Cat-scratch disease (CSD)

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

CSD, cat scratch disease, cat scratch fever, Katzenkratzlymphadenitis, benigne Inokulationslymphoretikulose, benign inoculative lymphoreticulosis, Maladie des griffes de chat, cat scratch disease.

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

• Worldwide occurrence. 
• Predominantly 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, monotrich flagellated rod, is responsible for almost 95% of all diseases. In rare cases, Afipia felis can also trigger cat cat disease. B. henselae is mainly found in surface water. 
• Damage to the epithelium by external forces (e.g. scratches, flea and tick bites) with subsequent transmission from the cat (host) to humans. Infested endothelial cells cause the release of growth factors and thus endothelial cell proliferation. 

• An erythematous papule or nodule develops in the area of the inoculation area and is often described as an inconspicuous primary effect. During the course (after approx. 6 weeks) a maculopapular exanthema and a locoregional lymph nodeadenopathy develop, rarely with melting and perforation of the lymph node. 
• Reduced general condition (febrile temperatures, cephalgia, myalgia, splenomegaly, fatigue) occurs in 75% of cases. 
• At the same time, erythema exsudativum multiforme, erythema nodosum, herpes zoster and encephalopathy may occur. 
• In rare cases the cat scratch disease is also associated with acute tonsillitis and retropharyngeal and peritonsillar abscesses. 
• Special form: Okuloglandular Parinaud syndrome. 
• If the conjunctiva is the inoculation site, preauricular adenopathy occurs. 
• In immunosuppressed patients, the disease can 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). 

Especially uncovered body parts (in 50% of cases at the upper extremity).

Epitheloid cell, granulomatous, necrotizing 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 nerve palsy. 
• Arthritis. 
• Splenomegaly. 
• Neuritis. 
• Neuroretinitis with acute amaurosis. 
• Pneumonia. 
• Osteolysis of various bones. 
• Thyroiditis. 
• Glomerulonephritis. 
• Generalized lymph node swelling. 

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