Cat-scratch disease (CSD)

Last Updated: 2020-11-19

Author(s): Anzengruber F., Navarini A.

ICD11: -

  • 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. 

  • Antiseptic envelopes (Tannosynt, Betadine® solution and Octenisept® solution). 
  • Antibiograms of this disease often show no agreement with the resistance in vivo. For this reason, the antibiotics listed below should be adhered to and consulted with the infectious diseases department. 

 

First-line therapy after goodbye

Observation 

C

Second-line therapy after goodbye

Azithromycin p.o. 500 mg 1x on day 1, then 250 mg 1x daily for 2 more days  A

Third-line therapy after goodbye 

Erythromycin C
Rifampin C
Gentamicin C
Surgical intervention  C
Doxycyclines  C
Ciprofloxacin  C
Trimethoprim sulfamethoxazoles  C

 

  1. Frandsen J, Enslow M , Bowen AR. Orf parapoxvirus infection from a cat scratch. Dermatol Online J 2011;17:9.
  2. Goldblum RW , Piper WN. Artificial Lichenification Produced by a Scratching Machine1. Journal of Investigative Dermatology 1954;22:405-15.
  3. Nosal J. Bacillary angiomatosis, cat-scratch disease, and bartonellosis: what's the connection? International Journal of Dermatology 1997;36:405-11.
  4. Palmieri JR, Santo A , Johnson SE. Soil-acquired cutaneous nocardiosis on the forearm of a healthy male contracted in a swamp in rural eastern Virginia. Int Med Case Rep J 2014;7:41-7.
  5. Reynolds MG, Holman RC, Curns AT, O??Reilly M, McQuiston JH , Steiner CA. Epidemiology of Cat-Scratch Disease Hospitalizations Among Children in the United States. The Pediatric Infectious Disease Journal 2005;24:700-4.
  6. Shinall EA. Cat–scratch Disease: A Review of the Literature. Pediatric Dermatology 1990;7:11-8.
  7. Margileth AM. Antibiotic therapy for cat-scratch disease: clinical study of therapeutic outcome in 268 patients and a review of the literature. Pediatr Infect Dis J 1992;11:474-8.
  8. Carithers HA. Cat-scratch disease. An overview based on a study of 1,200 patients. Am J Dis Child 1985;139:1124-33.
  9. Margileth AM. Cat scratch disease. Adv Pediatr Infect Dis 1993;8:1-21.
  10. Lebwohl, Mark. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. Elsevier, 2014. Print.