Cat scratch disease
Encyclopedia
Cat scratch disease (also known as "Cat scratch fever", "Teeny's Disease", "Inoculation lymphoreticulosis", and "Subacute regional lymphadenitis") is a usually benign infectious disease
caused by the intracellular bacterium Bartonella
. It is most commonly found in children following a scratch or bite from a cat
by about one to two weeks. It was first discovered in 1889 by Henri Parinaud
.
of the disease in 1950 by Dr. Robert Debré. Judy Dolan was the first person to be diagnosed with the disease in the United States of America.
The causative organism was first thought to be Afipia felis, but this was disproved by immunological studies demonstrating that cat scratch fever patients developed antibodies to two other organisms, Bartonella henselae
(B. henselae) and Bartonella clarridgeiae, which are rod-shaped Gram-negative
bacteria.
Kitten
s are more likely to carry the bacteria
in their blood
, and may therefore be more likely to transmit the disease rather than an adult cat
s. However, the results of experimental studies showed that fleas serve as a vector for transmission of B. henselae among cats, and that viable B. henselae are excreted in the feces of Ctenocephalides felis, the cat flea. Another study showed that cats could be infected with B. henselae through intradermal inoculation using flea feces containing B. henselae. As a consequence, it is believed that a likely means of transmission of B. henselae from cats to humans may be inoculation with flea feces containing B. henselae through a contaminated cat scratch wound or across a mucosal surface. Although Bartonella DNA has been reported in ticks, there is no evidence that CSD can be transmitted by tick bites.
Classic cat scratch disease presents as tender and swollen regional lymph nodes, a condition referred to as regional lymphadenopathy
. There may be a papule
at the site of initial infection. While some patients have fever and other systemic symptoms, many do not. Other associated complaints include headache
, chills
, backache
and abdominal pain. It may take 7 to 14 days, or as long as two months, before symptoms appear. Most cases are benign
and self-limiting, but lymphadenopathy
may persist for several months after other symptoms disappear. In general, the prognosis is favorable. In temperate climates, most cases occur in fall and winter. The disease usually resolves spontaneously, with or without treatment, in one month. In immunocompromised patients more severe complications sometimes occur.
Atypical cat scratch disease takes several different forms depending on organ systems involved. Atypical forms of disease are becoming increasingly recognized in clinical practice.
Parinaud's oculoglandular syndrome
is a granulomatous conjunctivitis
with concurrent swelling of the lymph node near the ear.
Optic neuritis, involvement of the retina, and neuropathy can also occur.
Bacillary angiomatosis
is caused by Bartonella henselae, the causative organism of cat scratch disease. It is primarily a vascular skin lesion that may extend to bone or be present in other areas of the body. In the typical scenario, the patient has HIV or another cause of severe immune dysfunction.
Bacillary peliosis
is a condition that most-often affects patients with HIV and other conditions causing severe immune compromise. The liver and spleen are primarily affected, with findings of blood-filled cystic spaces on pathology
Acute encephalopathy
(generalized dysfunction of the brain) can occur. The New York Times Magazine
described a case, presenting as a meningitis
, with fever, headache, and impaired vision (due to swelling of the optic nerves). Despite the severity of initial presentation, patient outcome can be favorable.
Enlarged spleen and sore throat can also occur in rare cases
enlargement of regional – usually the cervical and axiallary – lymph nodes. Under the microscope, the skin lesion demonstrates a circumscribed focus of necrosis, surround by histiocytes, often accompanied by multinucleated giant cells, lymphocytes, and eosinophils. The regional lymph nodes demonstrate follicular hyperplasia with central stellate necrosis with neutrophils, surrounded by palisading histiocytes (suppurative granuloma
s) and sinuses packed with monocytoid B cells, usually without perifollicular and intrafollicular epithelioid cells
is used to confirm the presence of B. henselæ.
Azithromycin
, ciprofloxacin
, doxycycline
, and multiple other antibiotics have been used successfully.
Azithromycin
is especially used in pregnancy, to avoid the side-effects of doxycycline.
Infectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...
caused by the intracellular bacterium Bartonella
Bartonella
Bartonella is a genus of Gram-negative bacteria. Facultative intracellular parasites, Bartonella species can infect healthy people but are considered especially important as opportunistic pathogens. Bartonella are transmitted by insect vectors such as ticks, fleas, sand flies and mosquitoes...
. It is most commonly found in children following a scratch or bite from a cat
Cat
The cat , also known as the domestic cat or housecat to distinguish it from other felids and felines, is a small, usually furry, domesticated, carnivorous mammal that is valued by humans for its companionship and for its ability to hunt vermin and household pests...
by about one to two weeks. It was first discovered in 1889 by Henri Parinaud
Henri Parinaud
Henri Parinaud was a French ophthalmologist and neurologist, most noted for his work in the field of neuro-ophthalmology.- Early life :...
.
Transmission
The cat was recognized as the natural reservoirNatural reservoir
Natural reservoir or nidus, refers to the long-term host of the pathogen of an infectious disease. It is often the case that hosts do not get the disease carried by the pathogen or it is carried as a subclinical infection and so asymptomatic and non-lethal...
of the disease in 1950 by Dr. Robert Debré. Judy Dolan was the first person to be diagnosed with the disease in the United States of America.
The causative organism was first thought to be Afipia felis, but this was disproved by immunological studies demonstrating that cat scratch fever patients developed antibodies to two other organisms, Bartonella henselae
Bartonella henselae
Bartonella henselae, formerly Rochalimæa, is a proteobacterium that can cause bacteremia, endocarditis, bacillary angiomatosis, and peliosis hepatis. It is also the causative agent of cat-scratch disease which, as the name suggests, occurs after a cat bite or scratch...
(B. henselae) and Bartonella clarridgeiae, which are rod-shaped Gram-negative
Gram-negative
Gram-negative bacteria are bacteria that do not retain crystal violet dye in the Gram staining protocol. In a Gram stain test, a counterstain is added after the crystal violet, coloring all Gram-negative bacteria with a red or pink color...
bacteria.
Kitten
Kitten
A kitten is a juvenile domesticated cat.The young of big cats are called cubs rather than kittens. Either term may be used for the young of smaller wild felids such as ocelots, caracals, and lynx, but "kitten" is usually more common for these species....
s are more likely to carry the bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
in their blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
, and may therefore be more likely to transmit the disease rather than an adult cat
Cat
The cat , also known as the domestic cat or housecat to distinguish it from other felids and felines, is a small, usually furry, domesticated, carnivorous mammal that is valued by humans for its companionship and for its ability to hunt vermin and household pests...
s. However, the results of experimental studies showed that fleas serve as a vector for transmission of B. henselae among cats, and that viable B. henselae are excreted in the feces of Ctenocephalides felis, the cat flea. Another study showed that cats could be infected with B. henselae through intradermal inoculation using flea feces containing B. henselae. As a consequence, it is believed that a likely means of transmission of B. henselae from cats to humans may be inoculation with flea feces containing B. henselae through a contaminated cat scratch wound or across a mucosal surface. Although Bartonella DNA has been reported in ticks, there is no evidence that CSD can be transmitted by tick bites.
Other names
The condition has also been termed Cat-Scratch Adenitis, Cat-Scratch-Oculoglandular Syndrome, Debre's Syndrome, Debre-Mollaret Syndrome, Foshay-Mollaret Cat Scratch Fever, Foshay-Mollaret syndrome, Foshay-Mollaret Cat-Scratch Fever Syndrome, Lymphadenitis-Regional Non-bacterial, Lymphoreticulosis-Benign Inoculation, maladie des griffes du chat, Parinaud oculoglandular disease, and Petzetakis' disease.Signs and symptoms
Manifestations of cat scratch disease can be divided into classic and atypical.Classic cat scratch disease presents as tender and swollen regional lymph nodes, a condition referred to as regional lymphadenopathy
Lymphadenopathy
Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". It could be due to infection, auto-immune disease, or malignancy....
. There may be a papule
Papule
A papule is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to 1 cm.With regard to the quote "...varying in size from a pinhead to 1cm," depending on which text is referenced, some authors state the cutoff between a papule and a plaque as 0.5cm,...
at the site of initial infection. While some patients have fever and other systemic symptoms, many do not. Other associated complaints include headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
, chills
Rigor (medicine)
Rigor is a shaking occurring during a high fever. It occurs because cytokines and prostaglandins are released as part of an immune response and increase the set point for body temperature in the hypothalamus....
, backache
Back pain
Back pain is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine.The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain...
and abdominal pain. It may take 7 to 14 days, or as long as two months, before symptoms appear. Most cases are benign
Benign
A benign tumor is a tumor that lacks the ability to metastasize. Common examples of benign tumors include moles and uterine fibroids.The term "benign" implies a mild and nonprogressive disease. Indeed, many kinds of benign tumors are harmless to human health...
and self-limiting, but lymphadenopathy
Lymphadenopathy
Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". It could be due to infection, auto-immune disease, or malignancy....
may persist for several months after other symptoms disappear. In general, the prognosis is favorable. In temperate climates, most cases occur in fall and winter. The disease usually resolves spontaneously, with or without treatment, in one month. In immunocompromised patients more severe complications sometimes occur.
Atypical cat scratch disease takes several different forms depending on organ systems involved. Atypical forms of disease are becoming increasingly recognized in clinical practice.
Parinaud's oculoglandular syndrome
Parinaud's oculoglandular syndrome
Parinaud's oculoglandular syndrome is the combination of granulomatous conjunctivitis in one eye, and swollen lymph nodes in front of the ear on the same side. Most cases are caused by cat-scratch disease, although it is an unusual feature of this condition...
is a granulomatous conjunctivitis
Conjunctivitis
Conjunctivitis refers to inflammation of the conjunctiva...
with concurrent swelling of the lymph node near the ear.
Optic neuritis, involvement of the retina, and neuropathy can also occur.
Bacillary angiomatosis
Bacillary angiomatosis
Bacillary angiomatosis is a form of angiomatosis associated with bacteria of the Bartonella genus.-Causes:It is caused by either Bartonella henselae or Bartonella quintana....
is caused by Bartonella henselae, the causative organism of cat scratch disease. It is primarily a vascular skin lesion that may extend to bone or be present in other areas of the body. In the typical scenario, the patient has HIV or another cause of severe immune dysfunction.
Bacillary peliosis
Bacillary peliosis
Bacillary peliosis is a form of peliosis hepatis that has been associated with bacteria in the genus Bartonella....
is a condition that most-often affects patients with HIV and other conditions causing severe immune compromise. The liver and spleen are primarily affected, with findings of blood-filled cystic spaces on pathology
Acute encephalopathy
Encephalopathy
Encephalopathy means disorder or disease of the brain. In modern usage, encephalopathy does not refer to a single disease, but rather to a syndrome of global brain dysfunction; this syndrome can be caused by many different illnesses.-Terminology:...
(generalized dysfunction of the brain) can occur. The New York Times Magazine
The New York Times Magazine
The New York Times Magazine is a Sunday magazine supplement included with the Sunday edition of The New York Times. It is host to feature articles longer than those typically in the newspaper and has attracted many notable contributors...
described a case, presenting as a meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...
, with fever, headache, and impaired vision (due to swelling of the optic nerves). Despite the severity of initial presentation, patient outcome can be favorable.
Enlarged spleen and sore throat can also occur in rare cases
Pathology
The primary cutaneous lesion consists of a red papule at site of inoculation, 1–2 weeks after contact, which may become pustular or crusted, which is accompanied byenlargement of regional – usually the cervical and axiallary – lymph nodes. Under the microscope, the skin lesion demonstrates a circumscribed focus of necrosis, surround by histiocytes, often accompanied by multinucleated giant cells, lymphocytes, and eosinophils. The regional lymph nodes demonstrate follicular hyperplasia with central stellate necrosis with neutrophils, surrounded by palisading histiocytes (suppurative granuloma
Granuloma
Granuloma is a medical term for a tiny collection of immune cells known as macrophages. Granulomas form when the immune system attempts to wall off substances that it perceives as foreign but is unable to eliminate. Such substances include infectious organisms such as bacteria and fungi as well as...
s) and sinuses packed with monocytoid B cells, usually without perifollicular and intrafollicular epithelioid cells
Treatment
The Warthin–Starry stainWarthin–Starry stain
The Warthin–Starry stain is a silver nitrate-based staining method used in histology. It was first introduced in 1920 by American pathologists Aldred S. Warthin and Allen C. Starry, for the detection of spirochetes...
is used to confirm the presence of B. henselæ.
Azithromycin
Azithromycin
Azithromycin is an azalide, a subclass of macrolide antibiotics. Azithromycin is one of the world's best-selling antibiotics...
, ciprofloxacin
Ciprofloxacin
Ciprofloxacin is a synthetic chemotherapeutic antibiotic of the fluoroquinolone drug class.It is a second-generation fluoroquinolone antibacterial. It kills bacteria by interfering with the enzymes that cause DNA to rewind after being copied, which stops synthesis of DNA and of...
, doxycycline
Doxycycline
Doxycycline INN is a member of the tetracycline antibiotics group, and is commonly used to treat a variety of infections. Doxycycline is a semisynthetic tetracycline invented and clinically developed in the early 1960s by Pfizer Inc. and marketed under the brand name Vibramycin. Vibramycin...
, and multiple other antibiotics have been used successfully.
Azithromycin
Azithromycin
Azithromycin is an azalide, a subclass of macrolide antibiotics. Azithromycin is one of the world's best-selling antibiotics...
is especially used in pregnancy, to avoid the side-effects of doxycycline.
External links
- CDC information
- Cat Scratch Disease on National Organization for Rare Disorders site
- Cat Scratch Fever Disease
- Cat Scratch Fever