Communicable Diseases

Cat-Scratch Disease

Identification

A sub-acute, usually self-limited bacterial disease characterized by malaise, granulomatous lymphadenitis, and variable patterns of fever. Often preceded by a cat scratch, lick or bite that produces a red papular lesion with involvement of a regional lymph node, usually within 2 weeks; may progress to suppuration. The papule at the inoculation site can be found in 50%–90% of cases. Parinaud oculoglandular syndrome (granulomatous conjunctivitis with pretragal adenopathy) can occur after direct or indirect conjunctival inoculation; neurological complications such as encephalopathy and optic neuritis can also occur. Prolonged high fever may be accompanied by osteolytic lesions and/or hepatic and splenic granulomata. Bacteremia, hepatic extravasation of blood (peliosis hepatis) and bacillary angiomatosis due to this infection may occur among young children and among immunocompromised persons, particularly those with HIV infection.

Cat-scratch disease can be clinically confused with other diseases that cause regional lymphadenopathies (e.g. tularemia, brucellosis, tuberculosis, plague, pasteurellosis, and lymphoma).

Diagnosis is based on a consistent clinical picture combined with serological evidence of antibody to Bartonella henselae. A titer of 1/64 or greater by IFA assay is considered positive.

Histopathological examination of affected lymph nodes may show consistent characteristics, but is not diagnostic. Pus obtained from lymph nodes is usually bacteriologically sterile by conventional techniques. Immunodetection and PCR are highly efficient in detecting Bartonella in biopsies or aspirates of lymph nodes. Bartonella has been grown from blood and from lymph node aspirates after prolonged incubation on rabbit blood agar in 5% CO at 36°C (96.8°F), and in other cell culture systems.

Cat-Scratch Disease has been found in Communicable Diseases

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