Cat scratch disease

Classification according to ICD-10
A28.1	Cat scratch disease
ICD-10 online (WHO version 2019)

The cat scratch disease ( KKK ) is a human disease caused by scratching injuries to cats is transmitted. It is an infectious disease that is usually recognized by the swelling of the lymph nodes in the armpit or neck and is usually benign . The cats are only carriers of the disease caused by the bacterium Bartonella henselae , but according to the current state of knowledge they only show signs of the disease very rarely. The pathogen causing cat scratch disease can also be detected in cat fleas . The disease is likely to be transmitted from cat to cat through him.

root cause

The causative agent of the disease is Bartonella henselae , a gram-negative , rod-shaped bacterium. In addition, Bartonella clarridgeiae also plays a role. The bacterium Afipia felis , which was also regarded as a trigger in the past , is now regarded as insignificant for this disease. The bacteria are transmitted by cats scratching or biting. In a number of patients, however, no cat contact was detectable. Cat fleas can also transmit the pathogen causing cat scratch disease.

Synonyms

Cat scratch fever ; Cat scratch lymphadenitis ; also found in German in science English cat scratch disease or fever ; benign inoculative lymphoreticulosis ; benign inoculatory lymphoriculosis or benign vaccine lymphoreticulosis ; french Maladie des griffes de chat . It used to be assumed that there was a viral infection and the disease was also called virus scratch lymphadenitis .

distribution

The disease can break out in both children and adults. In particular, people with an immune deficiency get sick more quickly. Although cat scratch disease is widespread worldwide, it is usually not recognized immediately because a specific blood test is necessary. If this is not done, the disease cannot be clearly identified. The pathogen can be detected in 10 to 70% of cats in Germany. A familial occurrence of the disease can be triggered by a newly acquired cat. Human-to-human transmission has not yet been described. The disease is not notifiable .

Symptoms

human

After two to ten days, a red-brown papule can appear on the contact wound . These papules do not cause pain and disappear spontaneously after a few days or weeks. A little later, lymph node swellings can be detected in the lymphatic drainage area of ​​the wound , which can be painless or painful. Severe lymphadenopathies and bacteremia are treated with antibiotics. In some cases, purulent meltdown of the lymph nodes occurs. The lymph nodes can remain enlarged for weeks.

There are severe atypical forms of the disease with high fever , limb pain and headache . In particular, if the body's defenses are weakened, the central nervous system or sepsis can be involved.

Complications are primarily inflammations of the central nervous system such as encephalitis , polyneuritis and radiculitis with paralysis ( Parinaud's syndrome can also result) and neuroretinitis . Other organs and organ systems such as the skeleton ( osteomyelitis ), lungs ( pneumonia ), heart ( endocarditis ), liver ( peliosis hepatis ) and blood vessels ( bacillary angiomatosis ) can also be affected. Hemolysis and thrombocytopenia can occur in the blood .

In addition, there may be a generalized spread of the skin papules.

Cats

Clinical symptoms have so far only been observed in a few experimental infections in cats. They showed a slight fever and reluctance to eat. Hyperplasia of the lymph nodes , splenic follicles and lymphocytic cholangitis could be demonstrated pathologically . Fertility disorders have also been observed in infected animals.

Diagnosis

Micro photo of cat scratch disease. HE staining .

Contact with cats should be clarified in advance. The infection can be detected indirectly via the antibody detection in the blood or directly via a polymerase chain reaction (PCR) for the detection of B. henselae DNA.

The ultrasound examination of the lymph nodes and the biopsy or fine needle biopsy from a lymph node can be used for clarification. In the fine tissue , granulomatous inflammation with central necrosis is evident . A non-specific increase in inflammation levels ( CRP , leukocytes ) can be detected in the blood .

In cats, the pathogen can be cultivated using a blood culture , antibody detection or PCR.

Differential diagnostics

• Lymphadenitis caused by other pathogens:
  • Lymph node infestation by mycobacteria , especially by tuberculosis
  • infectious mononucleosis
  • Cytomegalovirus infection
  • acute HIV infection
  • Toxoplasmosis
  • Secondary stage of syphilis
  • Lymphogranuloma venereum
  • Actinomycosis
  • Brucellosis
  • Tularemia
• Lymph nodes metastatic malignant tumors
• Lymphomas such as Hodgkin's disease or non-Hodgkin lymphoma

therapy

In the majority of cases, the disease heals after about two to three months without treatment. If this is not the case, antibiotic therapy must be given. There have been positive experiences with azithromycin . Other antibiotics such as erythromycin or doxycycline in combination with rifampicin are also effective, depending on the symptoms, among other things.

In cats, erythromycin, enrofloxacin, or doxycycline can be used for two to three weeks. However, new infections can occur at any time.

literature

• Gerd Jürgen Ridder, Carsten Christof Boedeker, Katja Technau-Ihling, Anna Sander: Cat-scratch disease: Otolaryngologic manifestations and management. In: Otolaryngology - Head and Neck Surgery . Vol. 132, No. 3, 2005, pp. 353-358, PMID 15746844 , doi : 10.1016 / j.otohns.2004.09.019 .
• Gerd Jürgen Ridder, Carsten Christof Boedeker, Katja Technau-Ihling, Roland Grunow, Anna Sander: Role of cat-scratch disease in lymphadenopathy in the head and neck. In: Clinical Infectious Diseases . Vol. 35, No. 6, 2002, pp. 643-649, PMID 12203159 , doi : 10.1086 / 342058 .
• Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 185 ( cat scratch disease ).

Web links

• Epidemiology, Clinic and Diagnosis of Bartonella Infections , by Anna Sander, in: Antibiotika Monitor 5/2003, accessed on September 25, 2016
• Tips for cat owners with a weakened body defense: Cat scratch disease , by Danielle Gonin Jmaa, in: Information from the Swiss Association for Small Animal Medicine, accessed on September 25, 2016
• Cat disease can be fatal , by Jana Zeh, in: n-tv online, accessed September 25, 2016

Individual evidence

1. ↑ ^{a b c d} Reinhard Weiss: cat scratch disease. In: Marian C. Horzinek (Ed.): Diseases of the cat. 4th, revised edition. Enke, Stuttgart 2005, ISBN 3-8304-1049-2 , pp. 171-172.
2. ↑ Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 9-223, here: p. 211.
3. ↑ Marianne Abele-Horn (2009), p. 185.
4. ↑ Marianne Abele-Horn (2009), p. 185.
5. ↑ Marianne Abele-Horn (2009): p. 185.
6. ↑ Marianne Abele-Horn (2009), p. 185.

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