Dangerous symptoms of cat scratch disease. How to treat cat scratches

Cats most often have a playful character, which is reflected in the number of scratches the owner has. During play, the animal often loses control of its claws, and therefore inflicts wounds. These consequences are even given a special definition - BKC, which stands for “disease cat scratches" However, not every owner knows how to treat cat scratches and why skin damage takes so long to heal.

Why are scratches dangerous?

Small longitudinal wounds left by pets are not so safe. Bacteria ingested can cause felinosis or BCD. For infection to occur, the animal must itself be contagious and be a carrier of the disease.

The cat's sharp claws violate the integrity of the epidermis. Pathogenic bacteria enter an open wound from claws or licking. Cat scratches are also dangerous for humans because a small pimple without liquid inside begins to form around the skin. As the disease progresses, damage to the lymph nodes and other complications of the lymphatic system of the human body are possible.

Symptoms of felinosis

From the beginning of contact with the cat, felinosis does not manifest itself in any way. A small spot forms at the site of the scratch, which later develops into a papule and a small ulcer. The wound heals very slowly and constantly festeres. Its surface remains moist despite the use of healing agents.

Swelling or swelling occurs at the site of the scratch. The following symptoms occur occasionally:

• allergic reaction;
• toxicosis;
• painful sensations in the bones and body;
• fatigue;
• insomnia.

After three weeks, a person develops a fever, which is the first sign of damage to the body. The lymph nodes in the armpits and elbows are enlarged, and upon palpation they deliver discomfort and even pain. Possible suppuration, tonsillitis and a red rash.

Why do wounds take a long time to heal?

Lacerated wounds heal much harder than smooth ones. That is why a crust forms on the surface for a long time, which is periodically moistened. Insufficient treatment of a wound immediately after it appears only blocks healing, as bacteria and microbes accumulate in the scratch. The shape of the scratch makes it difficult to treat.

How to treat scratches

When a wound forms, first of all it must be disinfected. This helps prevent the spread of felizone bacteria and other infectious disease carriers.

This can be done using hydrogen peroxide, as well as chlorhexidine. Afterwards, the wound can be smeared with brilliant green, fucorcin or iodine.

If the scratch is deep and blood is oozing from it, then it is clamped with a sterile bandage for several minutes. The bleeding quickly stops and helps make the wound easier to clean.

Restore skin damaged by cats short term You can use healing ointments. The most effective are Levomekol, Panthenol, and Actovegin ointment. All of them have regenerating properties and are able to restore skin cells.

You can treat scratches from a cat using: traditional medicine. Fast healing Plantain juice, which every person used in childhood, promotes wounds. The crumpled sheet is applied to the scratch for several hours. Instead of plantain leaf, you can use beet tops, as well as yarrow leaves or weak compresses from it.

It is strictly forbidden to cover a scratch with cosmetics, as this manipulation can introduce an infection inside. You should not leave cat scratches unattended, as they can cause the development of pathologies of the lymph nodes.

Cat scratch disease is an acute or chronic infectious disease that develops after being scratched or bitten by an infected cat. In medicine, this pathology has several other names: felinosis, benign lymphoreticulosis, Mollaret granuloma. For the first time, felinosis was described independently by 2 scientists - R. Debre and P. Mollare - in the middle of the 20th century. At first it was believed that the disease was of a viral nature, but in 1963, scientists from Russia - V.I. Chervonskaya, A.Yu. Bekleshov and I.I. Terskikh - a pathogen was isolated, which turned out to be a bacterium of the rickettsia group - Rochalimaea henselae.

Causes, epidemiology and mechanism of disease development

So, the causative agent of benign lymphoreticulosis is a bacterium of the genus Rochalimea called Rochalimaea henselae.

The disease is widespread and is characterized by seasonality - 2/3 of incidence cases occur in the cold season. People of all ages suffer, but 8-9 out of 10 cases are children and young people under 20 years of age.

The natural reservoir and source of infection are mammals, in particular. The causative bacterium does not cause allergic reactions or others pathological conditions, but negatively affects human health. It is not transmitted from person to person.

The portal of infection is the skin of the upper and lower extremities, head, face and neck, and sometimes the conjunctiva.

The microorganism gets on and through the existing damage (scratches or others noted before contact with the cat or appeared as a result of it) penetrates deeper. As a result of the release of microbial toxins, inflammation develops at the site of injury. By destroying cells, the pathogen penetrates the lymphatic bed and, with the lymph flow, enters the nearest lymph node, where an inflammatory reaction also occurs. After this, the bacterium penetrates the blood and spreads throughout the body, settling in many organs and tissues. This phenomenon is called “dissemination of infection” and manifests itself pathological changes from the target organs (those on which the bacteria have settled) - enlarged lymph nodes, spleen and skin rashes, and so on.

Factors contributing to the development of this pathology are:

• disorders in the cellular immune system;
• long-term use of certain medications, in particular (prednisolone, methylprednisolone) and cytostatics (cyclosporine, azathioprine, cyclophosphamide);
• alcohol abuse.

In HIV-infected individuals, cat scratch disease is especially severe, characterized by a long, often atypical course.

After recovery, a person develops strong immunity.

Clinical manifestations of cat scratch disease

90% of cases of benign lymphoreticulosis are characterized by a typical course. The incubation period ranges from 3 days to 3 weeks. The onset of the disease is gradual: in the area of ​​the entrance gate of the infection (the scratch through which the pathogen entered has healed by this time), a tubercle (papule) appears, which after a few days turns into a vesicle or pustule, which then breaks through, forming an ulcer. The general condition of the patient at this stage does not suffer, remaining satisfactory.

After 2-3 weeks from the moment of infection, the most characteristic sign of cat scratch disease appears - regional (an inflammatory process in the lymph nodes located closest to the gate of infection). It is characterized by an increase in the patient’s body temperature to febrile (38-41°C) values, lasting from 7 to 30 or more days. In half of patients, fever may be absent.

In addition to fever, patients have other symptoms of intoxication: general weakness, lethargy, poor sleep and appetite, sweating, palpitations, which usually last no more than 2 weeks. Regional lymph nodes (usually axillary, elbow, cervical) are enlarged in size up to 3-5 cm, and in some cases up to 8-10 cm, they are not fused to each other and surrounding tissues, and are painless on palpation. In half of the cases, the affected lymph nodes suppurate. In 5% of patients, not only regional, but also other, distant groups of lymph nodes are involved in the pathological process - so-called generalized adenopathy develops. The average duration of adenopathy is about 3 months, but can last from 2 weeks to a year.

In approximately 5% of patients, as a result of the saliva of an infected cat getting on the conjunctiva of the eye, an atypical form of the disease develops - ocular. In this case, the pathological process usually involves 1 eye, the conjunctiva of which is sharply swollen, reddened (hyperemic), specific nodules appear on it, in place of which ulcers can form.

The anterior auricular lymph node is enlarged - reaches up to 5 cm or more in diameter, sometimes suppurates, after which a fistula is formed, leaving a scar in its place. In some cases, lymphadenopathy is determined not only in the anterior ear, but also in the posterior ear and submandibular lymph nodes. Often this process is accompanied by a significant increase in body temperature, as well as weakness, palpitations, deterioration of sleep and other signs of intoxication of the body. The duration of the ocular form of cat scratch disease varies from 1 week to 7 months, while its manifestations from the conjunctiva disappear after 7-14 days.

In isolated cases, benign lymphoreticulosis also affects the nervous system. 7 days - 1.5 months after the enlargement of the lymph nodes, neurological symptoms characteristic of myelitis, encephalopathy, and other diseases appear. Episodes of short-term disturbance of consciousness up to coma are possible.

HIV-infected patients, along with classic complaints, note the appearance of various sizes of hemorrhages in the skin, developing as a result of damage by the causative agent of vascular disease. This phenomenon indicates the spread of bacteria throughout the body through the bloodstream.

Complications of cat scratch disease include:

• myocarditis;
• spleen abscess;
• and others.

Diagnosis of cat scratch disease

As a rule, the diagnosis of “benign lymphoreticulosis” does not cause difficulties for a specialist. Already at the stage of the first conversation with the patient - collecting complaints and anamnesis data - he will suspect this particular disease, since he will perceive the connection between the patient’s contact with the cat and subsequent symptoms in the form of inflammation at the site of the scratch and in the area of ​​regional lymph nodes. A microbiological blood test or a histological study of material obtained by performing a biopsy of an element of the rash: a tubercle (papule), an abscess (vesicle) or the affected lymph node itself will help confirm or refute this diagnosis. In addition, in some cases, a diagnostic method such as molecular genetic testing of bacterial DNA isolated from a biopsy is used.

In a general blood test of individuals suffering from cat scratch disease, an increase in the level of eosinophils and erythrocyte sedimentation rate is determined.

This disease should be differentiated from the following conditions:

• tuberculosis of the lymph nodes;
• cutaneous bubonic form of tularemia;
• lymphogranulomatosis;
• lymphadenitis (inflammation of the lymph nodes) of a bacterial nature.

Treatment of benign lymphoreticulosis

In most cases, this disease heals spontaneously, but sometimes it cannot be avoided without medical intervention.

The greatest importance in therapy is played by etiotropic treatment, namely the use of antibacterial agents in order to quickly eliminate the causative microbe. Typically, antibiotics are used such as erythromycin, doxycycline, ciprofloxacin, azithromycin, clarithromycin, ofloxacin, chloramphenicols and others. In the case of an atypical ocular form of the disease, the antibiotic is used not only systemically, but also locally - in the form of eye drops.

In case of severe lymphadenitis, anti-inflammatory treatment is carried out using drugs from the group: diclofenac, nimesulide and others. Compresses with dimexide are also recommended - 1 part of the drug to 4 parts of water - applied 1-2 times a day for 2 hours.

With strong pain syndrome If necessary, painkillers are prescribed - ibuprofen, paracetamol.

In case of suppuration of the lymph node, it is punctured: under sterile conditions, the lymph node is pierced with a special needle, the contents (purulent masses) are sucked out and the cavity is washed with an antiseptic solution.

Prevention

Unfortunately, there are no specific preventive measures today. If a cat scratches or bites you, you should treat the damaged area with a disinfectant: hydrogen peroxide, alcohol or other antiseptic.

Cat scratch disease is an infectious disease that develops as a result of a scratch or bite from a cat infected with a pathogen. It has a number of other names: benign lymphoreticulosis, Mollare granuloma, felinosis. All of them, one way or another, are associated either with the source of infection - the cat, or with clinical manifestations - the formation of granulomas and inflammation of the lymph nodes. The disease can be acute or chronic and, as a rule, does not have serious consequences.

You can get infected from a cat dangerous infection

This disease was first described 85 years ago, in the early 30s of the last century, by French scientists A. Debreu and C. Fosha. 20 years later, a neurologist, also a Frenchman, V. Mollaret described benign lymphadenopathy that occurs after scratching a cat. Having linked the deterioration of health and unsuccessful games with cats, scientists have not been able to identify the pathogen. This only happened in the late 80s, when antibodies to Bartonellahenselae were detected in the blood of patients.

Bartonellahenselae is a gram-negative rod that can take different shapes, belonging to the Bartonella family. It enters the human body from a cat, which, in turn, becomes infected by the bite of the Cfenocephalidesfelis flea. The pathogen can live in the body of cats, most often kittens, for more than a year without harming their health. There is an opinion that the bacillus is part of the normal composition of the microflora of the oral cavity of animals, and about 50% of domestic and wild cats. Less commonly, felinosis develops after contact with dogs, rodents, goats, and even after pinching with crab claws.

The causative agent of the infection passes from cat to person

Living in the saliva of the animal, the pathogen enters the human blood through damaged skin through bites and scratches. Infection is also possible when a cat's saliva gets on the conjunctiva of a person's eye. The disease is not transmitted from person to person.

Cat scratch disease is more common in children and young people under 25 years of age.
Males are more susceptible to this disease. There are also cases described when a whole family is sick. Winter and autumn are the most the right times years for the infection to develop.

After recovery, stable immunity usually develops, although relapses occur among adults.

The main factor that contributes to the development of benign lymphoreticulosis is a lack of immunity. It can develop due to:

• pathologies of cellular immunity (for example, DiGeorge Syndrome);
• long-term use of certain medications, especially glucocorticosteroids (prednisolone, methylprednisolone);
• alcohol abuse;
• HIV infection.

In the case of immunodeficiency, a common form of the disease occurs, which is characterized by a more severe course.

Pathogens enter the blood causing inflammation

The pathogen, entering deep into the skin through the wound, begins to release toxins. This leads to inflammation developing at the site of penetration. Next, the microorganism enters the lymphatic vessels and, with the flow of lymph, into the nearest lymph node, where inflammation also develops. Next, the bacterium penetrates the blood and spreads throughout the body, settling in all organs and tissues. As a result of this, pathological processes develop in the affected organs: enlargement of the lymph nodes, liver, spleen, skin rashes and myocarditis.

Scratch made by a cat

The first manifestations of the disease appear after 8-15 days, but sometimes the incubation period can last 3 days or 1.5 months.

Felinosis occurs in a typical form, although an atypical course is not uncommon. A typical form is characterized by the presence of certain periods of its development:

• Initial period. After the incubation period, a “primary affect” appears: a rash in the form of red papules appears at the site of an already healed scratch. They resemble small peas and do not hurt or itch. After a few days, the papules resemble an abscess, which then bursts and turns into an ulcer. During this time, the person’s general condition does not deteriorate.
• The height of the disease. A few weeks after the formation of papules, the lymph nodes that are closest to the site of infection begin to become inflamed. Lymph nodes increase to 5 cm, and sometimes up to 10 cm in diameter, and become denser. When touched, it hurts. Inflammation of the inguinal, axillary and femoral lymph nodes is most characteristic of felinosis. Cat scratch disease sometimes manifests itself exclusively as pathology of the lymph nodes, which can last up to several months. During this period, body temperature rises to 38C, and sometimes to 41C. The fever can last from a week to a month. In addition, there are other symptoms of intoxication: lethargy, weakness, decreased appetite, sleep disturbances, headache, increased sweating and shortness of breath.
• Recovery. In most cases, the typical course of the disease ends on its own: the fever disappears, the lymph nodes stop hurting and gradually decrease in size.

Atypical forms of felinosis

If the body of a child or adult is weakened due to impaired immunity, or the pathogen enters the body in an unusual way, one of the atypical forms of the disease develops.

• Eye shape. It develops when a microorganism enters the conjunctiva of the eye. Cat scratch disease in this case manifests as granulomatous conjunctivitis. Basically, the process is one-sided and has quite pronounced symptoms. The eyelid becomes swollen, making it difficult for the patient to open the eye. The conjunctiva turns red, granulomas and ulcers appear. In addition, inflammation develops in the parotid and submandibular lymph nodes. Often such changes are accompanied by fever, general weakness, lack of appetite and other symptoms of intoxication. Eye symptoms disappear within a few weeks, but changes in the lymph nodes can persist for up to six months.
• Neuroretinitis. It can develop when the pathogen enters the typical route or through the conjunctiva. This form is swelling of the optic disc, mainly of one eye. The patient complains of blurred vision on one side, other manifestations are not typical. Therefore, most often the ophthalmologist is the first to conduct an examination and may suspect felinosis. This is not difficult to do, because this form has a characteristic symptom - “macular star”: spots resembling a star appear on the retina of the eye. In addition, nodules form on the retina, and changes in the vessels of the fundus are observed.
• Neurological form. Occurs quite rarely. A few weeks after damage to the lymph nodes, polyneuritis, radiculitis or neuropathy may appear. Encephalitis or meningitis are very rare. Short-term disturbances of consciousness and even coma are possible.
• Damage to the liver and spleen. Occurs in 5% of patients. This form is characterized by the formation of granulomas in the liver or spleen, which leads to inflammation in these organs. The general symptoms include an undulating course of fever and inflammation of many lymph nodes. Upon examination, an increase in the affected organs is detected, and an ultrasound scan confirms the development of granulomas in them.
• Bacillary angiomatosis. Attention is drawn to the skin manifestations of the disease: red-violet spots and papules appear, later forming nodes up to 3 cm in diameter, around which erosions appear in the form of a “collar”. The rash covers different parts of the body: face, neck, torso, arms and legs. Damage to the lymph nodes, as well as the liver and spleen, cannot be ruled out. All this is accompanied high temperature body and intoxication. This form of the disease is most typical for HIV infection.

Felinosis can occur in other forms, such as endocarditis, pleurisy, osteomyelitis, but they are extremely rare.

General analysis blood

As a rule, there are no difficulties in making a diagnosis. Even at the stage of communication with the patient, the doctor may suspect cat scratch disease based on the following signs: injury received during contact with the cat and the appearance of a papule at the site of the wound. During the examination, enlarged lymph nodes are also identified, and in atypical forms, the liver and spleen.

To finally confirm the diagnosis, it is necessary to carry out a series of laboratory research. For this purpose, the following is carried out:

• sowing of discharge from a papule or abscess;
• biopsy of a papule, abscess or lymph node followed by histological examination;
• detection of antibodies to the pathogen in the blood;
• general blood analysis.

These studies are necessary not only to confirm the diagnosis of felinosis, but also to exclude other diseases with similar manifestations. These include lymphoma, lymph node tuberculosis, tularemia and mononucleosis.

To make the disease go away faster, anti-inflammatory drugs are prescribed

Treatment of a disease with a typical course is carried out at home. Hospitalization is required for bacillary angiomatosis and high fever in children.

This disease tends to go away on its own, but drug treatment helps the body quickly get rid of the pathogen and ease its course. Usually prescribed

• antibiotics systemically and in eye drops for the ophthalmic form (doxycycline, azithromycin, erythromycin, ciprofloxacin, ofloxacin, rifampicin);
• non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac);
• antihistamines (Cetrin, Claritin, Erius).

Treatment is carried out by a therapist or infectious disease specialist. If necessary, consultation with other specialists is recommended: dermatologist, venereologist, ophthalmologist, cardiologist and surgeon.

As for prevention, there are no specific methods yet. Since cat scratch disease develops after prolonged contact with cats, it is advisable to reduce the number of such contacts. Domestic cats should undergo a systematic examination by a veterinarian, and it is better not to touch stray animals again. Since children are most susceptible to this disease, it is important to ensure that they do not play with stray cats. If the animal does bite or scratch the child, you need to treat the wound with any disinfectant: alcohol, peroxide, iodine or brilliant green. The same applies to adults.

If the first manifestations of the disease appear at the site of damage, you should consult a doctor.

• Which doctors should you contact if you have cat scratch disease?

What is Cat Scratch Disease?

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 Causes 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 observed - the most constant and characteristic symptom of the disease. 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 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. Lesions of regional lymph nodes are more often observed, internal organs(including the heart by type of 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 may ulcerate with the discharge of serous or bloody discharge and the formation of crusts).

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 Diseases

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 of 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 in normal condition immune system or 8–12 weeks for immunodeficiency (rifampicin may 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.

Cat scratch disease is an acute zoonotic infectious disease whose clinical symptoms were first described in the medical literature in 1931. Only in 1992 in the blood domestic cat The causative agent of this disease, Bartonella Henselae, was isolated and described, 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 observed and it can be characterized as a stage of asymptomatic carriage.
• The initial period, or debut of the disease. Primary affect appears, which is characteristic feature 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 is formed (a non-purulent formation that rises above the skin level).
• 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.
Inflammation of the lymph nodes is the most typical sign of this disease and persists throughout the entire illness (from two weeks to several months). In addition to the above symptoms, at the height of the disease, the patient may experience symptoms of general intoxication of the body: fever, increased sweating, general weakness and malaise, headaches, neuralgia, etc. The patient may experience hyperthermic syndrome in waves; the body temperature will rise to levels from 38 to 41 degrees. This condition is accompanied by chills and fever.
• 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 others infectious diseases. For atypical forms of the disease, patients may 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 typical shape clinical course, 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.