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Why is cat scratch disease dangerous?

Why is cat scratch disease dangerous?

01.08.2019

Disease cat scratches is an acute zoonotic infection, the clinical symptoms of which were first described in medical literature in 1931. Only in 1992 in the blood domestic cat the pathogen was isolated and described of this disease- Bartonella Henselae, which is a strain of gram-negative bacteria of the genus Bartonella. Most often, this disease occurs when a cat bites or scratches.

The disease has various clinical manifestations. It is customary to distinguish between typical and atypical forms of pathology. Clinical diagnosis is established on the basis of bacteriological examination of the purulent contents of emerging pustules, as well as by polymerase chain reaction and enzyme immunoassay of the patient’s blood. Treatment depends on the severity of the disease, its form and clinical manifestations. The basis of therapy for cat scratch disease is antibiotic therapy.

Features of the course of cat disease in an atypical form of the disease

Among the most common forms of atypical felinosis are the following:

ophthalmic (most common);
abdominal;
pulmonary;
cerebral and others.

When the pathogen enters the mucous membrane of the eye, the patient experiences symptoms of ulcerative-granulomatous conjunctivitis: severe swelling of the conjunctiva and its hyperemia, single or multiple ulcerations, which are granulomatous growths or inclusions in the form of grains. As a rule, only one eye of the patient is involved in the pathological process. With the ocular variant of felinosis, the patient's visual acuity may significantly decrease. These phenomena are accompanied by persistent lymphadenitis of the parotid and submandibular lymph nodes. When examined by an ophthalmologist, characteristic changes in the structures of the visual organs (retina, fundus and optic nerve) can be detected, the most common of which is the “macular star” symptom.

The neurological variant has the most severe consequences cat disease. Clinical manifestations can be very different: from fever and a sharp deterioration in the general somatic condition of the patient to disorientation, confusion and coma.

The first symptoms of neurological manifestations appear 2-3 weeks after the onset of the initial manifestations of lymphadenitis. The patient's general condition suddenly deteriorates sharply. This form of felinosis can cause serious diseases: meningitis, encephalopathy, encephalitis, polyneuritis, radiculitis, etc. It is encouraging that this form of the disease occurs in only 2% of patients.

Some authors note the possibility of developing complications from the liver and spleen in cat scratch disease. In such conditions, the patient's liver or spleen is significantly enlarged, and the organs are subject to undulating fever. The general somatic condition of the patient is disturbed, and symptoms of intoxication of the body may appear.

Cat scratch disease, the symptoms of which are very diverse, is a fairly serious pathology that requires immediate intervention by medical personnel.

Causes of cat scratch disease

The infection is transmitted by cats, for which Bartonella Henselae is a conditionally pathogenic microflora. It is often impossible to visually distinguish a sick cat from a healthy one. It is worth noting that most often young animals under the age of one year are carriers of bacteria of the genus Bartonella. Thus, in 90% of cases, when collecting an anamnesis, contact with a cat was identified. Cases have been recorded when patients indicated contact with other animals: dogs, goats, squirrels, crayfish, etc. Infection occurs when an animal bites or scratches, as well as when a person licks damaged skin. Cat fleas can also transmit pathogens.

Scientists noted that cat scratch disease most often affects young children and young people under the age of 20, and there is some seasonality: a greater number of infections occur in autumn and spring. The disease is not transmitted from person to person, so the infected person does not pose a threat to others. There are cases when the whole family gets sick at the same time, but they are rare. The bacterial microflora Bartonella Henselae causes diseases such as felinosis and benign lymphoreticulosis in humans. Atypical forms of the disease are considered to be the most dangerous for humans, requiring the involvement of specialized specialists (ophthalmologists, neurologists, pulmonologists, gastroenterologists, etc.) in the treatment of patients.

Symptoms of cat scratch disease

As already noted, cat scratch disease can have typical and atypical forms. The typical form of this pathology is characterized by the following stages of the disease:

The incubation period lasts from 3 to 60 days. During this period, no changes in the somatic condition of the patients are noted and it can be characterized as a stage of asymptomatic carriage.
The initial period, or debut of the disease. Primary affect appears, which is a characteristic sign for this stage of the disease. Primary affect is a condition in which an inflammatory process begins to localize at the site of penetration of the pathogen. At the initial stage of the disease, a papule (non-purulent formation rising above the skin level) is formed.
The height of the disease. This stage is characterized by the fact that the papule degenerates into a pustule (pustular formation). The pustule tends to open up and form a completely typical ulcer. Such an ulcer becomes covered with a crust, which falls off on its own over time and leaves no marks on the patient’s skin. The main symptom of cat scratch disease is lymphadenitis - inflammation, enlargement and hardening of the lymph nodes. The lymph nodes of the cervical and axillary regions become inflamed most often, but the inguinal, mandibular and other lymph nodes can also be involved in the inflammatory process.
After 2-4 months, cat scratch disease ends with complete recovery of the patient. This period is called the period of convalescence (the final period of the disease).

Diagnosis of cat scratch disease

The most specific and highly accurate method for diagnosing cat scratch disease is a skin test. However this method has a number of disadvantages and is fraught with the possibility of infecting the patient with various blood-borne diseases, since the allergen for the test is obtained from the blood of a person diagnosed with “cat scratch disease”. To establish an accurate diagnosis, it is customary to carry out laboratory and clinical tests of the patient’s blood (RIF, PCR, ELISA, etc.), as well as bacteriological examination of the contents of lymph nodes or abscesses.

Patients need differential diagnosis of felinosis with mononucleosis, lymphoma, cytomegalovirus, toxoplasmosis and other infectious diseases. If not typical forms ah disease patients can be referred for consultation with narrow specialists(ophthalmologists, pulmonologists, cardiologists, dermatovenerologists, neurologists, cardiologists and others).

Treatment of cat scratch disease

If a patient is diagnosed with cat scratch disease, treatment includes complex symptomatic therapy. If the disease has a typical clinical course, then this condition most often goes away on its own. In some cases, the doctor may decide to use drug therapy, including the use of antibiotics, non-steroidal anti-inflammatory drugs and antiallergic drugs. In cases where suppuration of the lymph nodes occurs, they can be opened surgically or removed altogether.

Physiotherapeutic procedures in the complex treatment of felinosis are highly effective. For atypical forms of pathology, symptomatic therapy is carried out in accordance with the prescriptions of specialized specialists.

Cat scratch disease- an infectious disease that occurs after a cat bite and scratch and proceeds with the formation of a primary affect in the form of a suppurating papule with the subsequent development of regional lymphadenitis. ( Synonyms: Mollaret's granuloma, felinosis, cat scratch fever, benign lymphoreticulosis).

What provokes / Causes of Cat Scratch Disease:

The causative agent of cat scratch disease- Rochalimaea henselae. Polymorphic non-motile gram-negative bacterium; is morphologically similar to representatives of the genus Rickettsia and exhibits similar properties to Afipia felis. A motile, non-fermenting, gram-negative rod-shaped bacterium. It is fastidious for in vitro cultivation, preferably grown on HeLa cells.

Reservoir and source of infection count various mammals (cats, dogs, monkeys, etc.). The disease is registered everywhere. In regions with a temperate climate, an increase in incidence is noted from September to March. Considering the nature of the infection, the main contingent is persons under 21 years of age; 90% have a history of bites or scratches caused by kittens. Studies conducted on animals have shown that the microorganism does not cause the development of any pathology in them and they do not respond with the development of hypersensitivity reactions when the pathogen antigen is administered intradermally. Incidence - 10:100,000 population (25,000 cases annually).

Pathogenesis (what happens?) during Cat Scratch Disease:

Risk factors for developing the disease:
- Disorders of cellular immune responses
- HIV infection, especially when the CD4+ lymphocyte count is below 100 in 1 μl
- Long-term use of GC, azathioprine, cyclophosphamide, cyclosporine, alcohol abuse.

Penetration of the pathogen through damaged skin or, less commonly, through the mucous membrane of the eye subsequently leads to the development of an inflammatory reaction in the form of a primary affect. Then, through the lymphatic ducts, the microbe enters the regional lymph nodes, which is accompanied by the occurrence of lymphadenitis. Morphological changes in the lymph nodes are characterized by reticulocellular hyperplasia, the formation of granulomas, and later microabscesses. The disease is usually accompanied by hematogenous dissemination with the involvement of other lymph nodes, liver, central nervous system, and myocardium in the pathological process. A severe and prolonged, and often atypical course of the disease is observed in patients with HIV infection.

Symptoms of Cat Scratch Disease:

Incubation period lasts from 3 to 20 days (usually 7-14 days). According to clinical manifestations, typical forms (about 90%) can be distinguished, manifested in the appearance of primary affect and regional lymphadenitis, and atypical forms, which include:
a) eye shapes;
b) damage to the central nervous system;
c) damage to other organs;
d) cat scratch disease in HIV-infected people.

The disease can progress as follows: acute form, and in chronic. It also differs in the severity of the disease.

Typical disease begins, as a rule, gradually with the appearance of primary affect. In place of a scratch or cat bite that has already healed by that time, a small papule appears with a rim of skin hyperemia, then it turns into a vesicle or pustule, and then into a small ulcer. Sometimes the abscess dries out without forming an ulcer. Primary affect is often localized on the hands, less often on the face, neck, and lower extremities. The general condition remains satisfactory. 15-30 days after infection, regional lymphadenitis is noted - the most permanent and characteristic symptom diseases. Sometimes this is almost the only symptom. An increase in body temperature (from 38.3 to 41°C) is observed only in 30% of patients. Fever is accompanied by other signs of general intoxication (general weakness, headache, anorexia, etc.). The average duration of fever is about a week, although in some patients it can last up to a month or more. Weakness and other signs of intoxication last on average 1-2 weeks.

The elbow, axillary, and cervical lymph nodes are most often affected. Some patients (about 5%) develop generalized lymphadenopathy. The sizes of enlarged lymph nodes usually range from 3 to 5 cm, although in some patients they reach 8-10, are painful on palpation, and are not fused with the surrounding tissues. In half of the patients, the affected lymph nodes suppurate with the formation of thick yellowish-greenish pus, which cannot be isolated when cultured on ordinary nutrient media. The duration of adenopathy ranges from 2 weeks to one year (on average about 3 months). Many patients experience an enlargement of the liver and spleen, which persists for about 2 weeks. In some patients (5%), exanthema appears (rubella-like, papular, erythema nodosum type), which disappears after 1-2 weeks. The typical clinical form accounts for about 90% of all cases of the disease.

Eye shapes diseases are observed in 4-7% of patients. In their manifestations, these forms resemble Parinaud's oculoglandular syndrome (Parinaud's conjunctivitis). It probably develops as a result of saliva from an infected cat coming into contact with the conjunctiva. As a rule, one eye is affected. The conjunctiva is sharply hyperemic and edematous; against this background, one or more nodules appear that can ulcerate. The lymph node located in front of the earlobe significantly enlarges (reaching a size of 5 cm or more), the lymph node often suppurates, the duration of lymphadenopathy reaches 3-4 months. After suppuration and formation of fistulas, cicatricial changes in the skin remain. Sometimes not only the parotid but also the submandibular lymph nodes become enlarged. The acute period of the disease is characterized by severe fever and signs of general intoxication. Inflammatory changes in the conjunctiva persist for 1-2 weeks, and the total duration of the oculoglandular form of cat scratch disease ranges from 1 to 28 weeks.

Nervous system changes observed in 1-3% of patients. They manifest themselves in the form of encephalopathy, meningitis, radiculitis, polyneuritis, myelitis with paraplegia. Neurological symptoms are accompanied by high fever. They appear 1-6 weeks after the onset of lymphadenopathy. Neurological examination reveals diffuse and focal changes. There may be a short-term disturbance of consciousness. Cases of coma have been described. Thus, lesions of the nervous system develop against the background of classic clinical manifestations of cat scratch disease (in severe cases of this disease). They can also be considered complications of this disease.

Other complications may also occur: thrombocytopenic purpura, primary atypical pneumonia, splenic abscess, myocarditis.

In persons with immunodeficiencies the disease becomes generalized. HIV-infected people are characterized by a gradual onset, increased fatigue, general malaise, weight loss, recurrent fever, headaches; local lesions are rarely observed. Neurological manifestations are possible: impaired cognitive functions and behavior. They can be mistaken for mental disorders caused by HIV. Disseminated skin lesions resembling Kaposi's sarcoma are typical in patients with AIDS; Damage to bones and various organs is noted. Patients with impaired immune status are characterized by the development of bacterial angiomatosis and peliosis, accompanied by excessive proliferation of the capillary network. More often, lesions are observed in regional lymph nodes, internal organs (including the heart, such as endocarditis; liver, spleen) and skin (on the latter in the form of nodules and/or papules of a flesh-colored or bluish-violet color; the nodules can ulcerate with the discharge of serous or bloody discharge and crusting).

Course and prognosis. In typical cases, the disease is self-limiting after 2–4 months. With proper treatment, complete recovery occurs. If the process recurs, a second course of antibiotics is prescribed.

Diagnosis of Cat Scratch Disease:

Diagnostics classical forms Cat scratch disease is not very difficult. Important has contact with a cat (in 95% of patients), the presence of a primary affect and the appearance of regional lymphadenitis (usually after 2 weeks) in the absence of reaction of other lymph nodes. The diagnosis can be supported by a microbiological study of blood with plating on blood agar, a histological study of a biopsy of a papule or lymph node with staining of sections using silver and a microscopic search for accumulations of bacteria, as well as a molecular genetic study of the DNA of the pathogen from a patient’s biopsy.

Differentiated from the cutaneous bubonic form of tularemia, tuberculosis of the lymph nodes, lymphogranulomatosis, bacterial lymphadenitis.

In some patients, eosinophilia and increased ESR are noted in the hemogram. Skin test with a specific antigen (positive in 90% of patients 3–4 weeks after the onset of the disease).

Treatment for Cat Scratch Disease:

The disease ends in spontaneous recovery. In case of suppuration of the lymph node - puncture with suction of pus. The use of a new antibiotic, ketolide, from the group of macrolides, is promising.

Drugs of choice:
- In uncomplicated cases - erythromycin 500 mg 4 times / day or doxycycline 100 mg 2 times / day orally, or ciprofloxacin 500 mg 2 times / day orally for 10-14 days with a normal state of the immune system or 8-12 weeks for immunodeficiency (rifampicin can be additionally prescribed)
- For endocarditis, lesions of internal organs or bones - erythromycin 500 mg 4 times / day or doxycycline 100 mg 2 times / day parenterally for 2-4 weeks and then orally for 8-12 weeks
- Alternative drugs - tetracyclines, azithromycin, clarithromycin, chloramphenicol, ofloxacin, ciprofloxacin.

Prevention of Cat Scratch Disease:

Specific prevention has not been developed. Cat scratches and bites should be disinfected.

Which doctors should you contact if you have Cat Scratch Disease?

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A cat is not only a source of affection and relief from a bad mood naturally, without taking any herbs or pills. This relative of wild predators, especially at a young age, through his bite or scratch can transmit felinosis - cat scratch disease. This disease has a long course, accompanied by inflammation and sometimes suppuration of the lymph nodes near the scratched area. If at the time of infection the person’s immunity was not suppressed by the disease or medications, the disease passes without complications. IN otherwise Complications from the liver, brain and spleen may occur.

About the causative agent of the disease

Felinosis is caused by a very unusual bacterium - Bartonella henselae. This is an intermediate form between a bacterium and a virus: in shape it does not differ from a bacterium and even has a flagellum; destroyed by antibiotics. But, like a virus, it lives inside a cell and is grown not on nutrient media, but on living cells. Her " cousins", Rickettsia, are the causative agents of many diseases, including typhus - a pathology that appears in some people who have lice on their heads.

The name of the disease, felinosis, comes from the word “Felis,” which is the Latin name for cats. The “name” of the bacterium – Bartonella hensele – was given to it in honor of the microbiologist who discovered the microbe and described its properties, Diana Hensel.

How and from whom do they get infected?

The main number of Bartonella “lives” in the body of domestic and wild cats. The bacterium is transmitted to each other by cat fleas, in whose intestines the microbe lives for up to 9 days. These insects are not dangerous to humans.

According to statistics, almost half of cats have this pathogen in their blood, and the animals do not experience any symptoms of the disease, although they have been sick for several years. There is even an opinion that this bacterium normally inhabits the mouth of cats. They excrete the bacterium in their urine and saliva, from where it ends up on the cats' paws.

Therefore, you can become infected:

when bitten by an animal;
through damage from a cat's claw;
through contact with saliva in the eye (on the conjunctiva) or on damaged skin;
if the water/food that the cat drank came into contact with mucous membranes or injured skin;
if there is an injection with a fishing hook, a splinter or thorns of plants on which the cat’s saliva has come into contact.

The most dangerous in terms of contagiousness are kittens that are not yet 1 year old. Adult cats are slightly less dangerous. But dogs, monkeys, and rodents can also become a source of infection. You can even become infected by pricking yourself with a hedgehog needle or a bird feather.

Usually affected:

hands;
leg skin;
head;
face;
rarely – eyes.

A person cannot infect a person. And someone who has had felinosis once will not develop the disease again. 5% of people are immune to felinosis (of which 25% are owners of domestic cats).

Some statistics

In temperate climates, infections most often occur from September to March (almost 2/3 of all cases). This is explained by closer human contact with pets during the cold season. There is no seasonality in the tropics.

About 90% of cases are children and adolescents under 20 years of age. Boys get sick more often. Family outbreaks are rare: usually only 1 child gets sick, although everyone has played with the same kitten.

What increases the chance of a more severe course of felinosis

A person who has come into contact with Bartonella hensele develops a severe or even atypical form of felinosis in the following situations:

there is a congenital pathology of the cellular immune system;
after a serious illness or surgery;
when you need to take glucocorticoids (for the treatment of autoimmune diseases such as rheumatoid arthritis, autoimmune hepatitis, psoriasis, and so on);
after treatment with cytostatic drugs (cyclophosphamide, cyclosporine, azathioprine);
in persons who abuse alcohol;
in patients diabetes mellitus;
in HIV-infected people.

In the latter case, felinosis is very severe and long-lasting; sometimes its manifestations are so atypical that they don’t even think about this diagnosis.

How does the disease manifest itself?

A scratch or site of a cat bite heals slowly for the first 3-10 days, without causing any concern on the part of the person: it may hurt a little or irritate, like a regular skin injury. This is the incubation period; At this time, the pathogen overcomes the barriers of the integumentary tissue and multiplies. This period can extend up to 3 weeks, then at the time the first symptoms of felinosis appear, skin trauma no longer exists.

After the time it takes for the microbe to penetrate and accumulate (3 days to 3 weeks, on average 7-14 days), a rash appears in the place where there was a scratch or where a crust remains. It looks like several nodules the size of a millet grain to a pea, which do not itch or hurt.

After 2-3 days, the period of the height of the disease begins: such nodules fester and open up on their own, after which they become covered with a crust and may begin to itch slightly (especially if a child with allergies has been scratched). Within 1-3 weeks, the crusts dry and fall off, after which the bite site ceases to be noticeable: there are no scars or darker areas of skin left. This means that Bartonella has multiplied in sufficient quantities, overcome the local immunity of the skin area and entered the lymphatic system.

After 10-14 days (less often - longer) from the moment the first nodules appear, the microbe is caught by regional lymph nodes - local filters that try to prevent it from passing further.

If the arm below the elbow was bitten, one or more groups of lymph nodes enlarge: elbow, axillary, cervical. The order in which lymphadenitis appears may be exactly this, but the axillary nodes may immediately enlarge, while the ulnar nodes remain unchanged. Also, starting from the axillary fossa, the lymph nodes will enlarge if the forearm or shoulder is damaged by claws or teeth.

If the bite/scratch is on the leg, the lymph nodes in the femoral and groin area become inflamed. When the face is scratched, the submandibular, anterior or posterior ear groups may be the first to react; after which one or more lymph nodes from the cervical group enlarge.

Signs that indicate that the lymph nodes are damaged due to felinosis:

lymph nodes gradually increase, reaching from 5 to 10 cm in diameter;
they are dense;
it hurts to feel them;
the skin over them is not red or hot to the touch;
lymph nodes can be moved - they do not pull the skin along with them;
when enlarging the entire group of nodes, probing them, you can “roll” them independently of each other: they are not soldered together.

Enlarged lymph nodes are accompanied by a deterioration in the person’s general condition. The following symptoms appear:

fever, sometimes up to 39°C or higher;
headache;
malaise;
weakness;
poor sleep;
sweating;
loss of appetite;
heartbeat.

Not everyone’s temperature rises to such high numbers: in some cases, it may be completely absent. The increase in temperature lasts from a week to a month, other symptoms gradually disappear within 2 weeks. Lymph nodes remain enlarged for up to three months. In half of the cases, they suppurate and can spontaneously open: then thick yellow-green pus is released to the surface, which, when taken for bacteriological examination, does not show signs bacterial infection(as you remember, Bartonella does not grow on nutrient media).

During the same period, a reddish rash may appear on the skin of a person’s body or limbs, occupying larger or smaller areas of the skin. It does not itch or hurt and disappears after a few days.

During the period of lymph node enlargement, the following may also be observed:

discomfort and pain in the right hypochondrium - this is an enlargement of the liver, which is also a filter on the way of Bartonella, which by this time has entered the blood;
a feeling of “needles” or discomfort in the left hypochondrium: this may indicate an enlarged spleen, which can also be affected by felinosis. An enlarged liver and spleen can also be detected on ultrasound abdominal cavity without any symptoms;
heart pain, arrhythmias. These are signs of heart damage;
enlargement of lymph nodes located far from the site of infection.

The above symptoms of cat scratch disease occur in people whose immunity is not active enough and allows the infection to enter the blood. In those people who are called “immunocompromised” (who have received drugs that suppress the immune system, suffer from diabetes mellitus, congenital immunodeficiency, HIV, chronic alcoholism), felinosis proceeds completely atypically. In them, the infection can remain in the body forever, causing chronic disease.

Usually the disease ends a month or a little less after the first lymph node enlarges: the temperature drops, the headache goes away, sleep and appetite are restored, the lymph nodes gradually decrease in size and become dense little “balls” that are not fused to each other and the skin. Very rarely, with moderately weak immunity, felinosis can last 1-2 years, when its symptoms either subside or reappear.

Atypical forms of the disease

This term is called:

a disease that occurs in response to a microbe entering a place other than the skin (for example, the conjunctiva of the eye);
Bartonellosis organ damage, characteristic only of people with “compromised” immunity.

Atypical forms are not complications of felinosis; they are a severe, atypical current infection.

Eye damage

If a cat's saliva gets on the conjunctiva of the eye, it may develop:

Conjunctivitis Parilo. In this case, only one eye is affected. It is red, swollen, and difficult to open. It doesn’t hurt, and nothing comes out of it. Upon examination, the ophthalmologist will see nodules and ulcers on the conjunctiva.

Simultaneously with the damage to the eye, the parotid lymph nodes on the same side become inflamed. The anterior auricular node is always affected: it grows to 5 cm or more, can suppurate and open, after which a scar forms. The submandibular and cervical lymph nodes may also enlarge. At the same time, the general condition worsens: weakness, palpitations appear, body temperature rises, and sleep deteriorates.

Neuroretinitis. At the same time, vision in one eye deteriorates. The state of health has not changed. Changes characteristic of felinosis are seen by an ophthalmologist during examination.

Damage to the nervous system

If Bartonella gets into the blood, 2-3 weeks after inflammation of the regional lymph nodes, signs of damage to the nervous system may appear. This includes a decrease in sensitivity only in the area of socks and gloves, or spreading higher, a violation of the motor function of one or more limbs, trembling, and a lack of coordination.

Felinosis can also cause convulsions, inappropriate behavior, impaired consciousness, and paralysis of the facial nerve.

Atypical forms in immune deficiency

In people whose immunity is greatly reduced, felinosis occurs as bacillary angiomatosis or peliosis hepatitis.

Bacillary angiomatosis

This is the name of the pathology (it often develops only in HIV-infected people), when in response to the presence of bacteria of the genus Bartonella, vascular proliferation occurs.

Here after the damage cat's claw or the teeth undergo an incubation period of several weeks or even months, that is, the wound heals. Cutaneous manifestations of the disease appear not in the place where the cat scratched, but in a random location. The mucous membranes of the mouth, genitals, and larynx are also affected.

The disease begins with the appearance of not small red nodules on the skin, but red or purple spots, not protruding above it. Nodules appear later, against the background of these spots. Moreover, the nodes are not small, but large, up to 3 cm in diameter, painful, covered with red, inflamed skin. There may be several of them, individual ones, but there may be hundreds. Around each of them there is a “collar” of thin, eroded (reddish and oozing) epidermis.

The disease is accompanied by malaise, fever, and weight loss. Other organs may be affected: liver, spleen, heart, central nervous system, muscles, bone marrow.

Bacillary angiomatosis occurs in different ways: it can go away on its own, but can, with severe damage to internal organs, lead to death.

Peliosis hepatitis

In this case, cavities filled with blood form in the liver, causing the liver tissue to take on the appearance of a sponge. Symptoms of liver damage due to cat scratch disease:

prolonged fever;
chills occur periodically;
the stomach feels “bloated”, which is due to the accumulation of gases in it;
the skin takes on a pale yellow appearance;
bleeding gums increases;
areas of hemorrhage associated with damage to the blood coagulation system may appear on the skin.

Complications

When Bartonella, which causes felinosis, spreads through the blood to various internal organs, may occur:

pleurisy;
myocarditis;
spleen abscess;
osteomyelitis;
arthritis;
atypical pneumonia.

The bacterium can also cause significant blood complications, consisting of a decrease in various blood cells:

platelets (thrombitopenic purpura);
red blood cells (hemolytic anemia);
eosinophilic leukocytes (eosinophilia);
leukocytes ().

Diagnostics

An infectious disease specialist is involved in the treatment and diagnosis of felinosis. This specialist is already appearance distinguishes cat scratch disease from wound suppuration. So, if a cat scratches and the hand swells, this is most likely (although an inspection needs to be done) infection of the wound with ordinary (nonspecific) flora: strepto- or staphylococci, Proteas, maybe fungal flora. Such suppuration begins already on the second day after a scratch or bite, the site of injury is red, painful, a light liquid may be released from it, and later pus. With felinosis, the scratch heals, and against the background of a crust or even without it, nodules appear in this place that do not fester, do not hurt or itch.

“Bloating” of the hand after a bite or scratch is most likely a description of phlegmon (purulent melting of tissue) or, even worse, an anaerobic infection of the type. Needed here urgent help surgeon, most likely with hospitalization.

If a person begins to be bothered by enlarged lymph nodes, a consultation with an infectious disease specialist is required. Best of all, not a doctor from a clinical hospital, but a doctor from the emergency department of an infectious diseases hospital. There is less chance of infecting other patients, because such manifestations, in the absence of nodules on the skin, must be distinguished from HIV infection, lymphogranulomatosis, infectious mononucleosis, as well as such dangerous diseases as plague and tularemia.

Having suspected felinosis based on the medical history (contact with a cat, the appearance of nodules), an infectious disease doctor will help confirm the diagnosis with the help of studies, for which he needs tissue material either from nodules, or from an abscess, or from a lymph node, for which the doctor must puncture the pathological element and take its contents for the following types of research:

by polymerase chain reaction (PCR): this is how B.hanselae particles are detected and recognized. The analysis is performed by paid laboratories;
histological: under a microscope, characteristic tissue changes, as well as bacteria, are visible.

Serological tests - the determination of antibodies to Bartonella - also help in diagnosis. To do this, reactions called either ELISA or RSK are performed.

At 3-4 weeks of illness, you can conduct a skin allergy test by injecting a solution with Bartonella particles under the skin: in 90% of people with felinosis, the response will be redness and swelling in this place. This study has not been conducted in children.

A general blood test, in which the number of eosinophils is increased and the ESR is accelerated, does not confirm the diagnosis, but allows us to draw a conclusion about the severity of the disease. Determination of liver tests will help to find out whether the liver function is affected and to what extent, and an ultrasound of the abdominal cavity will reveal an enlargement of the liver and/or spleen, which will give reason to adjust the regime to semi-bed (the spleen is a delicate organ, its capsule can be damaged by severe human activity).

Treatment of the disease

Felinosis is treated as follows: medications are prescribed for systemic use, compresses, and surgical treatment can be used.

Typical uncomplicated lesions of the heart, liver, spleen, and nervous system can be treated at home. Other forms require hospitalization of the person.

Drug treatment

Appointed:

Antibiotics: doxycycline, erythromycin, tetracycline, ofloxacin, gentamicin, clarithromycin. They are used in the form of tablets, and in case of eye damage, also in the form of eye drops.
Anti-inflammatory and painkillers: ibuprofen, mefenamic acid.
Antihistamines: cetrin, L-cet, zodak, erius and others.
In severe cases, glucocorticoids may be prescribed: dexamethasone, prednisolone.

Compresses

It is recommended to apply compresses to the area of inflamed lymph nodes. Take 1 part dimethyl sulfoxide to 4 parts water, wet gauze with this mixture, apply it to the lymph node, put polyethylene on top, and then secure it with a bandage and insulate it with a warm cloth.

Physiotherapeutic methods

The area of inflamed lymph nodes is exposed to UHF and diathermy.

Surgery

If the affected lymph nodes are tense and painful, they are punctured for the purpose of drainage: this way the pressure in the node decreases, which helps in relieving the pain process.

Cat scratch disease in children

Felinosis in children usually occurs in a typical form: a scratch from a cat's claw goes away, and nodules appear in its place, which suppurate and open. After this, 1 or several nearby lymph nodes enlarge. The disease lasts about a month and can go away even without treatment.

An atypical form may develop in HIV-infected child, a child who has undergone chemotherapy or organ transplantation. In this case, it is impossible to predict which organ or system will be affected. Symptoms of atypical forms in children correspond to those described above.

Diagnostics in children is the same; punctate PCR is its main method.

Treatment is carried out with the drug Sumamed at a dose of 10 mg/kg per day. From 8 years of age, doxycycline or tetracycline can be used. Drugs such as ciprofloxacin or ofloxacin are allowed from 16-18 years of age.

Disease prognosis

In most cases, the disease ends with the complete disappearance of all symptoms. With timely treatment, even severe forms of pathology can be cured. The prognosis for damage to the nervous system is questionable, since Bartonella can cause irreversible changes in the brain.

Prevention of disease

What to do if a cat scratches you:

wash the wound with laundry soap under running water;
treat with 3% hydrogen peroxide;
cauterize with alcohol or brilliant green.

Taking antibiotics is ineffective. Treatment of cats as potential sources of infection is useless.

Cat scratch disease has several synonymous names, among which the most famous is felinosis. No matter how much we love pets, most often it is cats who bring us this infectious disease - for this reason the name has taken root. Although dogs, monkeys, etc. can be carriers of the infection.

It is important to understand that cats and other pets do not react in any way to the presence of the causative agent of felinosis. They do not develop any pathology. But they are carriers of the pathogen.

It is a mistake to think that cat scratches and bites are not dangerous to humans.

For reference. Statistics show that people under the age of 21 are at risk, and almost 90% of them have been bitten or scratched by kittens. The peak incidence rate is believed to occur between September and March.

Cat scratch disease, also called felinosis, is an acute zoonotic infectious pathology, characterized by transmissible contact routes of infection and characterized by damage to the lymphatic system and the occurrence of specific skin lesions at the site of bacterial penetration (primary affect) in the form of suppurating papules.

For reference. In some cases, patients develop conjunctivitis, angiomatosis (proliferation of blood vessels) and liver tissue damage.

ICD 10 classifies cat scratch disease as A28.1.

Cat scratch disease - causative agent

For reference. Mostly children and adolescents suffer from felinosis. After suffering from the disease, stable lifelong immunity is formed. Repeated cases of the disease are extremely rare.

Felinosis - cat scratch disease: causes

Cats are the reservoir of Bartonella felinosis. Humans become infected when a cat infected with Bartonella bites, scratches, or licks damaged skin. Infection is also possible when Bartonella gets on the eye conjunctiva.

In isolated cases, a person may become infected after a cat flea bite.

Attention. A person infected with cat scratch disease is not contagious.

Cats are infected by flea bites. In the future, Bartonella can remain in the cat’s body for more than 12 months without causing illness and occurring in the form of asymptomatic bacteremia.

How does cat scratch disease develop?

Cat scratch disease begins with lymphogenous and hematogenous spread of Bartonella from the entrance gate (bites, scratches). At the same time, Bartonella actively penetrates erythrocyte cells, as well as vascular endothelial cells.

In patients with various immunodeficiency conditions, this process may be accompanied by the development of bacillary angiomatoses (proliferation of vascular tissue, especially small capillaries).

The occurrence of bacillary angiomatosis can be accompanied by significant damage to erythrocyte cells and bone marrow.

In places of massive penetration of the pathogen, the process of active proliferation of endothelial cells begins and inflammation develops, involving adjacent tissues in the pathological process.

For reference. Subsequently, some of the cells of the affected endothelium undergo necrosis, leading to the development of lymphadenopathy (damage to the lymph nodes) typical of cat scratch disease. Neutrophilic and eosinophilic cells accumulate around areas with inflammatory infiltrates.

Felinosis bacteria can infect:

vascular endothelium,
erythrocyte cells,
skin,
Bone marrow,
The lymph nodes,
liver,
endocardium

In some cases, the disease is accompanied by the occurrence of severe endocarditis with the occurrence of multiple bacterial vegetations and perforations on the valve leaflets.

In patients with bacillary angiomatosis, there is a massive proliferation of affected vascular endothelial cells with the appearance of single or multiple hematomas protruding above the skin (hematomas can be on a short stalk).

These formations are painless, however, if they are damaged, bleeding occurs. In some cases, papules and hematomas may become necrotic.

For reference. The size of these tumors can vary. In severe cases, the size of hemangiomas can reach 1-2 centimeters.

Felinosis - classification

The disease can pass:

atypical
typically.

In typical cases, benign lymphoreticulosis develops. Atypical forms of cat scratch disease include bacillary angiomatosis and ocular variants of felinosis.

Cat scratch disease - symptoms

The incubation period for felinosis ranges from three to twenty days (usually seven to fourteen days).

For reference. When typical forms of cat scratch disease occur, a primary affect is formed - a small papule at the site of already healed wounds (scratches or bites). The size of the papule can vary from two to five millimeters. They are painful, protrude above the skin and are surrounded by a halo of hyperemia.

Subsequently, the papules transform into vesicles or pustules, and then into ulcers covered with crusts. It should be noted that in some cases, the primary affect does not form during felinosis (in approximately 30% of patients). Also, it is not always detected during examination, since by the time you see a doctor, the crust has already fallen off and the ulcer has completely healed.

In most cases, the primary affect of cat scratch disease is located on the hands or forearms. In rare cases, on the skin of the face, legs, torso, etc.

The general condition of patients at this stage of felinosis is not impaired. Within 14-20 days, damage to the lymphatic system occurs, occurring as regional lymphadenitis. Most often, felinosis is accompanied by damage to the elbow and axillary lymph nodes, less often - to the parotid, cervical and inguinal.

For reference. The affected lymph nodes can increase to five centimeters in diameter. On palpation, they are mobile, dense, low-painful, and not fused to the skin. The inflammatory process can involve one or several regional lymph nodes.

Hepatosplenomegaly may also be present. Enlarged lymph nodes can last from several months to a year.

In half of the patients, enlarged lymph nodes are accompanied by weakness, fever and symptoms of general intoxication. The duration of the febrile period can be from one to three weeks.

Suppuration of the lymph nodes can occur approximately a month after the onset of primary affects, however, with a mild course of the disease, felinosis can be accompanied only by regional lymphadenitis (without further suppuration of the lymph nodes).

The affected lymph nodes are enlarged, painful and adherent to the skin. Redness and tension of the skin over them are noted. When palpating the lymph node, fluctuation is noted.

For reference. Subsequently, a fistula forms, from which purulent contents can be released for several months.

In severe forms of the disease, approximately five percent of patients experience damage to the central nervous system, manifested by serous meningitis, polyneuritis, myelitis, paraplegia, and polyneuritis.

Also, with cat scratch disease, the development of thrombocytopenic purpura, myocarditis, pneumonia, endocarditis, osteomyelitis, and splenic abscesses is possible.

Symptoms of the ocular forms of cat scratch disease are:

unilateral conjunctivitis (the second eye is rarely affected);
pronounced swelling of the eyelid;
the appearance of ulcerating yellowish nodules on the upper eyelid;
the appearance of purulent discharge from the eye;
damage to the parotid lymph node, with its subsequent suppuration and the formation of a fistulous tract;
enlargement of the submandibular lymph nodes.

The duration of the disease can range from 1 to 8-10 weeks.

Development of hepatitis in cat scratch disease

In isolated cases, in persons with various immunodeficiencies, the formation of bacillary purpuric hepatitis is possible. This form of felinosis is accompanied by severe damage to the liver parenchyma.

Against the background of damage to the hepatic vessels, cystic formations filled with bloody contents form, compressing the hepatic parenchyma.

For reference. Against the backdrop of severe blood stagnation, liver dysfunction occurs. Vomiting, nausea, diarrhea, chills, fever, anemia, thrombocytopenia, bleeding, bloating, hepatomegaly, etc. are noted.

Diagnosis of cat scratch disease

When diagnosing felinosis, specific symptoms and medical history are taken into account.
(contact with a cat). A tank can be used to confirm the diagnosis. blood test and histological diagnosis of biopsy of lymph nodes, hemangiomas or papules.

Differential diagnosis of the disease is carried out with:

Kaposi's sarcoma,
tuberculosis of the lymph nodes,
cutaneous bubonic forms of tularemia,
bacterial lymphadenitis.

For reference. If necessary, consultation with narrow specialists (dermatovenereologists, surgeons, ophthalmologists, cardiologists) is recommended.

Cat scratch disease - treatment for children and adults

For mild cases of felinosis, treatment is carried out at home. Hospitalization is indicated for patients with severely complicated bacillary angiomatosis and purpuric hepatitis.

For reference. The length of sick leave depends on the severity of the patient’s condition and the presence of complications.

Treatment of felinosis is carried out with antibacterial drugs:

ciprofloxacin – 500 mg x 2 times a day orally,
azithromycin,
doxycycline – 100 mg x 2 times a day orally,
roxithromycin,
norfloxacin.

The duration of antibacterial therapy is from two to three weeks.

If bone tissue is damaged, combined antibacterial therapy (fluoroquinolone antibiotic and rifampicin) is prescribed.

Attention! Suppurating lymph nodes are not opened (to avoid the formation of fistulas), but punctured to remove purulent contents.

Usually, if treated correctly, the disease goes away completely within two to four months. If a relapse occurs, this means undertreatment of the primary disease. The course of treatment is repeated again and long-term prophylaxis with antibiotics is prescribed.

Felinosis: prevention

No specific prevention of cat scratch disease has been developed. To prevent infection, it is recommended to limit contact with stray animals, not let domestic cats go outside, and trim their claws regularly.

Attention. Bites and scratches should be treated with iodine or brilliant green.

Cat scratch disease (felinosis) is an infectious disease that begins to progress as a result of a cat bite or scratch. It occurs with the formation of a specific suppurating papule, which becomes the cause of regional lymphadenitis. The consequences of such a pathology can be extremely dangerous.

A person of any age can become infected, but the disease is still more often diagnosed in young children. This is due to the fact that children love to play with cats, and also because they the immune system is not yet formed enough to fully resist infection. Treatment of the disease is recommended to be carried out in a hospital setting under the supervision of specialists, but it is also possible to carry out therapy at home (in case of a mild form).

Etiology

The main reason for the progression of the pathology is the introduction of the mobile bacterium Bartonella into the body. It lives and actively reproduces in the oral cavity of mammals (cats, monkeys, dogs, etc.). The animals themselves are infested by fleas. Bartonella is found in their excrement, which remains on the animal's fur and skin. The pathogen enters the oral cavity and claws when the cat begins to lick the skin or simply itches.

Risk factors

keeping domestic cats;
disruption of cellular immune reactions;
long-term use of certain groups of medications: azatrioprine, glucocorticoids, cyclosporine, etc.

Development mechanism

Cat scratch disease begins to progress gradually. The pathogenic microorganism penetrates into the deep layers of the epidermis through microtraumas skin(scratches, abrasions, cuts, punctures). Inflammation with suppuration begins at the injection site. Infectious agents spread throughout the body through the blood and lymph. The inflammatory process also progresses in the lymph nodes.

General symptoms

The incubation period for cat scratch disease ranges from several days to 1.5 months. The fact that the bacterium does not immediately show its activity after being introduced into the body significantly complicates the diagnosis of felinosis. It is difficult to connect a scratch that was received a month ago with the deterioration of the patient’s condition at the moment. Symptoms of the disease usually appear gradually.

After the scratch heals, a small red bump appears in its place. If you press on it, they appear painful sensations. He later regenerates into a bubble. Either one bubble or several may form. Pathological elements on the skin do not last long. After they disappear, an ulcer remains, covered with a crust on top. But cat scratch disease doesn't end there.

After the bubbles disappear, symptoms of the development of the inflammatory process in the lymph nodes begin to appear:

the lymph node enlarges;
temperature rise to critical levels (since the process is infectious, an increase of up to 40 degrees is possible);
When pressing on the affected lymph node, its pain is noted.

As felinosis develops, the patient's general condition gradually worsens. He develops prolonged and severe headaches and drowsiness. Sometimes observed increased sweating. 10 days after the first symptoms of the pathology appear, remission occurs. At this time, the inflammation in the node either goes away completely, or it is necessary to consult a doctor in order to remove the purulent contents from it.

Forms

Cat scratch disease has two forms of development:

typical;
atypical.

Typical

This form of felinosis is diagnosed in 90% of patients. Symptoms appear gradually. Damage to the skin and regional lymph nodes is observed. Inflammation of the lymph nodes in the neck, armpits, elbows, and groin area is more common. The affected node can increase in size up to 12 cm. With felinosis, a pronounced intoxication syndrome is observed:

headache;
temperature increase;
drowsiness;
increased fatigue;
lack of appetite;
pain in the muscle structures of the limbs;
increased sweating.

Atypical form

This form of felinosis occurs in 10% of cases. It is usually diagnosed in children, as well as the elderly (people whose body reactivity is reduced). The duration of the disease is from 6 to 8 weeks.

When infectious agents come into contact with the mucous membrane of the eye, there is a high risk of developing conjunctivitis. Symptoms in case of contact with skin:

fever;
the appearance of ulcers;
suppuration of injuries;
After healing, scars form.

Complications

If, when the first symptoms of felinosis appear, you do not consult a doctor and do not fully treat the pathology, then dangerous complications may develop. If it progresses, vision loss may occur. Damage to the central nervous system is possible. This leads to progression, inflammation of the brain and spinal cord.

Diagnostics

Diagnosis of felinosis includes:

personal examination by a dermatologist;
taking an anamnesis (especially checking whether there have been contacts with domestic animals, in particular cats);
skin test with specific Ar;
histological examination of lymph node material taken through biopsy.

Differential diagnosis:

Bubonic plague;
sporotrichosis;
babesiosis;
erysipeloid;
histoplasmosis.

Treatment

Treatment of the pathology should be carried out only after the diagnosis has been accurately confirmed. The doctor prescribes therapy based on test results, as well as taking into account the patient’s condition and the severity of his illness. In the case of mild felinosis, specific treatment is usually not required, since the symptoms disappear on their own after 2 weeks. The complex form involves treatment in a hospital setting with the following appointments:

antibiotics;
vasoconstrictor drugs;
painkillers;
the affected area must be treated with disinfectant solutions.

Doctors also treat complications that could develop due to pathology. It is possible to increase the dose of antibiotics and antimicrobial drugs if meningitis or endocarditis progresses. Treatment is considered effective if all symptoms of the disease disappear and the patient’s general condition stabilizes.

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