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Catscratch Disease
Updated: Mar 6, 2008
Introduction
Background
Catscratch disease (CSD) is an infrequent self-limiting infectious disease classically characterized by painful regional lymphadenopathy following the scratch of a cat (typically a kitten). The first description is credited to Henri Parinaud, who referenced the condition in French medical literature in 1889. Dr. Robert Debré was the first to recognize the cat as a vector for this disorder and coined the term catscratch disease in 1931. After first being identified in 1985, Rochalimaea henselae, later reclassified as Bartonella henselae, was determined conclusively to be the primary organism causative of CSD.
For a related CME activity, see Companion Animals and Human Health: Part II -- Zoonotic Diseases.
Pathophysiology
Bartonella henselae, a curved, pleomorphic, gram-negative bacillus, has been determined to be nearly exclusively responsible for CSD. Speculation exists that other pathogens, including Afipia felis and Bartonella clarridgeiae, produce a fraction of cases.
Studies have demonstrated seropositivity rates ranging from 3.1-61.6% in the general population depending on the country in which the study was performed. In all instances, few patients ever experienced symptoms, suggesting only a minority of exposures to B henselae result in CSD.
Frequency
United States
A limited survey performed in 1993 by the Centers for Disease Control and Prevention reported approximately 22,000 cases of CSD diagnosed annually, although many additional cases are likely unrecognized.1 More than 2,000 hospital admissions are reported annually with a discharge diagnosis of CSD.1 The estimated incidence among ambulatory patients is approximately 9.3 cases per 100,000 persons per year.1 In 2000, approximately 437 pediatric hospitalizations associated with CSD were reported.2
Approximately 70-90% of CSD cases occur in the fall and early winter months. This seasonality is presumed to be due to a midsummer rise in kitten births accompanied by increased flea infestation.
Mortality/Morbidity
CSD is a self-limiting disorder with an excellent prognosis, even in patients with profound manifestations. Among healthy individuals, the condition usually resolves spontaneously over 2-5 months with rare permanent sequelae. However, immunocompromised patients may experience a dramatic and potentially life-threatening course of disease.
Sex
The male-to-female ratio is 3:2.
Age
Patients are younger than 21 years in approximately 80% of cases.
Clinical
History
- More than 90% of patients with the disease report recent contact with a cat, usually a kitten.
- In typical CSD, accounting for approximately 90% of cases, an incubation period of 3-12 days is followed by the development of one or more cutaneous papules or pustules at the inoculation site. The primary lesion lasts for 1-3 weeks then recedes as regional lymphadenopathy appears, generally immediately proximal to the inoculation site.
- Regional lymphadenopathy, which occurs in approximately 90% of patients, is characteristically the most remarkable manifestation and is usually the symptom that prompts medical evaluation. Lymphadenopathy primarily involves axillary nodes, followed in frequency by cervical and inguinal areas. Lymph nodes are often painful and spontaneously suppurate in 25-30% of cases.
- Constitutional symptoms are usually mild and may include malaise, low-grade fever, anorexia, nausea, fatigue, or headache.
- Atypical presentation (approximately 10% of cases) may include the following:
- Altered mental status, confusion (encephalopathy)
- Vision loss (neuroretinitis)
- Prolonged fever
- Joint pain (arthritis, synovitis)
- Respiratory complaints (atypical pneumonitis)
- Parinaud oculoglandular syndrome: An uncommon presentation of CSD (5-6% of cases), Parinaud oculoglandular syndrome caused by conjunctival inoculation. The syndrome is characterized by granulomatous conjunctivitis and ipsilateral preauricular lymphadenitis.
- Abdominal pain: The presence of abdominal pain with a history consistent with CSD suggests CSD hepatitis/splenitis, a self-limited granulomatous condition.
Physical
- Typical features
- Erythematous, tender papules or pustules at inoculation site
- Tender unilateral lymphadenopathy (>90%): Among patients with this disease, 50% have involvement of a single node, 30% have involvement of nodes in multiple sites, and 20% have involvement of several nodes in the same region.
- Low-grade fever (30-60%)
- Transient truncal maculopapular rash (5%)
- Atypical presentations
- Seizures (often associated with encephalitis)
- Transverse myelitis
- Arthritis
- Splenic abscess
- Optic neuritis
- Thrombocytopenic purpura
- Encephalitis
- Occurring in approximately 2-4% of CSD cases, the condition is characterized by confusion, restlessness, combativeness, disorientation, and coma. Generalized headache and transient nuchal rigidity are often present.
- Although encephalitis usually follows development of lymphadenopathy by 1-3 weeks, it may precede or occur without the presence of lymph node involvement.
- CSD encephalitis is self-limited, does not mandate specific treatment, and rarely results in persistent impairment.
- Neuroretinitis
- Neuroretinitis is characterized by a painless, unilateral, sudden loss of visual acuity; CSD neuroretinitis often follows lymphadenopathy or an influenzalike syndrome. Fundal examination reveals papilledema with macular exudates in a star pattern.
- CSD neuroretinitis should be followed by an ophthalmologist but is predictably self-limited.
- Osteomyelitis
Causes
As indicated by its name, the preponderance of cases can be traced back to the scratch of a cat. Other suspected sources include dog and monkey bites, pins, thorns, and splinters. Cat fleas have been shown to be responsible for transmission of B henselae between cats; however, no evidence exists to suggest transmission from cat fleas to humans. Human-to-human transmission has not been verified.
More on Catscratch Disease |
 Overview: Catscratch Disease |
| Differential Diagnoses & Workup: Catscratch Disease |
| Treatment & Medication: Catscratch Disease |
| Follow-up: Catscratch Disease |
| References |
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References
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Further Reading
Keywords
CSD, cat-scratch disease, Parinaud oculoglandular disease, kitten scratch disease, la maladie des griffes du chat, benign inoculation lymphoreticulosis, benign inoculation reticulosis, catscratch fever, cat-scratch fever, regional granulomatous lymphadenitis, regional lymphadenopathy, regional lymphadenitis, conjunctival granuloma with conjunctivitis, suppurative preauricular adenitis,encephalopathy, erythema thrombocytopenic purpura nodosum, arthritis, synovitis, pneumonia, splenomegaly, pharyngitis, transient truncal maculopapular rash, preauricular adenopathy, encephalitis with seizures, facial nerveparesis,myelitis, neuroretinitis, polyneuritis, radiculitis, optic neuritis withtransient blindness, osteitis, osteomyelitis, hepatomegaly, hepatosplenomegaly with hepatic granulomata, erythema nodosum, erythema marginatum, erythema multiforme, Afipia felis, Afelis, Bartonella henselae, B henselae, Rochalimaea henselae, R henselae
