eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Catscratch Disease: Differential Diagnoses & Workup
Updated: Apr 28, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Atypical Mycobacterial Infection
Brucellosis
Coccidioidomycosis
Histoplasmosis
Toxoplasmosis
Tuberculosis
Other Problems to Be Considered
Brachial cleft cyst
Dermoid cyst
Fungal infections
Histiocytosis X
Infectious mononucleosis
Lymphoma
Lymphogranuloma venereum
Thyroglossal cyst
Tumors
Workup
Laboratory Studies
- History and physical findings strongly suggest the diagnosis of catscratch disease (CSD). Routine laboratory evaluation is usually not necessary or valuable.
- When necessary, confirmation can be established with histopathology tests.
- Lymph node biopsy evaluation can be helpful. Biopsy findings depend on when in the course of the disease the biopsy is performed.
- Early findings include lymphoid and reticular cell hyperplasia and arteriolar proliferation. Later, granulomas with central necrosis often appear along with multinucleated giant cells. Microabscesses appear later.
- Polymerase chain reaction (PCR) can be useful in detecting the DNA of Bartonella species in clinical specimens; however, PCR remains primarily an experimental technique for catscratch disease diagnosis.
- Staining specimens with Warthin-Starry stains can show clumps of pleomorphic rods. These are usually found in the walls of blood vessels and in the microabscesses and macrophages that line the sinuses.
- Liver and spleen biopsies may also show granulomas and abscesses.
- Although difficult, Bartonella species can be grown from clinical species. The organism is fastidious and may take 9-40 days to grow on specialized medium.
- Confirmation can also be established with serology tests.
- Most patients have measurable antibody titer to Bartonella species; however, distinguishing one Bartonella species from another is difficult using most serologic techniques.
- Indirect immunofluorescence assay to B henselae performed by the Centers for Disease Control and Prevention (CDC) is 96% sensitive, and enzyme-linked immunoassay can be 71% sensitive. PCR assays are available in some research and commercial laboratories.
- Skin testing is rarely used. In the past, material from infected lymph nodes was processed to make antigen used for skin testing. The test is no longer used because of the risk of transmitting pathogens.
Imaging Studies
- CT scan findings in patients with encephalopathy are usually not diagnostic.
- Ultrasonography or CT scan findings may reveal multiple abnormalities (granulomatous inflammation) in the liver and spleen.
Other Tests
- EEG in patients with encephalopathy usually reveals diffuse slowing or focal abnormalities.
Procedures
- Cerebral spinal fluid (CSF) findings in patients with encephalopathy is usually not diagnostic.
Histologic Findings
- Histologic findings in individuals with catscratch disease progress over time.
- Lymphoid hyperplasia, reticular cell hyperplasia, and arteriolar proliferation are followed by granulomas with central necrosis.
- Microabscesses appear later.
More on Catscratch Disease |
| Overview: Catscratch Disease |
 Differential Diagnoses & Workup: Catscratch Disease |
| Treatment & Medication: Catscratch Disease |
| Follow-up: Catscratch Disease |
| Multimedia: Catscratch Disease |
| References |
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References
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Further Reading
Keywords
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