Cat Scratch Disease: What We Need to Know



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Cat Scratch Disease: What We Need to Know

Cat Scratch Disease, a study published on the StatPearls, does an interesting research on the risks that cat scratches can cause. We can read: "Cat scratch disease is an illness caused by an intracellular gram-negative rod known as Bartonella henselae.

It affects the lymph nodes draining the area where a cat scratch or bite occurs, causing regional lymphadenopathy. This activity illustrates the evaluation and treatment of cat scratch disease and explains the role of the interprofessional team in managing patients with this condition.

Cat scratch disease (Cat scratch fever) causes a febrile illness with subacute regional lymphadenopathy. The agent of infection is Bartonella henselae. In most cases, there is a spontaneous resolution within 2 to 4 weeks. More severe and disseminated disease can occur in both immunocompetent and immunocompromised hosts.

Cat scratch disease was initially described in the 1930s, and the association of the illness with cats was identified in the 1950s. Cat scratch should be considered in the differential diagnosis of any acute, subacute, or chronic lymphadenopathy.

Histological examination of the lymph nodes is characterized by granulomas, classically with microabscesses in the center of the lesion. Similar histologic changes may occur in the inoculation site as well as regional lymph nodes.

Eighty-five percent to 90% of children have self-limited lymphadenopathy accompanied by high fever. Patients with disseminated illness may have a spectrum of complications, especially in the very young, elderly, and immunocompromised hosts such as transplant or patients with HIV.

Involved systems may include the cutaneous, lymphatic, and visceral organs. More uncommonly, there may be ocular and neurologic involvement. Cutaneous manifestations begin as an erythematous papule, vesicle, or nodule, which is known as the primary inoculation lesion.

This lesion usually persists from one to three weeks but can last for months. The primary inoculation site may be a mucous membrane such as the conjunctiva that heals without scarring and is not detected. Examination of intertriginous areas, other skin creases as well as the scalp may help demonstrate the primary lesion.

There may be a presumptive diagnosis of cat scratch disease, given the correct historical and examination findings. B. henselae is difficult to culture. Exposure to cats is usually necessary for diagnosis. Serologic testing may confirm the diagnosis with EIA or IFA; however, negative serologic tests do not rule out the diagnosis.

Lymph node biopsy is not indicated routinely but should be considered if the diagnosis is unclear. Historically, excision of affected lymph nodes has been avoided for fear of the development of fistulas. Ultrasound may aid needle aspiration to obtain tissue.

In 90 to 95% of children, cat scratch disease will resolve spontaneously with symptomatic control, including analgesics, antipyretics, and warm compresses. In patients with disseminated disease, recovery may take months to a year with morbidities depending on the system involved. The immunocompromised host may have a debilitating course. "