Lymphadenitis proximal to the site of entry.In
immunocompetent individuals, cat scratch disease is
usually self-limiting and benign, although the symptoms
may last for 1-5 months and occasionally longer
About
- Bacterial infection after cat scratch or lick
Aetiology
- Infected cat licks a person’s open wound, or bites or scratches a person hard enough to break the surface of the skin.
- Transmits Bartonella henslae. Gram negative rod fastidious, facultative, intracellular bacillus
Clinical
- Adults
- Initial formation of a papule/pustule at the
inoculation site
- Development of a solitary or regional lymphadenopathy within 1-2 weeks
- Tends to be self limiting in immunocompetent adult
- Clinical in Children or Immunocompromised
- Malaise, fatigue, enlarged parotid, Encephalitis, coma
- Pneumonia, osteomyelitis, erythema nodosum
- Localised Lymphadenitis often in children or teenagers
- Oculoglandular syndrome: conjunctivitis + enlarged preauricular lymph node
- Angioproliferative lesions resembling those of Kaposi sarcoma in the skin, liver, spleen, bone, and other organs.
- Self limiting within 2-3 months
Differentials
Investigations
- Organisms may be detected in tissues
with Warthin-Starry silver stain and Brown-Hopps Gram stain
- Cat Scratch Disease antigen skin test
- Biopsy shows caseating granulomas
- Low platelets, High ESR
Management
- Analgesia if needed. Antibiotics only needed if severe signs of systemic infection.
- Endocarditis: Surgical excision and replacement of the involved valve
may also be necessary
- Azithromycin 500 mg PO qd for 5 days
- Ciprofloxacin 500 mg bd x 7- 21 days
- Prolonged treatment (4-
6 months) has been used in patients who relapse
References