Cat scratch disease

Cat scratch disease - (a synonym - Lymphoreticulosis benign). For disease are characteristic a secund lymphadenitis, regional to a place of entrance hiluses of the originator, and a benign outcome of disease.

Aetiology - B. henselae. It is named in honour of D.Hensel who has secured the originator after persevering (more than 6000 seedings) cultivation attempts.

Disease obviously has more a wide circulation, than it is known by present time; possibly within habitals of the human and the cats bound to it.

Infestation of the human descends contact by, through damages of a skin or an eye conjunctiva.

Localisation of a place of entrance hiluses defines the subsequent involving of the regional lymph nodes draining a place of damage of a skin.

Symptoms and flow. The incubation interval lasts from 3 till 20 days (more often 7-14 days). On clinical implications it is possible to secure typiforms (about 90 %), showing in appearance of primary affect both a regional lymphadenitis, and atypical forms which include:

• Ophthalmic forms
• Lesion of the central excitatory system
• Lesion of other organs
• Cat scratch disease at a HIV-infected

Disease can proceed both in the acute form, and in the chronic. Differs as well on gravity of disease.

Typical disease begins, as a rule, gradually with appearance of primary affect. On a place of scratch which have already begun to live by then or a puncture of a cat there is a small papule with a dermahemia fillet, then it turns to a vesicle or a pustule, further in a small ulcer. Sometimes the pustule dries up without an ulceration. The primary affect is more often localised on arms, is rarer on the person, a neck, the inferior extremities. The general condition remains satisfactory. In 15-30 days after infestation the regional lymphadenitis - the most constant and characteristic symptom of disease becomes perceptible. Sometimes it is almost unique symptom. The fervescence (from 38,3 to 41°С) becomes perceptible only at 30 % of patients. The fever is accompanied by other signs of the general intoxication (the general delicacy, a headache, an anorexia, etc.) . Average duration of a fever about one week though at some patients it can be tightened about one month and more. Delicacy and other signs of an intoxication last on the average 1-2 weeks.

To brake ulnar, axillary, cervical lymph nodes are amazed. At some patients (about 5 %) the generalised lymphadenopathy educes. The dimensions of the enlarged lymph nodes more often in limens from 3 to 5 sm though at some patients they get 8-10 centimetres. Ganglions, painful at a palpation, are not soldered to surrounding tissues. At half of patients the struck lymph nodes abscess with formation of dense zheltovato-virescent pus at which sowing on usual nutrient mediums of a bacteriemic microflora to secure it is not possible. Duration of an adenopathy from 2 weeks till one year (on the average about 3 months). At many patients the augmentation of a liver and a lien which remains about 2 weeks becomes perceptible. Some patients (at 5 %) have an exanthema (rubeola, papular, as a nodulose erythema) which in 1-2 weeks disappears. On the typical clinical form it is necessary about 90 % of all cases of diseases.

Ophthalmic forms of disease are observed at 4-7 % of patients. On the implications these forms remind dorsal midbrain syndrome (Parinaud's Syndrome). Educes, possibly, as a result of hit on a conjunctiva of a saliva of the infected cat. One eye is amazed, as a rule. The conjunctiva is sharply hyperemic, hydropic, on this background appears one or several nodules which can canker. The lymph node located before an ear lobule of an auricle is considerably enlarged (reaching the dimensions of 5 sm and more), the lymph node often abscesses, reaches duration of a lymphadenopathy 3-4 months After a pyesis and formation of fistulas there are cicatrical changes of a skin. Submandibular lymph nodes are sometimes enlarged not only parotic, but also. For the acute season of disease the expressed fever and signs of the general intoxication is characteristic. Inflammatory changes of a conjunctiva remain within 1-2 weeks, and the general duration of the form of disease of the cat's scratch fluctuates from 1 till 28 weeks.

Changes of the excitatory system become perceptible at 1-3 % of patients. They show in the form of an encephalopathy, a meningitis, a radiculitis, a polyneuritis, a myelitis with a paraplegia. Neurologic symptoms are accompanied by a high fever. There are they in 1-6 weeks after lymphadenopathy appearance. At neurologic research tap diffusive and focal changes. There can be a short-term disorder of consciousness. Coma cases are described. Thus, lesions of the excitatory system educe against classical clinical implications of disease of the cat's scratch (at serious flow of this disease). They can be surveyed and complications of the given disease.

Can be observed and other complications: a Werlhof's disease, a primary atypical pneumonia, a lien abscess, a myocarditis.

The diagnosis and the differential diagnosis. Diagnostics of classical forms of disease of the cat's scratch does not represent the big difficulties. The great value has contact to a cat (at 95 % of patients), presence of primary affect and appearance of a regional lymphadenitis (more often in 2 weeks) in the absence of reaction of other lymph nodes. The diagnosis can be supported by a microbialogic blood analysis with seeding on a blood agar, histological studying of a biopsy sample of a papule or a lymph node with a staining of sections with application of silver and microscopical search of clumps of bacteria, and also molekuljarno-genetic research of DNA of the originator from a biopsy sample of the patient.

Differentiate from dermo-bubonnoj form of a tularemia, a scrofula, a lymphogranulomatosis, bacteriemic lymphadenites.