Cat scratch disease is an acute zoonotic infectious disease, the clinical symptoms of which were first described in the medical literature in 1931. Only in 1992, the causative agent of this disease, BartonellaHenselae, which is a strain of gram—negative bacteria of the genus Bartonella, was isolated and described in the blood of a domestic cat. Most often, this disease occurs when a cat is bitten or scratched.
The content of the article:
Features of the course of feline disease in an atypical form of the disease
Causes of Cat Scratch Disease
Symptoms of Cat Scratch Disease
Diagnosis of cat scratch disease
Treatment of Cat Scratch Disease
Cat Scratch Disease
The disease has various clinical manifestations. It is customary to distinguish between typical and atypical forms of pathology. The 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 feline disease in an atypical form of the disease
Among the most common forms of atypical felinosis are the following:
ocular (the most common);
abdominal;
pulmonary;
cerebral and others.
When the pathogen enters the mucous membrane of the eye, the patient experiences the phenomena of ulcerative-granulomatous conjunctivitis: pronounced swelling of the conjunctiva and its hyperemia, single or multiple ulceration, representing 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 oculist, characteristic changes in the structures of the visual organs (retina, fundus and optic nerve) can be detected, the most common of them is the symptom of a “macular star”.
The most severe consequences are the neurological variant of feline disease. Clinical manifestations can be very different: from fever and a sharp deterioration in the general somatic condition of the patient to disorientation, confusion of thinking and coma.
The first symptoms of neurological manifestations occur 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 severe diseases: meningitis, encephalopathy, encephalitis, polyneuritis, sciatica, etc. The fact that this form of the disease occurs only in 2% of patients can be considered encouraging.
Some authors note the possibility of complications from the liver and spleen in cat scratch disease. In such conditions, the patient’s liver or spleen is significantly enlarged, the organs are susceptible to wave-like fever. The general somatic condition of the patient is disturbed, symptoms of intoxication of the body may appear.
Cat scratch disease, the symptoms of which are very diverse, is a rather serious pathology that requires immediate intervention by medical personnel.
Causes of Cat Scratch Disease
The vector of infection is cats, for which BartonellaHenselae is a conditionally pathogenic microflora. It is often impossible to visually distinguish a sick cat from a healthy one. It is worth noting that more often the carriers of bacteria of the genus Bartonella are young animals under the age of one year. Thus, in 90% of cases, when collecting anamnesis, contact with a cat was detected. There were cases when patients indicated contact with other animals: dogs, goats, squirrels, crayfish, etc. Infection occurs when an animal is bitten or scratched, as well as when licking damaged human skin. Cat fleas can also become carriers of pathogens.
Scientists have noted that young children and young people under the age of 20 suffer from cat scratch disease more often, while there is some seasonality: more 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 isolated. The bacterial microflora of BartonellaHenselae 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 narrow specialists in the treatment of patients (ophthalmologists, neurologists, pulmonologists, gastroenterologists, etc.).
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 course of diseases:
The incubation period, which has a duration of 3 to 60 days. During this period, there are no changes in the somatic state of patients and it can be characterized as a stage of asymptomatic carriage.
The initial period, or the onset of the disease. Primary affect is manifested, which is a 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 rising above the skin level).
The height of the disease. This stage is characterized by the fact that the papule is reborn into a pustule (pustular formation). The pustule has the property of opening up and forming a quite typical ulcer. Such an ulcer is covered with a crust, which disappears independently over time and leaves no traces on the patient’s skin. The main symptom of cat scratch disease is lymphadenitis — inflammation, enlargement and consolidation of lymph nodes. The lymph nodes of the cervical and axillary regions are more often inflamed, 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 disease (from two weeks to several months). In addition to the above symptoms, in the midst of the disease, the patient may experience the phenomena of general intoxication of the body: fever, increased sweating, general weakness and malaise, headaches, neuralgia, etc. The patient may have a wave-like hyperthermic syndrome, the body temperature will rise to values from 38 to 41 degrees. This condition is accompanied by chills and fever.
After 2-4 months, the cat scratch disease ends with a complete recovery of the patient. This period is called the period of convalescence (the final period of the course of the disease).
Diagnosis of cat scratch disease
The most specific and highly accurate method of 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 conduct laboratory and clinical studies of the patient’s blood (RIF, PCR, ELISA, etc.), as well as bacteriological studies of the contents of lymph nodes or abscesses.
Patients need differential diagnosis of felinosis with mononucleosis, lymphoma, cytomegalovirus, toxoplasmosis and other infectious diseases. With atypical forms of the disease, patients can be referred for consultation with narrow specialists (ophthalmologists, pulmonologists, cardiologists, dermatovenerologists, neurologists, cardiologists and others).
Treatment of Cat Scratch Disease
If the patient is diagnosed with cat scratch disease, treatment includes comprehensive symptomatic therapy. If the disease has a typical form of clinical course, then this condition most often passes on its own. In some cases, the doctor may decide to use drug therapy, which includes the use of antibiotics, nonsteroidal anti-inflammatory drugs and antiallergic drugs. In cases where suppuration of the lymph nodes occurs, they can be opened surgically or removed altogether.
Physiotherapy procedures in the complex treatment of felinosis show high efficiency. In atypical forms of pathology, symptomatic therapy is carried out in accordance with the prescriptions of narrow specialists.
