The cat scratch disease – an acute zoonotic infection caused by the gram-negative bacterium Bartonella henselae, which penetrates into the human body by bites or scratches of cats. A typical form of cat scratch disease occurs with primary affect in the form of papular-pustular rash, regional lymphadenitis, fever, hepatosplenomegaly.
Perhaps the emergence of atypical forms of the disease – pain, angina, abdominal, pulmonary, cerebral, and so Clinical diagnosis is confirmed by microbiological sowing detachable pustules, histological examination of the lymph nodes, ELISA and PCR diagnostics. Causal treatment of cat scratch disease is an antibacterial treatment.
Disease cat scratch
The cat scratch disease (benign lymphoreticulosis, felinos, the granuloma Mollard) is an infectious human disease that develops as a result of penetration of the pathogen through damaged skin (scratches and bites of cats). Felines is widely and widespread zoonosis; annually 25 thousand cases of cat scratch disease. 80% of cases are persons under the age of 21; dominate children get sick more often boys than girls.
Felines usually found in the form of sporadic cases, however, it is also possible and outbreaks in families, when alternately a few sick children and adults. The greatest danger with cat scratch disease represent atypical forms of the disease requiring the involvement of not only infectious diseases, but also specialists from neurology, ophthalmology, pulmonology etc.
Causes of cat scratch disease
The cat scratch disease in the majority of cases (more than 96%) is caused by gram-negative Bacillus of the Bartonella Hensel (Bartonella henselae). In some cases, noted the etiological role Alipia felis, Bartonella clarridgeiae, Bartonella quintana. Cats are just asymptomatic carriers of pathogens and rarely have signs of the disease were obliterated. The carriage of Bartonella often diagnosed in kittens and young cats up to 2 years. Between cats pathogens spread by fleas. Less common reservoirs of infection are rodents, dogs, birds.
The mechanism of human infection by cat scratch disease is associated with the penetration of the pathogen through damaged skin or mucous membranes (usually bites and scratches), together with the saliva of infected cats. The cat scratch disease has a seasonal dependence and is more likely to occur in autumn and winter. After infection usually develops a strong immunity.
In place of the introduction of Bartonella develops an inflammatory reaction in the form of primary affect, where by lymphogenous the pathogens into regional lymph nodes where multiply rapidly, releasing toxins and causing lymphadenitis. Morphological changes in lymphoid tissue hyperplasia reticulocytosis presented with transformation into a granuloma, and then microabscesses. In case of atypical course of the disease cat scratch possible hematogenous dissemination of the infection with involvement of liver, spleen, heart, lungs, CNS, eyes, bone etc.
Symptoms of cat scratch disease
The cat scratch disease can occur in typical and atypical forms. In the development of the disease distinguish the incubation period, initial period, the period of height of disease and convalescence.
A typical form of cat scratch disease is characterized by a triad of clinical signs: primary affect, regional lymphadenitis, fever. The incubation period for felinese lasts on average 10-14 days (from 3 days to 2 months). The starting point of the initial period is the appearance in the place of the entrance gate of the infection is reddish papules with a diameter of 2-5 mm By this time the cat bites and scratches in most of the cases are healed, so painless nodule patients do not pay attention. The primary affect is usually localized on the hands, lower limbs, face, neck.
After 2-3 days, during the height of the disease cat scratch transformirovalsya papules to pustules, which revealed a small ulcer. After drying element and falling off of the crusts on the skin leaving no defects. At the same time closest to the lesion, the lymph nodes become inflamed, thicken and increase in size – developing regional lymphadenitis (usually cervical and axillary region; at least – submandibular, supraclavicular, inguinal). Lymphadenitis is the most constant symptom of the typical form of the disease cat scratch and lasts for 2 weeks – 2 months. Enlargement of lymph nodes accompanied by fever and intoxication syndrome: sweating, weakness, muscle and headaches, malaise. Also during the height of felinese may be enlargement of the liver and spleen (hepatosplenomegaly). In most cases, the cat scratch disease ends in recovery in 2-4 months. Perhaps recurrent, fluctuating course.
To the atypical forms of felinese include ocular, cerebral, abdominal, lung, etc. Eye disease cat scratch (3-7%) develops in contact with Bartonella the mucous membranes of the eyes and proceeds as ulcerative-granulomatous conjunctivitis. While there is swelling of the century, hyperemia of the conjunctiva with formation of ulcers and granulomas of the parotid and submandibular lymphadenitis. In some cases, eye damage takes the form of neuroretinitis, clinically manifested by impaired visual acuity of one eye.
Involvement of the Central and peripheral nervous system in case of atypical course of the disease cat scratch may be the development of encephalitis, meningitis, cerebellar ataxia, encephalopathy, myelitis, polyneuritis. When abdominal form there is hepatosplenomegaly, mezadenita, abscesses of the spleen. In more rare cases, felines proceeds with the development of endocarditis, myocarditis, pleurisy, pneumonia, tonsillitis, retropharyngeal abscess, erythema nodosum, osteomyelitis, etc. in HIV-infected patients with a high risk of generalized forms of cat scratch disease – bacillary angiomatosis of the. It is characterized by fever, intoxication, angiomatosis of the skin, hepatosplenomegaly, endocarditis, lymphadenitis.
Diagnosis of cat scratch disease
Preliminary diagnosis is based on data from epidemiological history indicates the development of the clinical symptoms of felinese after contact with a cat and violation of the integrity of the skin or mucous membranes. To confirm the clinical diagnosis used methods of laboratory diagnosis, aimed at identifying Bartonella henselae in tissue samples. This purpose can be carried out the microbiological seeding of the content of lymph nodes and abscesses, biopsy and histological examination of lymph nodes modified, PCR, ELISA and IFA. Highly sensitive and specific method for the diagnosis of cat scratch disease is a skin test for felines.
Typical form of cat scratch disease during the height must be differentiated from infectious mononucleosis, Hodgkin’s disease, lymphoma, tularemia, brucellosis, histoplasmosis, coccidioidomycosis, toxoplasmosis, cytomegalovirus infection, sarcoidosis and other diseases. When atypical forms of cat scratch disease, patients may need consultation of a dermatologist, neurologist, ophthalmologist, pulmonologist, cardiologist, and other narrow specialists.
Treatment and prevention of cat scratch disease
A typical form of cat scratch disease can be docked on their own without treatment however diagnosed cases of felinese assigned to medical therapy. The standard scheme of treatment of cat scratch disease consists of the use of antimicrobial drugs (azithromycin, erythromycin, doxycycline, clindamycin), NSAIDs, antihistamines. Shows the impact of physiotherapy (diathermy, UHF) on the area of altered lymph nodes. In the case of suppuration of lymph nodes is a needle aspiration of pus, or opening an abscess; less common is the removal of the affected lymph node.
Specific prophylaxis of felinese not been developed. With the aim of preventing disease cat scratch care must be taken to remove the claws and removal of fleas in cats, care, and hygiene after contact with Pets. Scratches and wounds from cat bites must be treated with antiseptics.