Cat scratch disease

• Parinaud, 1889
• Petzetakis, 1935
• Debré et al., 1950
• Mollaret et al., 1950

Cat scratch fever, cat scratch disease, cat scratch fever, cat scratch lymphadenitis, benign inoculative lymphoreticulosis, Maladie des griffes de chat.

Actual to subactual infection with Bartonella henselae (formerly Rochalimaea) or Afipia felis, usually triggered by cat scratches or bites.

• World-wide occurrence
• Mostly children and adolescents are affected after a scratch injury
• Human-to-human transmission is not possible
• Seasonal accumulation in autumn and winter

• Incubation period: 10 days (3-60 days)
• Pathogen: Bartonella henselae, a gram-negative pleomorphic, monotrichous flagellated rod, is responsible for almost 95% of all diseases. Rarely, Afipia felis can also cause feline cat disease. B. henselae is mainly found in surface water
• Damage of the epithelium by external force (e.g.: scratches, flea and tick bites) with subsequent transmission from the cat (host) to humans. Infected endothelial cells lead to the release of growth factors and thus to endothelial cell proliferation

• An erythematous papule or nodule develops in the area of inoculation and is often described as an inconspicuous primary effect. In the course (after about 6 weeks), a maculopapular exanthema and a locoregional lymph node adenopathy develop, rarely with melting and perforation of the lymph node
• To red. General condition (febrile temperatures, cephalgia, myalgias, splenomegaly, fatigue) occurs in 75% of cases

• Simultaneous erythema exsudativum multiforme, erythema nodosum, herpes zoster and encephalopathy may occur
• In rare cases, cat scratch disease is also associated with acute tonsillitis and retropharyngeal and peritonsillar abscesses

• Special form: oculoglandular Parinaud's syndrome
• When the conjunctiva is the site of inoculation, preauricular adenopathy
occurs
• In immunosuppressed patients, disease may result in death

• Anamnesis (contact with cats?, has patient suffered scratches?)
• Clinic
• Biopsy
• Detection of pathogens (PCR diagnostics (serum), ELISA (serum), culture from skin swabs)

In particular, uncovered parts of the body (in 50% of cases on the upper extremity)

Epitheloid cell, granulomatous, necrotising inflammation

• In 5-14% of patients there is involvement of the liver, spleen, CNS or eye, which can lead to lethal complications
• Bacillary angiomatosis (in immunosuppression)
• Hepatic peliosis
• Encephalitis and encephalomyelitis
• Facial paresis
• Arthritis
• Splenomegaly
• Neuritis
• Neuroretinitis with acute amaurosis
• Pneumonia
• Osteolysis of various bones
• Thyroiditis
• Glomerulonephritis
• Generalised lymph node swelling

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