- Discussion:
- common acute infection which occurs most often in children;
- is also common in immuno-compromised patients;
- may arise from cat bite or scratch (more common w/ kittens), but may also be
transmitted by flea bites;
- up to 2 % of patients may have involvement of the CNS liver, spleen, lung,
bone, and skin;
- Causative Agents:
-
Rochalimaea:
- small gram-negative rods;
- genus may belong to Rickettsiaceae or Bartonellaceae;
-
Afipia felis:
- probably the main cause of cat stratch disease;
- has been cultured from lymph nodes;
- Diff dx:
- Kaposi's sarcoma;
- Clinical Findings:
- fever, chills, malaise, headache, and anorexia;
- firm subcutaneous nodules are common (2 to 6 cm in diameter);
- skin lesions may be solitary but are usually multiple;
- Labs:
- indirect fluorescent-antibody testing (serology);
- enzyme immunoassay for the detection of IgG antibodies to R. henselae;
- Histology:
- Examination of Skin Biopsy:
- demonstrates lobular angioproliferation w/ plump "epithelioid" cells;
- bacillary forms were identified in the lesions by Warthin-Starry staining;
- neutrophils are common;
- Histology of Nodes:
- stellate caseating granulomas, microabscesses, and follicular hyperplasia;
- Treatment:
- oral
erythromycin 500 mg PO qid;
------------------------------------
Review Article: Current Concepts: Cat Scratch Disease, Bacillary
Angiomatosis, And Other Infections Due To Rochalimaea.
Adal-Karim-A.
Cockerell-Clay-J.
Petri-William-A Jr.
The New England Journal of Medicine. 1994 May 26. 330 (21). pp 1509-1515.
Cat Scratch Disease Presenting as an Paravertebral Abscess.
A Case Report.
P.M. Bernini MD, J.T. Gorczyca MD, and J.F. Modlin MD.
JBJS Vol 76-A, No 12, Dec 1994. p. 1858.
