Bartonellosis

Definition

Cat scratch disease is an infectious illness caused by the bacteria bartonella. It is believed to be transmitted by cat scratches, bites, or exposure to cat saliva. This leads to swelling of the lymph nodes (lymphadenopathy) near the site of the scratch or bite.

Alternative Names

Causes

Cat scratch disease is caused by Bartonella henselae. The disease is spread through contact with an infected cat (a bite or scratch), or contact with cat saliva on broken skin or the white of the eye.

Lymph node swelling begins about 2 - 3 weeks after exposure and may persist for months. Swelling may occur at the site of the initial infection, followed by enlarged lymph nodes along the lymph drainage route from the injury site.

Occasionally, nodes may form a tunnel (fistula) through the skin and drain. Cat scratch disease is one of the common causes of chronic lymph node swelling in children. Until now, the disease often went unrecognized because of the difficulty in testing.

Recently however, the Bartonella henselae IFA test was shown to be highly sensitive and specific for the detection of infection caused by Bartonella henselae and for the diagnosis of cat scratch disease.

Symptoms

A person who has had contact with a cat may show common symptoms, including:

• Bump (papule) or blister (pustule) at site of injury, usually the first sign
• Swelling of the lymph nodes near where the skin was bitten or scratched
• Fever (in approximately one third of patients)
• Fatigue
• Overall discomfort (malaise)
• Headache

Less common symptoms may include:

• Loss of appetite
• Weight loss
• Enlarged spleen
• Sore throat
• Draining lymph nodes

Exams and Tests

A scratch or injury and a history of contact with a cat indicates that cat scratch disease is the likely cause of the lymph node swelling. In some cases, physical examination also shows an enlarged spleen (splenomegaly).

Tests used in the diagnosis of cat scratch disease:

• Positive bartonella blood tests
• Bartonella henselae IFA test (uses fluid or tissue from a lymph node)
• A lymph node biopsy to rule out other causes of swollen glands
• A positive CSD skin test

Treatment

Generally, cat scratch disease is not serious. Medical treatment is not usually needed. However, in severe cases, treatment with antibiotics can be helpful.

In AIDS

Outlook (Prognosis)

In children with normal immune systems, full recovery without treatment is the norm. In immunocompromised people, treatment with antibiotics generally leads to recovery.

Possible Complications

• Parinaud's syndrome
• Encephalopathy
• Neuroretinitis
• Osteomyelitis

When to Contact a Medical Professional

Call your health care provider if you have enlarged lymph nodes and a history of exposure to a cat.

Prevention

Avoiding contact with cats prevents the disease. Where this is not reasonable, good hand-washing after playing with a cat, avoiding scratches and bites, and avoiding cat saliva will lessen the risk of infection.