Abstract
To present a perspective on the current state of knowledge of cat scratch disease (CSD), including the evidence for Bartonella henselae as the etiological agent, epidemiological and clinical characteristics of the disease, available diagnostic tests and current therapeutic options. MEDLINE search of the literature published from 1966 to 1995 using 'cat scratch disease', 'Bartonella henselae', 'Rochalimaea henselae' as key words and bibliographies of selected papers. Selected studies reporting data on etiology, epidemiology, clinical characteristics, diagnosis and therapy of CSD were evaluated. Evidence accumulated to date supports B henselae as the etiological agent of CSD. The most significant risk factors for CSD are being licked on the face, scratched or bitten by a kitten and owning a kitten with fleas. Available serological tests can confirm classic CSD and identify B henselae as the cause of more atypical presentations, such as fever of unknown origin, granulomatous hepatitis, encephalitis and osteomyelitis. Symptomatic management is appropriate for isolated lymphadenopathy caused by CSD in healthy individuals; however, antibiotic therapy may be indicated for patients with more severe manifestations of the disease and immunocompromised hosts. Further study of CSD, in particular the epidemiology and therapy, is warranted. A better understanding of the pathogenesis of B henselae infection will have important implications in both immunocompetent and immunocompromised individuals.
Highlights
While bacillary angiomatosis (BA), bacillary peliosis (BP) and trench fever are caused by B quintana, this organism has not been identified in specimens from patients with cat scratch disease (CSD) by culture or polymerase chain reaction (PCR) [6,48,79]
B henselae has been established as the causative agent of CSD
Available serological tests can confirm the typical presentation of CSD and identify B henselae as the cause of more atypical cases, such as fever of unknown origin, granulomatous hepatitis, encephalitis and osteomyelitis
Summary
To present a perspective on the current state of knowledge of cat scratch disease (CSD), including the evidence for Bartonella henselae as the etiological agent, epidemiological and clinical characteristics of the disease, available diagnostic tests and current therapeutic options. In 1931 Debré observed the occurrence of regional lymphadenopathy following cat scratches, 20 years later published a report of “la maladie des griffe du chat”, establishing CSD as a clinical entity [1,2,3]. Serological testing for this organism in humans and their cats, as well as the culture of B henselae and the detection of B henselae DNA from lymph nodes in patients with clinical disease, supports the role of this organism in CSD [4,5,6,7]. Up to 30% of patients experience associated fever and malaise, with anorexia observed in 15%; these systemic symptoms may reflect unidentified systemic disease [2]
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