested by TaqI restriction enzyme and analyzed by gel electrophoresis. RESULTS: Seminested PCR analysis of the cultured isolates of B henselae, but not of A felis, showed specific amplification. However, nonnested PCR did not provide consistently positive results in tissue sections with CSD. Therefore, we used a seminested PCR, which revealed positivity in all of the cases with clinicopathologic diagnoses of CSD. None of the negative controls showed positivity. Restriction enzyme provided confirmation of the specific PCR amplification of the B henselae sequence. CONCLUSIONS: Since the amplification product has a low molecular size (<200 base pairs), this assay is useful for detection of B henselae in formalin-fixed, paraffin-embedded tissues. The seminested PCR protocol described here can be used for rapid and reliable confirmation of B henselae in samples that are histologically suggestive of CSD.

Adolescent↗
PubMedDate not supplied

[Hepatic and splenic micro-abscess in cat scratch disease. Report of a case].

Cat-scratch disease (CSD) is an infection caused by a gram-negative bacillus known as Bartonella Henselae. Hepatosplenic disease occurs in only 0.3-0.7% of patients. In this report we describe a 7-year-old male presented with a 4-week history of fever, after diagnosis of CSD with regional lymphoadenitis. Ultrasonography and tomography identified hepatic and splenic abscesses. Antibiotic treatment for three months was associated with resolution of lesions. In Patients affected by CSD, ultrasonography and tomography permit to identify hepatic and/or splenic lesions, indicating systemic CSD.

Abscess↗
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↗
PubMedDate not supplied

[Bartonella henselae as the causative agent in cat-scratch disease: case report].

In this article we reported typical clinical, primary skin lesion and regional lymphadenitis, and atypical, protracted fever and algic syndrome, characteristics of cat scratch disease (CSD) in a 21-year-old man (a student) from Zadar, Croatia. Laboratory parameters were in normal range. The histopathologic findings of affected lymph nodes included stellate caseating granulomas. By using IFA method a seroconversion of specific IgG antibodies (neg/1:512) and rise of IgM antibodies (1:160/ > 1:320) to B. henselae were detected in paired sera, and these serologic findings indicate on conclusion that B. henselae is probably etiologic agent of CSD in our patient.

Adult↗
PubMed2001

Zoonotic sporotrichosis. Transmission to humans by infected domestic cat scratching: report of four cases in São Paulo, Brazil.

BACKGROUND: Sporotrichosis is a chronic, granulomatous, deep mycosis caused by the dimorphic fungus Sporothrix schenckii that usually results in indolent cutaneous lesions. OBJECTIVE: To describe four cases of human sporotrichosis transmitted by domestic cats in south-eastern Brazil. METHODS: Confirmation of the diagnosis was performed by histopathology, culture, and/or inoculation of hamsters. RESULTS: In all cases, the clinical findings in both cat and human groups were highly distinctive of the disease. In all human cases, there was a previous history of cat scratching before the development of lymphocutaneous lesions. Histopathology of the human lesions demonstrated the classical granulomatous and exudative pattern with scarce or absent fungal elements. Conversely, in cats, the cutaneous lesions were multiple, extensive, necrotic, exudative, and ulcerated. Histopathology revealed a widespread histiocytic reaction with a large number of fungal organisms. Disseminated lymphatic and visceral mycotic infection was observed in two necropsied cats. CONCLUSIONS: Domestic cats may be an important carrier of agents of sporotrichosis to humans.

Adult↗
PubMed2002

Cat-scratch disease in children--Texas, September 2000-August 2001.

Cat-scratch disease (CSD), a bacterial infection caused by Bartonella henselae, has emerged as a relatively common and occasionally serious zoonotic disease among children and adults. To illustrate the spectrum of clinical manifestations of CSD observed during a 1-year period, Texas Children's Hospital (TCH) in Houston reviewed the medical records of 32 children evaluated at TCH during September 2000-August 2001 whose antibody titers indicated recent Bartonella infection. This report summarizes the evaluations of these cases and highlights four manifestations of infection with this pathogen in children. The findings emphasize that although CSD is generally a mild, self-limited illness, the differential diagnosis often includes more serious conditions (e.g., lymphoma, carcinoma, mycobacterial or fungal infection, or neuroblastoma) that might result in protracted hospital stays and lengthy treatments before diagnosis. Timely assessment of CSD is important, particularly when invasive diagnostic measures are being considered.

Bartonella henselae↗
PubMed2001

[Treatment of bite wounds and cat-scratch disease].

Although rabies is the most serious consequence of animal bite injuries, in urban rabies-free countries the risk of rabies is far lower than the risk of bacterial infections of the wound. The most frequent etiologic cause of the wound infections after dog bites is Pasteurella multocida, as well as in the case of bites by cats, after which cat-scratch disease may also develop, its main cause being Bartonella henselae. All bite injuries must be carefully cleaned and disinfected; it is necessary to estimate the need of antirabies and antitetanus protection, and to introduce antibiotic treatment for prevention, particularly in the case of deep sting wounds caused mostly by cats.

Animals↗
PubMed2002

Cat scratch disease. Survey on the presence of Bartonella henselae among cats of Tuscany.

To verify the presence of Bartonella henselae-infection in cats living in Tuscany (central Italy) serological and bacteriological surveys were carried out. The blood serum samples of 427 cats, 254 living in private houses and gardens and 173 in public or private catteries, were tested for anti-B. henselae antibodies by indirect immunofluorescence assay (IFA). Among these samples, 35 were examined by IFA to detect antibodies against Bartonella quintana. Bacteriological examinations were performed on the blood samples, collected in EDTA (ethylene diaminetetraacetic acid), of 18 cats (10 seropositive to B. henselae and 8 negative). From each of the same 18 specimens DNA was extracted and used as template in polymerase chain reaction (PCR). The primers p24E and p12B were employed in the PCR assay to amplify a 296 bp fragment of the Bartonella 16S rRNA gene. IFA detected 98 (22.95%) B. henselae-positive serum samples (40-40.82% from cats living in houses and gardens and 58-59.18% from cats of catteries) at different antibody titers (70 at 1:64 titer, 4 at 1:128, 22 at 1:256, 2 at 1:512). Among the 35 sera tested to detect antibodies against B. quintana, 9 (25.71%) resulted positive at 1:64 titer; all these samples showed higher antibody titers to B. henselae. Out of the 26 negative sera, 20 were negative to B. henselae too and 6 had antibodies against B. henselae at 1:64. Hemocultures gave negative results. PCR scored positive with DNA of 4 B. henselae-seropositive cats, two of which belonged to two children with cat scratch disease (CSD).

Animals↗