Cat-scratch disease

Last updated
Cat scratch disease
Other namesCat-scratch fever, Teeny's disease, inoculation lymphoreticulosis, subacute regional lymphadenitis [1]
Cat-scratch-disease.jpg
An enlarged lymph node in the armpit region of a person with cat-scratch disease, and wounds from a cat scratch on the hand.
Specialty Infectious disease
Symptoms Bump at the site of the bite or scratch, swollen and painful lymph nodes [2]
Complications Encephalopathy, parotitis, endocarditis, hepatitis [3]
Usual onsetWithin 14 days after infection [2]
Causes Bartonella henselae from a cat bite or scratch [2]
Diagnostic method Based on symptoms, blood tests [3]
Differential diagnosis Adenitis, brucellosis, lymphogranuloma venereum, lymphoma, sarcoidosis [3]
Treatment Supportive treatment, azithromycin [2] [3]
Prognosis Generally good, recovery within 4 months [3]
Frequency1 in 10,000 people [3]

Cat-scratch disease (CSD) or felinosis is an infectious disease that most often results from a scratch or bite of a cat. [4] Symptoms typically include a non-painful bump or blister at the site of injury and painful and swollen lymph nodes. [2] People may feel tired, have a headache, or a fever. [2] Symptoms typically begin within 3–14 days following infection. [2]

Contents

Cat-scratch disease is caused by the bacterium Bartonella henselae which is believed to be spread by the cat's saliva. [2] Young cats pose a greater risk than older cats. [3] Occasionally dog scratches or bites may be involved. [3] Diagnosis is generally based on symptoms. [3] Confirmation is possible by blood tests. [3]

The primary treatment is supportive. [3] Antibiotics speed healing and are recommended in those with severe disease or immune problems. [2] [3] Recovery typically occurs within 4 months but can require a year. [3] About 1 in 10,000 people are affected. [3] It is more common in children. [4]

Signs and symptoms

A lesion on the hand of a person with cat-scratch disease. Cat-scratch disease lesion.jpg
A lesion on the hand of a person with cat-scratch disease.

Cat-scratch disease commonly presents as tender, swollen lymph nodes near the site of the inoculating bite or scratch or on the neck, and is usually limited to one side. This condition is referred to as regional lymphadenopathy and occurs 1–3 weeks after inoculation. [5] Lymphadenopathy most commonly occurs in the axilla, [6] arms, neck, or jaw, but may also occur near the groin or around the ear. [4] A vesicle or an erythematous papule may form at the site of initial infection. [4]

Most people also develop systemic symptoms such as malaise, decreased appetite, and aches. [4] Other associated complaints include headache, chills, muscular pains, joint pains, arthritis, backache, and abdominal pain. It may take 7 to 14 days, or as long as two months, for symptoms to appear. Most cases are benign and self-limiting, but lymphadenopathy may persist for several months after other symptoms disappear. [4] The disease usually resolves spontaneously, with or without treatment, in one month.

In rare situations, CSD can lead to the development of serious neurologic or cardiac sequelae such as meningoencephalitis, encephalopathy, seizures, or endocarditis. [4] Endocarditis associated with Bartonella infection has a particularly high mortality. [5] Parinaud's oculoglandular syndrome is the most common ocular manifestation of CSD, [4] and is a granulomatous conjunctivitis with concurrent swelling of the lymph node near the ear. [7] Optic neuritis or neuroretinitis is one of the atypical presentations. [8]

People who are immunocompromised are susceptible to other conditions associated with B. henselae and B. quintana, such as bacillary angiomatosis or bacillary peliosis. [4] Bacillary angiomatosis 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 caused by B. henselae that most often affects people 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. [9]

Cause

Bartonella henselae is a fastidious, [5] intracellular, Gram-negative bacterium.

Transmission

The cat was recognized as the natural reservoir of the disease in 1950 by Robert Debré. [5] Kittens are more likely to carry the bacteria in their blood, so may be more likely to transmit the disease than adult cats. [10] However, fleas serve as a vector for transmission of B. henselae among cats, [5] and viable B. henselae are excreted in the feces of Ctenocephalides felis , the cat flea. [11] Cats could be infected with B. henselae through intradermal inoculation using flea feces containing B. henselae. [12]

As a consequence, 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 by cat saliva transmitted in a bite. [5] Ticks can also act as vectors and occasionally transmit the bacteria to humans. [4] Combined clinical and PCR-based research has shown that other organisms can transmit Bartonella, including spiders. [13] [14] Cryptic Bartonella infection may be a much larger problem than previously thought, constituting an unrecognized occupational health hazard of veterinarians. [15]

Diagnosis

Micrograph of a lymph node affected by cat scratch disease. H&E stain. Cat scratch disease - very low mag.jpg
Micrograph of a lymph node affected by cat scratch disease. H&E stain.
High-magnification micrograph of CSD showing a granuloma (pale cells - right of center on image) and a microabscess with neutrophils (left of image), H&E stain Cat scratch disease - very high mag.jpg
High-magnification micrograph of CSD showing a granuloma (pale cells - right of center on image) and a microabscess with neutrophils (left of image), H&E stain

The best diagnostic method available is polymerase chain reaction, which has a sensitivity of 43-76% and a specificity (in one study) of 100%. [5] The Warthin–Starry stain can be helpful to show the presence of B. henselae, but is often difficult to interpret. B. henselae is difficult to culture and can take 2–6 weeks to incubate. [5]

Histology

Cat-scratch disease is characterized by granulomatous inflammation on histological examination of the lymph nodes. Under the microscope, the skin lesion demonstrates a circumscribed focus of necrosis, surrounded 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 granulomas) and sinuses packed with monocytoid B cells, usually without perifollicular and intrafollicular epithelioid cells. This pattern, although typical, is only present in a minority of cases. [16]

Prevention

Cat-scratch disease can be primarily prevented by taking effective flea control measures; since cats are mostly exposed to fleas when they are outside, keeping cats inside can help prevent infestation. Strictly-indoor cats without exposure to indoor-outdoor animals are generally at negligible risk of infestation. [17] Cats which are carrying the bacterium, B. henselae, are asymptomatic, [18] thus thoroughly washing hands after handling a cat or cat feces is an important factor in preventing potential cat-scratch disease transmission from possibly infected cats to humans. [17]

Treatment

Most healthy people clear the infection without treatment, but in 5 to 14% of individuals, the organisms disseminate and infect the liver, spleen, eye, or central nervous system. [19] Although some experts recommend not treating typical CSD in immunocompetent people with mild to moderate illness, treatment of all people with antimicrobial agents (Grade 2B) is suggested due to the probability of disseminated disease. The preferred antibiotic for treatment is azithromycin, since this agent is the only one studied in a randomized controlled study. [20]

Azithromycin is preferentially used in pregnancy to avoid the teratogenic side effects of doxycycline. [21] However, doxycycline is preferred to treat B. henselae infections with optic neuritis due to its ability to adequately penetrate the tissues of the eye and central nervous system. [5]

Epidemiology

Cat-scratch disease has a worldwide distribution, but it is a nonreportable disease in humans, so public health data on this disease are inadequate. [22] Geographical location, present season, and variables associated with cats (such as exposure and degree of flea infestation) all play a factor in the prevalence of CSD within a population. [23] In warmer climates, the CSD is more prevalent during the fall and winter, [23] which may be attributed to the breeding season for adult cats, which allows for the birth of kittens. [23] B henselae, the bacterium responsible for causing CSD, is more prevalent in younger cats (less than one year old) than it is in adult cats. [22]

To determine recent incidence of CSD in the United States, the Truven Health MarketScan Commercial Claims and Encounters database was analyzed in a case control study from 2005 to 2013. [24] The database consisted of healthcare insurance claims for employees, their spouses, and their dependents. All participants were under 65 years of age, from all 50 states. The length of the study period was 9 years and was based on 280,522,578 person-years; factors such as year, length of insurance coverage, region, age, and sex were used to calculate the person-years incidence rate to eliminate confounding variables among the entire study population. [24]

A total of 13,273 subjects were diagnosed with CSD, and both in- and outpatient cases were analyzed. The study revealed an incidence rate of 4.5/100,000 outpatient cases of cat-scratch disease. For inpatient cases, the incidence rate was much lower at 0.19/100,000 population. [24] Incidence of CSD was highest in 2005 among outpatient cases and then slowly declined. The Southern states had the most significant decrease of incidence over time. Mountain regions have the lowest incidence of this disease because fleas are not commonly found in these areas. [24]

Distribution of CSD among children aged 5–9 was of the highest incidence in the analyzed database, followed by women aged 60–64. Incidence among females was higher than that among males in all age groups. [24] According to data on social trends, women are more likely to own a cat over men; [25] which supports higher incidence rates of this disease in women. Risk of contracting CSD increases as the number of cats residing in the home increases. [22] The number of pet cats in the United States is estimated to be 57 million. [23] Due to the large population of cats residing in the United States, the ability of this disease to continue to infect humans is vast. Laboratory diagnosis of CSD has improved in recent years, which may support an increase in incidence of the disease in future populations. [23]

Outbreaks

Historically, the number of reported cases of CSD has been low, there has been a significant increase in reports in urban and suburban areas in the northeast region of United States. An example of the increased incidence can be found in Essex County, New Jersey. In 2016, there were 6 reported cases. In 2017, there were 51 reported cases. In 2018, there were 263 reported cases. Although usually treated with antibiotics and minimal long-term effects, there have been 3 reported case of tachycardia more than one year after exposure. [26]

History

Symptoms similar to CSD were first described by Henri Parinaud in 1889, and the clinical syndrome was first described in 1950 by Robert Debré. [27] [5] In 1983, the Warthin-Starry silver stain was used to discover a Gram-negative bacillus which was named Afipia felis in 1991 after it was successfully cultured and isolated. The causative organism of CSD was originally believed to be Afipia felis, but this was disproved by immunological studies in the 1990s demonstrating that people with cat-scratch fever developed antibodies to two other organisms, B. henselae (originally known as Rochalimea henselae before the genera Bartonella and Rochalimea were combined) and B. clarridgeiae, which is a rod-shaped Gram-negative bacterium. [5]

Related Research Articles

Trench fever is a moderately serious disease transmitted by body lice. It infected armies in Flanders, France, Poland, Galicia, Italy, Macedonia, Mesopotamia, Russia and Egypt in World War I. Three noted cases during WWI were the authors J. R. R. Tolkien, A. A. Milne, and C. S. Lewis. From 1915 to 1918 between one-fifth and one-third of all British troops reported ill had trench fever while about one-fifth of ill German and Austrian troops had the disease. The disease persists among the homeless. Outbreaks have been documented, for example, in Seattle and Baltimore in the United States among injection drug users and in Marseille, France, and Burundi.

<i>Bartonella henselae</i> Species of bacterium

Bartonella henselae, formerly Rochalimæa henselae, is a bacterium that is the causative agent of cat-scratch disease (bartonellosis).

<i>Bartonella</i> Genus of bacteria

Bartonella is a genus of Gram-negative bacteria. It is the only genus in the family Bartonellaceae. Facultative intracellular parasites, Bartonella species can infect healthy people, but are considered especially important as opportunistic pathogens. Bartonella species are transmitted by vectors such as fleas, sand flies, and mosquitoes. At least eight Bartonella species or subspecies are known to infect humans.

<span class="mw-page-title-main">Carrion's disease</span> Infectious disease caused by Bartonella bacilliformis

Carrion's disease is an infectious disease produced by Bartonella bacilliformis infection.

Bartonellosis is an infectious disease produced by bacteria of the genus Bartonella. Bartonella species cause diseases such as Carrión's disease, trench fever, cat-scratch disease, bacillary angiomatosis, peliosis hepatis, chronic bacteremia, endocarditis, chronic lymphadenopathy, and neurological disorders.

Cytauxzoon felis is a protozoal organism transmitted to domestic cats by tick bites, and whose natural reservoir host is the bobcat. C. felis has been found in other wild felid species such as the cougar, as well as a white tiger in captivity. C. felis infection is limited to the family Felidae which means that C. felis poses no zoonotic risk or agricultural risk. Until recently it was believed that after infection with C. felis, pet cats almost always died. As awareness of C. felis has increased it has been found that treatment is not always futile. More cats have been shown to survive the infection than was previously thought. New treatments offer as much as 60% survival rate.

<span class="mw-page-title-main">Bacillary angiomatosis</span> Medical condition

Bacillary angiomatosis (BA) is a form of angiomatosis associated with bacteria of the genus Bartonella.

<span class="mw-page-title-main">Peliosis hepatis</span> Medical condition

Peliosis hepatis is an uncommon vascular condition characterised by multiple, randomly distributed, blood-filled cavities throughout the liver. The size of the cavities usually ranges between a few millimetres and 3 cm in diameter. In the past, it was a mere histological curiosity occasionally found at autopsies, but has been increasingly recognised with wide-ranging conditions from AIDS to the use of anabolic steroids. It also occasionally affects spleen, lymph nodes, lungs, kidneys, adrenal glands, bone marrow, and other parts of gastrointestinal tract.

Bartonella rochalimae is a recently discovered strain of Gram-negative bacteria in the genus Bartonella, isolated by researchers at the University of California, San Francisco (UCSF), Massachusetts General Hospital, and the United States Centers for Disease Control and Prevention. The bacterium is a close relative of Bartonella quintana, the microbe which caused trench fever in thousands of soldiers during World War I. Named after Brazilian scientist Henrique da Rocha Lima, B. rochalimae is also closely related to Bartonella henselae, a bacterium identified in the mid-1990s during the AIDS epidemic in San Francisco as the cause of cat scratch fever, which still infects more than 24,000 people in the United States each year.

Bartonella quintana, originally known as Rochalimaea quintana, and "Rickettsia quintana", is a bacterium transmitted by the human body louse that causes trench fever. This bacterial species caused outbreaks of trench fever affecting 1 million soldiers in Europe during World War I.

Rickettsia typhi is a small, aerobic, obligate intracellular, rod shaped gram negative bacterium. It belongs to the typhus group of the Rickettsia genus, along with R. prowazekii. R. typhi has an uncertain history, as it may have long gone shadowed by epidemic typhus. This bacterium is recognized as a biocontainment level 2/3 organism. R. typhi is a flea-borne disease that is best known to be the causative agent for the disease murine typhus, which is an endemic typhus in humans that is distributed worldwide. As with all rickettsial organisms, R. typhi is a zoonotic agent that causes the disease murine typhus, displaying non-specific mild symptoms of fevers, headaches, pains and rashes. There are two cycles of R. typhi transmission from animal reservoirs containing R. typhi to humans: a classic rat-flea-rat cycle that is most well studied and common, and a secondary periodomestic cycle that could involve cats, dogs, opossums, sheep, and their fleas.

Parinaud's oculoglandular syndrome (POS) is a medical condition characterized by a specific set of symptoms affecting the eye and nearby lymph nodes. Named after the French ophthalmologist Henri Parinaud, it should not be confused with the neurological syndrome caused by a lesion in the midbrain which is also known as Parinaud's syndrome. Both were named after the same person, Henri Parinaud.

<span class="mw-page-title-main">BH11960</span>

Bartonella henselae hypothetical protein 11960 (BH11960) is encoded by the BH11960 gene. This hypothetical protein is conserved in all Bartonella species whose genomes have been sequenced to date, and are highlighted in the picture below.

Rickettsia felis is a species of bacterium, the pathogen that causes cat-flea typhus in humans, also known as flea-borne spotted fever. Rickettsia felis also is regarded as the causative organism of many cases of illnesses generally classed as fevers of unknown origin in humans in Africa.

Bartonella elizabethae, formerly known as Rochalimaea elizabethae, is a bacterium. As with other Bartonella species, it can cause disease in animals.

Afipia felis is the type species of the Afipia bacterial genus. It was formerly thought to cause cat-scratch disease. It is a Gram-negative, oxidase-positive, nonfermentative rod in the alpha-2 subgroup of the class Proteobacteria. It is motile by means of a single flagellum. It is noted for having the longest authority citation of any accepted species.

Bartonella clarridgeiae is a Gram-negative bacteria from the genus Bartonella which was first isolated in the United States. Bartonella clarridgeiae is a zoonotic pathogen which can cause cat scratch disease.

<span class="mw-page-title-main">Feline zoonosis</span> Medical condition

A feline zoonosis is a viral, bacterial, fungal, protozoan, nematode or arthropod infection that can be transmitted to humans from the domesticated cat, Felis catus. Some of these diseases are reemerging and newly emerging infections or infestations caused by zoonotic pathogens transmitted by cats. In some instances, the cat can display symptoms of infection and sometimes the cat remains asymptomatic. There can be serious illnesses and clinical manifestations in people who become infected. This is dependent on the immune status and age of the person. Those who live in close association with cats are more prone to these infections, but those that do not keep cats as pets can also acquire these infections as the transmission can be from cat feces and the parasites that leave their bodies.

<span class="mw-page-title-main">Cat bite</span> Medical condition

Cat bites are bites inflicted upon humans, other cats, and other animals by the domestic cat. Data from the United States show that cat bites represent between 5–15% of all animal bites inflicted to humans, but it has been argued that this figure could be the consequence of under-reporting as bites made by cats are considered by some to be unimportant. Though uncommon, cat bites can sometimes cause rabies lead to complications and, very rarely, death.

<span class="mw-page-title-main">Abdominal tuberculosis</span> Medical condition

Abdominal tuberculosis is a type of extrapulmonary tuberculosis which involves the abdominal organs such as intestines, peritoneum and abdominal lymph nodes. It can either occur in isolation or along with a primary focus in patients with disseminated tuberculosis.

References

  1. ↑ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN   978-1-4160-2999-1.[ page needed ]
  2. 1 2 3 4 5 6 7 8 9 "Cat scratch disease". GARD. Retrieved 2018-04-17.
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  5. 1 2 3 4 5 6 7 8 9 10 11 Florin TA, Zaoutis TE, Zaoutis LB (2008). "Beyond cat scratch disease: widening spectrum of Bartonella henselae infection". Pediatrics. 121 (5): e1413–25. doi:10.1542/peds.2007-1897. PMID   18443019. S2CID   14094482.
  6. ↑ Jürgen Ridder R, Christof Boedeker C, Technau-Ihling K, Grunow R, Sander A. Clinical Infectious Diseases, Volume 35, Issue 6, 15 September 2002, Pages 643–649, https://doi.org/10.1086/342058
  7. ↑ Catscratch Disease~clinical at eMedicine
  8. ↑ Gajula V, Kamepalli R, Kalavakunta JK (2014). "A star in the eye: cat scratch neuroretinitis". Clinical Case Reports. 2 (1): 17. doi:10.1002/ccr3.43. PMC   4184768 . PMID   25356231.
  9. ↑ Perkocha LA, Geaghan SM, Yen TS, Nishimura SL, Chan SP, Garcia-Kennedy R, Honda G, Stoloff AC, Klein HZ, Goldman RL (1990). "Clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection". The New England Journal of Medicine. 323 (23): 1581–6. doi: 10.1056/NEJM199012063232302 . PMID   2233946.
  10. ↑ "Cat Scratch Disease | Healthy Pets, Healthy People | CDC". www.cdc.gov. 2021-09-17. Retrieved 2022-03-21.
  11. ↑ Higgins JA, Radulovic S, Jaworski DC, Azad AF (1996). "Acquisition of the cat scratch disease agent Bartonella henselae by cat fleas (Siphonaptera:Pulicidae)". Journal of Medical Entomology. 33 (3): 490–5. doi: 10.1093/jmedent/33.3.490 . PMID   8667399.
  12. ↑ Foil L, Andress E, Freeland RL, Roy AF, Rutledge R, Triche PC, O'Reilly KL (1998). "Experimental infection of domestic cats with Bartonella henselae by inoculation of Ctenocephalides felis (Siphonaptera: Pulicidae) feces". Journal of Medical Entomology. 35 (5): 625–8. doi:10.1093/jmedent/35.5.625. PMID   9775583.
  13. ↑ Copeland, Claudia S. (2015). "Cat Scratch Fever? Really?: Cats, Fleas and the Many Faces of Bartonellosis". Healthcare Journal of Baton Rouge: 28–34. Archived from the original on 2015-11-22.
  14. ↑ Mascarelli PE, Maggi RG, Hopkins S, Mozayeni BR, Trull CL, Bradley JM, Hegarty BC, Breitschwerdt EB (2013). "Bartonella henselae infection in a family experiencing neurological and neurocognitive abnormalities after woodlouse hunter spider bites". Parasites & Vectors. 6: 98. doi: 10.1186/1756-3305-6-98 . PMC   3639822 . PMID   23587343.
  15. ↑ Lantos PM, Maggi RG, Ferguson B, Varkey J, Park LP, Breitschwerdt EB, Woods CW (2014). "Detection of Bartonella species in the blood of veterinarians and veterinary technicians: a newly recognized occupational hazard?". Vector Borne and Zoonotic Diseases. 14 (8): 563–70. doi:10.1089/vbz.2013.1512. PMC   4117269 . PMID   25072986.
  16. ↑ Rosado FG, Stratton CW, Mosse CA (2011). "Clinicopathologic correlation of epidemiologic and histopathologic features of pediatric bacterial lymphadenitis". Archives of Pathology & Laboratory Medicine. 135 (11): 1490–3. doi: 10.5858/arpa.2010-0581-OA . PMID   22032579.
  17. 1 2 Nelson, Christina A.; Saha, Shubhayu; Mead, Paul S. (2016). "Cat-Scratch Disease in the United States, 2005–2013". Emerging Infectious Diseases. 22 (10): 1741–1746. doi:10.3201/eid2210.160115. PMC   5038427 . PMID   27648778.
  18. ↑ "Cat Scratch Disease". medlineplus.gov. Retrieved 2021-03-29.
  19. ↑ Carithers, H. A. (1985-11-01). "Cat-scratch disease. An overview based on a study of 1,200 patients". American Journal of Diseases of Children. 139 (11): 1124–1133. doi:10.1001/archpedi.1985.02140130062031. ISSN   0002-922X. PMID   4061408.
  20. ↑ Rolain, J. M.; Brouqui, P.; Koehler, J. E.; Maguina, C.; Dolan, M. J.; Raoult, D. (2004-06-01). "Recommendations for Treatment of Human Infections Caused by Bartonella Species". Antimicrobial Agents and Chemotherapy. 48 (6): 1921–1933. doi:10.1128/AAC.48.6.1921-1933.2004. ISSN   0066-4804. PMC   415619 . PMID   15155180.
  21. ↑ Catscratch Disease~treatment at eMedicine
  22. 1 2 3 Chomel, Bruno B.; Boulouis, Henri J.; Breitschwerdt, Edward B. (April 15, 2004). "Cat scratch disease and other zoonotic Bartonella infections" (PDF). Journal of the American Veterinary Medical Association. 224 (8): 1270–1279. doi:10.2460/javma.2004.224.1270. PMID   15112775. Archived from the original (PDF) on December 1, 2017. Retrieved November 30, 2017.
  23. 1 2 3 4 5 Windsor, Jeffrey J. (2001). "Cat-scratch Disease: Epidemiology, Etiology, and Treatment". British Journal of Biomedical Science. 58 (2): 101–110. PMID   11440202. S2CID   13122848.
  24. 1 2 3 4 5 Nelson, Christina A.; Saha, Shubhayu; Mead, Paul S. (2016). "Cat-Scratch Disease in the United States, 2005–2013". Emerging Infectious Diseases. 22 (10): 1741–1746. doi:10.3201/eid2210.160115. PMC   5038427 . PMID   27648778.
  25. ↑ "Profile of Pet Owners". Pew Research Center. November 4, 2010. Retrieved November 29, 2017.
  26. ↑ "Cat-Scratch Disease" . Retrieved 6 October 2019.
  27. ↑ Asano S (2012). "Granulomatous lymphadenitis". Journal of Clinical and Experimental Hematopathology. 52 (1): 1–16. doi: 10.3960/jslrt.52.1 . PMID   22706525.
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