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[Cutaneous vasculitis disclosing cat-scratch disease].

BACKGROUND: We describe a case of cat-scratch disease ingnaugurated by vascular purpura and discuss the role of the causal agent, Bartonella henselae. CASE REPORT: A 49-year-old woman presented vascular purpura without fever. Skin biopsy demonstrated leukocytoclasic vasculitis. She owned a cat and a had a scratch scar on the back of her left hand. A few days later, two inflammatory epitrochlear lymph nodes suppurated. Catscratch disease was confirmed by serology and PRC analysis of pus aspirated from the nodes. The purpura resolved spontaneously in three weeks. Left axillary adenopathy developed and suppurated. In spite of four antibiotics, the nodes subsided only ten months later, leaving scars. DISCUSSION: Two arguments favor Bartonella henselae as the causal agent in this cutaneous vasculitis. The simultaneous onset of the two diseases and the absence of another cause of vasculitis. This patient did not have Bartonella henselae endocarditis which could have explained this vasculitis. Only one case of hypersensitivity vasculitis has been described during cat-scratch disease. The exceptional feature of this association is perhaps the result of the unawareness of moderate or asymptomatic cat-scratch disease. Bartonella henselae was possibility caused hypersensitivity vasculitis.

Bartonella henselae↗

Cat scratch disease in Connecticut. Epidemiology, risk factors, and evaluation of a new diagnostic test.

BACKGROUND: Although cat scratch disease is commonly diagnosed in patients who have unexplained regional lymphadenopathy after encounters with cats, its epidemiology and the risk factors for disease are not clearly defined, and there is no generally accepted diagnostic test. METHODS: We conducted a physician survey to identify cases of cat scratch disease occurring over a 13-month period in cat owners in Connecticut. We interviewed both the patients (or their parents) and controls matched for age who owned cats. Serum from the patients was tested for antibodies to Rochalimaea henselae with a new, indirect fluorescent-antibody test. RESULTS: We identified 60 patients with cat scratch disease and 56 age-matched subjects. Patients were more likely than controls to have at least one pet kitten 12 months old or younger (odds ratio, 15), to have been scratched or bitten by a kitten (odds ratio, 27), and to have had at least one kitten with fleas (odds ratio, 29). A conditional logistic-regression analysis found that in kitten-owning households, patients were more likely than controls to have been scratched or bitten by a cat or kitten (odds ratio, 12.4; 95 percent confidence interval, 1.0 to 150). Of 45 patients, 38 had serum samples with titers of 1:64 or higher for antibody to R. henselae, as compared with 4 of 112 samples from controls (P < 0.001). The positive predictive value of the serologic test was 91 percent. Of 48 serum samples from patients' cats, 39 were positive for antibodies to R. henselae, as compared with positive samples from 11 of 29 control cats (P < 0.001). CONCLUSIONS: Cat scratch disease is strongly associated with owning a kitten, and fleas may be involved in its transmission. The serologic test for rochalimaea may be useful diagnostically, and our results suggest an etiologic role for this genus.

Adolescent↗

Cat-scratch disease and related clinical syndromes.

Bartonella (Rochalimaea) henselae is a common cause of cat-scratch disease. This newly identified bacterium is also the cause of several other clinical syndromes, including bacillary angiomatosis, bacillary peliosis hepatitis and splenitis, and acute and relapsing bacteremia. A high percentage of young cats carry B. henselae. Fortunately, serious complications of B. henselae infections are rare in immunocompetent patients. Cat-scratch disease is usually a self-limited illness that does not necessarily require antibiotic therapy. Severe or persistent cases respond well to several antibiotics, including erythromycin and doxycycline. Cat-scratch disease should be included in the differential diagnosis of serious neurologic disease, particularly when regional lymphadenopathy develops suddenly in a previously healthy patient who owns a cat. Treatment of uncomplicated central nervous system disease is generally supportive. Antibiotic therapy is reserved for patients with atypical or severe involvement, including encephalopathy and retinitis. Other internal and cutaneous manifestations of B. henselae infection have recently been described. These potentially life-threatening infections respond well to antibiotic therapy, even in immunocompromised patients.

Angiomatosis, Bacillary↗

Cat-scratch disease of the submandibular region. A case report.

A case report of cat-scratch disease manifest as submandibular lymphadenopathy has been presented. The etiology, histopathology, symptoms, diagnosis, treatment, and complications of cat-scratch disease have been discussed. Cat-scratch disease should be considered in the differential diagnosis of all equivocal cases of unilateral lymphadenopathy of the head and neck.

Adult↗

Optic neuritis in cat scratch disease.

A patient with optic neuritis is described whose associated lymphadenopathy, cat exposure, and positive cat scratch antigen skin test suggested the diagnosis of cat scratch disease. Optic neuritis and other neurologic abnormalities, especially encephalopathy, may be associated with, or the presenting manifestation of, cat scratch disease. To our knowledge, this is the fourth case of cat scratch disease-related optic neuritis to be reported.

Adolescent↗

Cell-mediated immunity in cat-scratch disease.

The importance of cell-mediated immunity in cat-scratch disease (CSD) is suggested by the positive skin test reactions and granulomatous histopathology noted in patients with this disease. However, an earlier investigation found that lymphocytes from patients with CSD and control subjects were equally unresponsive in vitro to cat-scratch antigen. In contrast, we found that 16 patients with CSD had significantly increased lymphocyte transformation responses to cat-scratch antigen when patients were compared to control subjects. This cell-mediated immune response may be directed against nonviable bacteria in the involved lymph nodes and may be the major mechanism responsible for the granulomatous reaction and clinical features of CSD.

Adolescent↗

Acquisition of the cat scratch disease agent Bartonella henselae by cat fleas (Siphonaptera:Pulicidae).

We assayed the ability of cat fleas to become infected with Bartonella henselae, using an artificial feeding device. Fleas fed a concentration of 1 x 10(5) cfu/ml in blood were examined using immunofluorescent antibody assay and polymerase chain reaction. Bacteria were present in the gut at 3 h, and persisted up to 9 d after infection. Qualitatively, the density of B. henselae was greater in the flea gut at 9 d, indicating that replication was occurring in the gut. B. henselae also was detected in the feces of infected fleas 9 d after infection, and produced viable colonies upon inoculation onto heart infusion agar/rabbit blood plates. Our results indicate that fleas can maintain infection with B. henselae, and may play a role in the transmission of this bacterium from infected cats to humans.

Animals↗

[Hepatosplenic cat-scratch disease in the immunocompetent adult].

Atypical manifestations of cat-scratch disease have been described in children and immunosuppressed adults. We report the first case of hepatosplenic cat-scratch disease in an immunocompetent subject, demonstration of diversity of this infection. A 33-year-old man presented with prolonged fever, lymphadenopathy and multiple hypodense lesions of liver and spleen in ultrasonographic imaging. The hepatic biopsy showed non-specific inflammatory reactions including granulomata and stellate necrosis. Anti-Bartonella antibodies have been found. The therapy with clarithromycin and doxycycline for many weeks was effective for hepatic lesions. A month ago a history of a cat contact with the presence of a skin lesion has been reported.

Adult↗

Cat-scratch disease caused by Bartonella henselae: the first case report in Taiwan.

We report a typical case of cat-scratch disease caused by Bartonella henselae, in Taiwan. A 20-year-old man developed right axillary lymphadenopathy 2 weeks after being scratched on his right hand by a kitten. The axillary lymphadenopathy resolved gradually and spontaneously after 10 weeks without specific treatment. Serologic tests were not done during the acute stage of the event. However, an immunofluorescent antibody test performed during the convalescent stage was positive for B. henselae antibodies, and the concentration dropped by fourfold 2 months later. Histopathologic examination of a biopsy specimen from the right axillary lymph node revealed findings characteristic of cat-scratch disease including multiple foci of microabscesses surrounded by histiocytes and infiltration by plasma cells and lymphocytes. This is the first reported case of cat-scratch disease in Taiwan, with a history of contact with a cat, a positive serologic test for B. henselae infection and characteristic histopathologic findings of cat-scratch disease which met the criteria for diagnosis.

Adult↗

Cat-scratch disease. An overview based on a study of 1,200 patients.

This study by one individual of 1,200 patients with cat-scratch disease provides a heretofore unavailable realistic evaluation of a common infectious disease. All patients had lymphadenopathy, a prerequisite for diagnosis. Suppuration occurred in 11.8% of patients. Cat contact was established for 99.1%, and the cat was immature in the vast majority. An inoculation site, the most neglected feature in the study of the patients, was detected in 92.6%. The results of a skin test, considered as specific as the standard tuberculin test and to be safe but not standardized, was positive in 99%. The 12 patients with negative skin tests probably were tested too early in the course of the disease to have developed reactivity. Skin tests of 578 family members of patients, who served as controls, gave positive results in 18.5%. Of 60 patients with unusual manifestations, 48 had the oculoglandular syndrome of Parinaud. Other manifestations included erythema nodosum, encephalopathy, osteolytic lesions, thrombocytopenic purpura, and erythema marginatum. Most patients in this series had received antibiotics of many types during the course of the disease. None appeared beneficial. The disease is benign in character in a majority of patients. Surgical removal of involved lymph nodes or biopsy of lymph nodes or inoculation sites is not necessary for diagnosis or management. A survey of hospitals in the United States discharging more than 750 pediatric patients annually indicates that cat-scratch disease is a problem in all sections of the country.

Adolescent↗

Cat scratch disease. A cause of regional lymphadenitis.

BACKGROUND: In the last decade, the microbiological cause of cat scratch disease (CSD) has been determined using a combination of traditional culture and modern molecular techniques. A bacterium known as Bartonelia henselae is responsible for the vast majority of cases. The natural history of the disease is being reinterpreted in the light of more sophisticated diagnostic tools. OBJECTIVE: To enable practitioners to have a sound basis for the diagnosis and treatment of cat scratch disease. DISCUSSION: Bartonelia henselae is ubiquitous in the domestic feline and causes zoonotic infection in humans. Although this infection is usually self limiting and benign, it may cause more extensive disease in the immunosuppressed. Antibiotic therapy may hasten recovery.

Adult↗

An unusual submandibular mass--cat scratch disease: report of case.

A case of cat scratch disease, initially considered a malignant disease or an aggressive inflammatory lesion, is reported. The lesion was excised and the characteristic disease pattern was established for this patient. The paper discusses the natural history of the disease and presents an extensive listing of swellings in the lateral part of the neck.

Adolescent↗

Ocular manifestation of cat-scratch disease in HIV-positive patients.

PURPOSE: To characterize ocular manifestations of cat-scratch disease in HIV-positive patients. DESIGN: Retrospective case series study. METHODS: Records and photography of patients with the diagnosis of cat-scratch disease and HIV were reviewed. RESULTS: From 2001 and 2004 three patients with cat-scratch disease and HIV were identified. All patients presented with subretinal mass associated with an abnormal vascular network. Fluorescein angiography revealed this abnormal vascular network more clearly. All patients were treated with antibiotics alone with good response. CONCLUSIONS: Subretinal mass associated with abnormal vascular network is characteristic of cat-scratch disease in HIV-positive patients. Fluorescein angiography is important to characterize this vascular pattern, and patients may benefit from systemic treatment.

Adult↗