Cat-scratch fever

Abstract

Summary This report, concerned with cases of cat-scratch fever, is the result of a series of studies carried out in children in the South Texas area. Within the past eighteen months twelve cases of cat-scratch fever have come to our attention, which emphasizes again the probable widespread incidence and frequent observation of this disease in the everyday practice of medicine. all of these patients showed the characteristic features of the disease: malaise, fever, and unexplained local adenopathy, in which the size of the enlarged lymph node may be quite impressive. The incubation period is somewhat variable, averaging from ten to thirty days. As a rule, the patient does not appear acutely or chronically ill. In most instances the history will reveal some association with cats, although the location or time of a specific scratch may be uncertain. At the time that medical advice is sought, lymphadenopathy is the chief presenting symptom, and there may be an exacerbation of redness and swelling at the site where a primary lesion has been in the process of healing. Patients with cat-scratch fever show uniformly a positive skin reaction when tested by intradermal injection with an antigen prepared by the Frei procedure from the bubo of a known case of cat-scratch fever. The preparation of this antigen for skin testing is described in detail. As a basis for comparison in the present study, a group of “control” subjects was tested for skin reaction of the type observed in cat-scratch fever. This group consisted of normal volunteers who showed complete absence of response to intradermal injection of the antigenic material, patients with no evidence of lymph node disease and patients with suppurative or nonsuppurative adenopathy thought to be attributable to other causes than catscratch fever. The results of these skin tests were negative consistently. No untoward effects of any kind occurred as a result of the injection of the antigenic skin-testing materials. In the course of the study, skintestingantigens were prepared from material obtained by needle aspiration of involved lymph nodes in three separate patients whose signs and symptoms were typical of cat-scratch fever. All three antigen samples gave similar results. With few exceptions the disease is mild and self-limited. No specific therapeutic measures have been of definite benefit in cases proved by skin-test reaction. Aureomycin seems to shorten the febrile course in some instances and to alleviate the systemic symptoms in some degree. While the etiology of this disease entity has not been clarified completely, there is considerable evidence in support of the view that the infectious agent concerned belongs to the psittacosis-lymphogranuloma group of viruses.