Tuesday, April 10, 2012

Cat scratch disease

Cat scratch fever; CSD (engl. Cat Scratch Disease)

Cat scratch disease is a bacterial infection carried by cats. Most frequently revealed in children and young people who have contact with kittens. Cat scratch disease can occur in patients who did not know they were in contact with animals.

What is it?
Infectious disease associated with cat scratches, bites or exposure to cat saliva, causing chronic swelling of the lymph nodes (lymphadenopathy).

Description of disease
Cat scratch disease is caused by gram-negative bacillus (bacteria forms short rods), which is now called bacilli of cat scratch disease and Bartonella henselae. The disease is spread through contact with an infected cat, as a result of cat bite or scratch, or by contact with cat saliva with broken skin or eye socket. Swelling of the lymph nodes begins about 2 to 3 weeks after infection and can last for months. Swelling may occur at the site of initial infection and then appear enlarged lymph nodes along the flow of lymphatic drainage from the site of injury. Sometimes nodes can create a fistula through the skin and its contents leak out of the body. Cat scratch disease is perhaps the most common cause of chronic lymph node swelling in children. To date, the disease is often not recognized because of the difficulty in testing. However, recently the indirect fluorescent antibody test for B. henselae proved highly sensitive and specific for detection of infection caused by the B. henselae and the diagnosis of cat scratch disease.

Who gets?
Children and young people who have contact with cats and kittens.

scratches or other injuries in contact with a cat (or dog in rare cases).

papules or pustules at the site of injury (inoculation)
swollen lymph nodes (adenopathy) appear close to where the skin was infected (bitten, scratched, etc..), usually in the neck, armpits and groin, and usually appear within 2 weeks after contact with a cat
fever in about one third of patients
joint pain (arthralgia)

Less frequently
loss of appetite (anorexia)
weight loss
splenomegaly (enlarged spleen)
sore throat
lymph nodes from which the fluid flows

What tests can a doctor do?
Scratches or injuries in contact with a cat (or dog in rare cases) indicates that cat scratch disease likely cause of swollen lymph nodes. In some cases, physical examination also revealed an enlarged spleen (splenomegaly). The tests used in diagnosis of cat scratch disease:
serologic test for B. henselae - an indirect fluorescent antibody test (IFA) (used fluid or tissue from a lymph node)
lymph node biopsy to rule out other causes of swollen glands (sometimes)

Generally, cat scratch disease has a relatively mild course. The patient should be instructed that the disease is not dangerous and that treatment is usually not necessary. Cat scratch disease is usually spontaneous regression within 2-4 months. However, in severe cases or patients with other serious diseases, it is useful to treat with antibiotics. Effective antibiotics include:
sulfamethoxazole and trimethoprim
Azithromycin has shown good results in clinical practice.
In patients with AIDS and others with weakened immune systems, cat scratch disease is mild, and the recommended antibiotic treatment.

Parinaud's syndrome
encephalopathy (brain lesions)
neuroretinitis (inflammation of the retina and optic nerve)
osteomyelitis (inflammation of bone tissue)

The disease is prevented by avoiding contact with cats. When it is not possible, thoroughly wash your hands after playing with a cat, avoiding scratches and bites a cat, and avoid contact with cat saliva reduces the risk of infection.

The prognosis (complications, expectations)
Children with normal immune systems heal spontaneously with complete recovery. In people with weakened immune systems antibiotic treatment usually leads to recovery.

When to go to the doctor?
Contact your doctor if you have enlarged lymph nodes, and if you were in contact with the cat.

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