(Cat scratch fever)
Cat-scratch disease is a caused by Bartonella henselae infection. The symptoms consist of local and regional lymphadenitis. The diagnosis is made clinically and confirmed by biopsy or serologic tests. The therapy consists of local application of heat, analgesics and sometimes antibiotics.
(See also overview of infections caused by Bartonella.)
Cat-scratch disease is a caused by Bartonella henselae infection. The symptoms consist of local and regional lymphadenitis. The diagnosis is made clinically and confirmed by biopsy or serologic tests. The therapy consists of local application of heat, analgesics and sometimes antibiotics. (See also overview of infections caused by Bartonella.) House cats, especially kittens, are an important reservoir for B. henselae. The prevalence of antibodies to B. henselae in the US is 14-50%. Approximately 99% of patients experience contacts with most healthy cats. The specific location of the body in the cat is unclear; However, periods of asymptomatic bacteremia in cycles occur. The infection occurs through to people through a bite or scratch injury. The cat flea transmits infection among cats and can be the cause of disease in people who have not come into contact with cats, although this theory has not been proven. Most commonly affects children. Symptoms and complaints within 3-10 days after a bite or scratch injury (rare once a pustule), most patients develop at the affected site an erythematous papule. Within 2 weeks, a regional lymphadenopathy developed. The nodes are hardened at the beginning and swollen, later fluctuate and can melt down under fistula. The lymphadenopathy may be accompanied by fever, malaise, headache and anorexia. Unusual phenomena occur at 5 to 14% of patients: Parinaud’sches Oculoglanduläres syndrome (conjunctivitis with palpable pre-auricular node) in 6% Neurologic manifestations (encephalopathy, seizure, Neuroretinitis, myelitis, paraplegia, cerebral arteritis) in 2% Hepatosplenic granulomatous disease in <1% patients can also imagine a fever of unknown origin. B. henselae is a leading cause of culture-negative endocarditis usually in patients with previous heart valve disease. In AIDS patients, it can lead to severe disseminated disease. The lymphadenopathy forms spontaneously within 2-5 months. Usually there will be a complete remission, except in severe neurological or hepatosplenischen disease fatal run or can leave permanent sequelae. Diagnosis Serological tests or PCR tests during the acute phase and convalescence Occasionally lymph node biopsy The diagnosis of cat scratch disease is usually caused by a positive serum antibody titers (it is recommended to test both acute and convalescent sera every 6 weeks), PCR or culture of Lymphknotenaspirat approved. Since a similar lymphadenopathy by other infections (eg. As tularemia, mycobacterial infection, brucellosis, fungal infection, lymphogranuloma venereum) may be caused, a test can be performed on those organisms if the diagnosis is not unique cat scratch disease. A lymph node biopsy can be performed if cancer is suspected or if the diagnosis of cat scratch disease must be confirmed. The diagnosis is suggested (z. B. purulent granulomas) by characteristic histopathological findings or the detection of organisms by immunofluorescence. In immunocompromised patients and patients with systemic symptoms and blood cultures should be. Aspirates of lymph nodes are rare culture positive. However Bartonella sp can be isolated from cultures of lymph node biopsy samples. Local therapy heat and analgesics Sometimes antibiotics for patients with weakened immune systems Treatment of cat scratch disease in immunocompetent patients consists of local application of heat and analgesics for this is usually self-limiting disease. With fluctuating lymph node needle aspiration often results in relieving pain. Antibiotic therapy is of no clear benefit and should not be generally performed with only local infection in an immunocompetent patient. However, azithromycin, erythromycin or doxycycline is often administered to reduce adenopathy and possibly reduce the risk of systemic spread. A fluoroquinolone, rifampin, gentamicin or doxycycline can be used against bacteremia in AIDS patients. Long-term therapy (eg. As weeks to months) is usually necessary to cure a bacteremia. In vitro Antibiotic vulnerabilities often do not correlate with the clinical results.