Cat Scratch Research Articles

Ocular manifestations of bartonellosis.

To review the systemic and ocular complications of Bartonella spp. infections specifically cat scratch disease, encompassing epidemiology, laboratory diagnostics, ophthalmic imagining, and treatment. Recent studies have shown that ocular manifestations occur in approximately 4.4% of cat scratch disease patients. The annual prevalence is lower than previously reported to be approximately 12 500 cases annually. Mainstay treatment continues to be oral antibiotics with and without corticosteroids and is dependent on associated systemic manifestations, age, and patient immune status. More recently anti-VEGF agents have been used for complications such as cystoid macular edema and choroidal neovascularization. Bartonella spp. infections continue to be a common cause uveitis with ophthalmic manifestations ranging from neuroretinits, vascular occlusions, to choroidal granulomas. Review of associated risk factors including contact with feline reservoirs will aid in recognition and diagnosis of this disease entity. Laboratory diagnostics continue to improve to help with the diagnosis of this entity.

Neuroretinitis: a review.

Neuroretinitis is an inflammatory disorder of the eye presenting with optic disc edema and the delayed development of a macular star secondary to optic nerve swelling toward the macular structures. Neuroretinitis can be divided into idiopathic, infectious (including neuroretinitis associated with cat scratch disease) and recurrent. The clinical presentation of neuroretinitis includes impaired visual acuity, dyschromatopsia, relative afferent pupillary defects and visual field abnormalities - particularly cecocentral and central scotomas. Features suggesting recurrent neuroretinitis include poorer visual recovery and visual field abnormalities representing damage to greater parts of the optic nerve. Treatment of neuroretinitis is based upon the cause of the disease. Specifically, in patients with cat scratch neuroretinitis, visual recovery is often favorable regardless of treatment with medication. However, some authors favor treatment with antibiotics early in the course of disease to limit progression and ensure eradication of the organism. Neuroretinitis can result from a number of infectious and noninfectious causes and it is essential that clinicians recognize the disease and determine the underlying etiology to ensure the best possible treatment and visual prognosis for the patient.

Neurological presentations of Bartonella henselae infection

Neurological symptoms in patients with cat-scratch disease (CSD) have been rarely reported. The aim of this study is to analyze the frequency of neurological CSD (NCSD) and describe the disease clinical presentation, management and outcome. We retrospectively selected patients with a CSD syndrome and Bartonella IgG titers > 1:256. Data regarding epidemiological, clinical, management, and follow-up features were analyzed and discussed. A comparison between NCSD and non-neurological CSD (NNCSD) was established. Thirty-nine CSD patients were selected. NCSD frequency was 10.25%. No children were found affected in the NCSD group. A 65.7% of NNCSD and the entirety of the NCSD group had a history of cat exposure. Immunosuppression was only present in the NNCSD group (8.6%). NCSD presentations were as follows: isolated aseptic meningitis (25%), neuroretinitis (50%), and isolated optic neuritis (25%). A greater proportion of patients in the NCSD group had fever and raised levels of acute phase reactants and white blood cells. 85.7% of NNCSD had a complete recovery, whereas only 50% of the NCSD patients experienced a full recovery. NCSD may be a distinctive group compared to NNCSD due to its later age of presentation, the more intense systemic response, and the poorer outcome.

Acute multifocal retinitis: a retrospective review of 35 cases

BackgroundAcute multifocal retinitis is a rare condition that has been considered to be often idiopathic. The purpose of this study was to analyze clinical features and causes of acute multifocal retinitis.ResultsThis study is a retrospective review of the charts of 35 patients with acute multifocal retinitis. Patients with three or more retinal lesions in at least one eye, with at least one lesion of less than 500 μm in size were included. All patients had complete ophthalmological examination, fundus photography, and fluorescein angiography. Twelve patients (34.3%) had optical coherence tomography. An extensive work-up was performed including a detailed comprehensive medical history, examination by an internist and an infectious disease specialist, a chest X-ray, Mantoux test, and laboratory tests for syphilis, human immunodeficiency virus, Bartonella, and Rickettsia. Of the 35 patients, 25 (71.4%) had bilateral involvement and 10 (28.6%) had unilateral involvement (total number of eyes: 60). Mean best-corrected visual acuity (BCVA) was 20/25 (range, 20/1000–20/20). Retinal lesions ranged from 3 to more than 20 in number in at least 1 eye, and from 150 to 1500 μm in size. Associated findings included mild anterior chamber inflammation in 5 eyes (8.3%), mild vitritis in 46 eyes (76.7%), optic disc swelling in 9 eyes (15%), macular star in 4 eyes (6.7%), exudative retinal detachment in 6 eyes (10%), and branch retinal artery occlusion in 6 eyes (10%). Acute multifocal retinitis was found to be caused by Rickettsia conorii infection in 20 patients (57.1%), Rickettsia typhi infection in 4 patients (11.4%), cat-scratch disease in 8 patients (22.9%), and syphilis in 1 patient (2.9%). It was idiopathic in two patients (5.7%). Retinal lesions resolved without scarring in 3 to 12 weeks in all but three eyes (5%), in which residual retinal pigment epithelial changes were noted.ConclusionRickettsial disease was the most common cause of acute multifocal retinitis. Other identified causes included cat-scratch disease and syphilis, and a very small subset of patients was diagnosed with idiopathic multifocal retinitis.

Imaging of Cat Scratch Disease

Cat scratch disease is caused by the inoculation of Bartonella henselae, a gram-negative bacterium, by either a bite or a scratch from an insect or a cat, and it most frequently occurs in adolescence. Cat scratch disease most commonly presents with fever, headache, fatigue, and tender regional lymphadenopathy that subsides in several weeks, with or without antibiotics. However, in 5% to 10% of patients, cat scratch disease may disseminate to involve multiple organ systems and mimic more serious systemic conditions both clinically and radiologically, requiring a more in-depth investigation.1 This article presents the common and rare imaging features of regional and multiorgan cat scratch disease using a multimodality imaging approach. We highlight key characteristics so that they may become more recognizable to the radiologist.

Imaging of Cat Scratch Disease

Imaging of Cat Scratch Disease

Neuroretinitis caused by Bartonella henselae: case report

Cat scratch disease is an infectious disease caused by Bartonella henselae characterized by regional lymphadenopathy and fever.Although it may involve other organs, ocular involvement is rare (5%-10%) and may manifest as neuroretinitis. We present a case ofan 11-year-old patient admitted to the emergency department because of vision loss on the right eye, detected on a vision screeningtest. Ophthalmological evaluation showed disc swelling, peripapillary microhaemorrhages and macular oedema with lipid-richexudates, suggestive of the macular star pattern. Serological studies revealed elevated titre of antibodies to Bartonella henselae. Thepatient was treated with rifampicin and doxycycline, with optimal response. Neuroretinitis is an uncommon manifestation ofBartonella henselae infection and should be suspected in any patient presenting loss of visual acuity, along with the fi nding of discswelling, macular star exudates, and a history of contact with cats. Most patients recover most or all of their pre-infection visual function,however, a small subset of patients with particularly severe neuroretinitis may be left with optic sequelae. There are no randomizedtrials on the eff ectiveness of treatment but antibiotic therapy with rifampicin and doxycycline seems to shorten the course of thedisease and hasten visual recovery.

A Rare Case of Cat-Scratch Disease Presenting as Axillary Lymphadenopathy with Non Tuberculous Mycobacterial Infection

A Rare Case of Cat-Scratch Disease Presenting as Axillary Lymphadenopathy with Non Tuberculous Mycobacterial Infection

Photodynamic Therapy as a Clinical Tool in the Management of Cat Scratch Lesions: Case Report

Several studies have demonstrated that photodynamic therapy may be an effective treatment for wound healing. It causes antibacterial induction, early activation of fibroblasts in ulcers, and improvement in the dermal matrix organization. In this context, this report describes the case of a 9-year-old boy who presented with multiple lesions on his face after he was attacked by a stray cat; treatment was sought after 1 week for multiple erythematous and ulcerated lesions on the lip philtrum and nose, with involvement of the nasal cartilage. Because it was not possible to identify a microbiologic pathogen, photodynamic therapy, using 0.05% methylene blue solution with 660 nm red laser (90 J/cm2), was provided in a single session. Clinical remission of the lesions was observed 48 hours after the session, without the use of antimicrobial drugs. The patient was monitored for 7 days; no clinical signs of the infection or remnants of the lesions were observed.

Cat scratch disease in children, a five year study in a pediatric tertiary hospital

Cat scratch disease in children, a five year study in a pediatric tertiary hospital

Cat Scratch Disease Osteomyelitis

Cat scratch disease, an infection caused by Bartonella henselae, is responsible for a variety of clinical manifestations, including (most commonly)

Depressiveness and Neuroticism in Bartonella Seropositive and Seronegative Subjects-Preregistered Case-Controls Study.

Several recent studies have demonstrated the association of cat-related injuries with major depression and with depressiveness in the general population. It was suggested that cat-scratch disease, the infection with the bacterium Bartonella henselae, can be responsible for the observed association. However, no direct evidence for the role of the Bartonella infection in this association has been published until now. In this preregistered case-controls study performed on 250 healthy subjects tested earlier for the presence of anti-Toxoplasma IgG antibodies, we searched for the positive association between presence of anamnestic anti-Bartonella IgG antibodies and depressiveness measured with Beck II inventory, depression subscale of neuroticism measured with N-70 questionnaire, and self-reported health problems. We found that that Bartonella seropositivity was positively correlated with Beck depression only in Toxoplasma-seronegative men and negatively correlated with health in Toxoplasma-seronegative women. Bartonella seropositivity expressed protective effects against Toxoplasma seropositivity-associated increased neuroticism in men while Toxoplasma-seropositivity expressed protective effects against Bartonella seropositivity-associated health problems in women. A comparison of the patterns of association of mental and physical health problems with Bartonella seropositivity and with reported cat-related injury suggests that different factor, possibly infection with different pathogen transmitted by cat related-injuries than the B. henselae, is responsible for the observed association of cat related-injuries with depressiveness and major depression. The existence of complex interactions between Bartonella seropositivity, Toxoplasma seropositivity, and sex also suggest that the effect of symbionts on the host's phenotype must by always studied in the context of other infections, and separately for men and women.

Bartonella spp. as a Possible Cause or Cofactor of Feline Endomyocarditis–Left Ventricular Endocardial Fibrosis Complex

Endomyocarditis is a commonly detected post-mortem finding in domestic cats presenting for sudden onset cardiovascular death, yet the aetiology remains unresolved. Cats are documented reservoir hosts for Bartonella henselae, the infectious cause of cat scratch disease in man. Various Bartonella spp. have been associated with culture-negative endocarditis, myocarditis and sudden death in man and animals. We hypothesized that Bartonella spp. DNA could be amplified more often from the hearts of cats with feline endomyocarditis-left ventricular endocardial fibrosis (FEMC-LVEF) complex compared with cats with hypertrophic cardiomyopathy (HCM) or cats with grossly and microscopically unremarkable hearts (designated non-cardiac disease controls). Formalin-fixed and paraffin wax-embedded, cardiac tissues from 60 domestic and purebred cats aged 3 months to 18 years were examined, and histological features were recorded. Cardiac tissue sections were tested for Bartonella DNA using multiple 16-23S intergenic transcribed spacer region polymerase chain reaction (PCR) primer sets, including two Bartonella genera, a Bartonella koehlerae species-specific and a Bartonella vinsonii subsp. berkhoffii-specific assay, followed by DNA sequence confirmation of the species or genotype. Special precautions were taken to avoid DNA cross-contamination between tissues. Bartonella spp. DNA was amplified by PCR and sequenced from 18 of 36 cats (50%) with FEMC-LVEF and 1/12 (8.3%) cats with HCM. Bartonella spp. DNA was not amplified from any non-cardiac disease control hearts. Based on PCR/DNA sequencing, one Bartonella spp. was amplified from 10 cats, while the remaining eight were coinfected with more than one Bartonella spp. To our knowledge, this study represents the first documentation of B. vinsonii subsp. berkhoffii genotype I infection in cats (n=11). Fluorescence in-situ hybridization testing facilitated visualization of Bartonella bacteria within the myocardium of four of seven PCR-positive FEMC-LVEF hearts. Collectively, these findings support the hypothesis that Bartonella spp. may play a primary role or act as a cofactor in the pathogenesis of FEMC-LVEF. Studies involving cats from other geographical regions and definitive demonstration of Bartonella spp. within regions of inflammation are needed to confirm an association between Bartonella spp. and FEMC-LVEF induced morbidity and mortality in cats.

Cat scratch disease - a case report

Cat scratch disease is benign self-limiting infectious disease caused by B.Henselae. It can occur world-wide with no racial or sex predilection. Cats are the major reservoirs. Transmission can occur through biting, scratching and licking. Patients present with regional lymphadenopathy. A 17-year-old male presented with a single swelling in the inguinal region of 15 days duration. It was gradually increasing in size. The swelling measured 6cm * 5cm, soft to firm in consistency, non-tender. The mobility was restricted. Fine needle aspiration cytology was performed which was diagnosed as granulomatous lymphadenitis. The swelling was excised and sent for histopathological examination. Histopathologically, a final diagnosis of Cat-scratch lymphadenitis was made. Cat-scratch Disease is a self-limiting illness in an immuno-competent host. The associated lymphadenitis is mainly solitary and unilateral. Although it is not a unique diagnosis, Cat-scratch disease is required to implement appropriate and targeted antibiotic therapy.

Manifestations ostéo-articulaires secondaires à une piqûre, griffure, morsure ou à germes inhabituels ou émergents

Osteoarticular manifestations after a sting, a bite or a scratch are rare but the diagnosis should not be neglected. Targeted antibiotic therapy is mandatory. Surgery might help the diagnosis with adequate biopsy and is sometimes essential for recovery. A detective work is needed to identify a history of wound. Pantoea agglomerans (P. agglomerans) and nocardiosis are seen after a telluric wound, Capnocytophaga canimorsus (C. canimorsus) and Pasteurella multocida (P. multocida) after a dog bite, Bartonella henselae (B. henselae) and P. multocida after a cat scratch, Erysipelothrix rhusopathiae (E. rhusopathiae) when the wound is caused by a pig bone or a fishbone. A contact with water soiled with rat urine during work or leisure activity could indicate infection with Streptobacillus moniliformis (S. moniliformis) Spirillum minus (S. minus), Leptospira interrogans (L. interrogans). Bacteriological documentation might be difficult but is often mandatory to ascertain diagnosis and to adapt antibiotics. A sting can be responsible for a non-infectious arthritis. Inflammation is directly mediated by foreign body and is called “thorn arthritis”. Foreign body is often not seen on conventional radiography, hardly seen in ultrasonography, and surgery is needed to extract it and sometimes to perform synovectomy. Atypical mycobacteria are seen in patients with immunodepression but not only. Contact with fish or fishing material brings Mycobacterium marinum (M. marinum) to mind and a history of joint injection evoke Mycobacterium kansasii (M. kansasii). Surgery is frequently needed for diagnosis and treatment of tenosynovitis or arthritis caused by atypical mycobacteria. Tick-borne arthritis are mainly caused by Borrelia burgdorferi but can also involve Babesia divergens or Rickettsia conorii. Among arthropod-borne viruses, chikungunya provides a model of infection-triggered inflammatory joint disease.

Enfermedad por arañazo de gato en paciente pediátrico y revisión de la literatura

La enfermedad por arañazo de gato, es una infección, que se presenta usualmente con linfadenopatia dolorosa, o fiebre de origen desconocido. Se transmite por arañazo o mordedura de un gato bacteriemico y/o asintomático. En este artículo se realizó el análisis de un paciente de 6 años que ingresa al servicio de urgencias por fiebre, síntomas constitucionales, adenopatías, emesis, con contacto previo con mordedura y arañazo de gato. Se consideró posible enfermedad por arañazo de gato, se inició prueba terapéutica con azitromicina, y finalmente egreso. Ambulatoriamente llega reporte de IgM (Inmunoglobulina M) para Bartonella henselae 1/200 diluciones, con lo que se confirmó su diagnóstico.

Utility of Molecular Identification and Quantitation of Bartonella Species with Species-Specific Real-Time PCR for Monitoring Treatment Response: A Case Series.

Background:Bartonella species are intracellular bacteria capable of producing several diseases in humans. The three most common and wellknown diseases are cat scratch disease (CSD), caused by B. henselae, trench fever, caused by B. quintana and Carrion’s Disease, caused by B. bacilliformis. Signs and symptoms are very different and aspecific: Fatigue, fever, headache, lymphadenopathy, malaise, loss of weight. No data exist to support guidelines’ recommendations to decide which drugs should be optimally used and how long they should be administered. Therefore, a marker of treatment response is needed to guide treatment strategies.Methods:We report herein three cases in which a species specific Reverse-Transcriptase Polymerase-Chain-Reaction (RT PCR) developed in-house was performed and compared to serology in order to make diagnosis and to evaluate treatment response.Results:Our species-specific RT PCR seemed to play a fundamental role both in diagnosis and treatment. Moreover, a discrepancy with the serology results was found.Conclusion:Further studies are necessary to validate these results and elucidate what is the best treatment for this pleomorphic disease. However, in absence of clear guidelines, RT PCR may be useful to orientate kind of treatment ad its duration.

LIKELY BACTERIAL ACUTE CERVICAL LYMPHADENITIS IN CHILDREN: FACTORS PREDICTIVE OF FAVORABLE OUTCOME

Abstract BACKGROUND Cervical lymphadenitis is frequent in the paediatric population and usually the result of infectious agents. Management of likely bacterial acute cervical lymphadenitis (LBACL) mainly relies on expert advice and may vary widely from antibiotherapy to surgery as no official guidelines have been published over the last decade. OBJECTIVES To identify factors associated with favorable outcome in the management of LBACL in children in order to create a decision algorithm and its further evaluation. DESIGN/METHODS This retrospective observational study was based on the review of medical records of patient from 1 month to 18 years old who have consulted for LBACL between July 2010 and July 2015 at a tertiary care paediatric center. LBACL were identified using electronic record databases (hospitalization, emergency). Patients were included if they had acute (≤10 days) episode of unilateral cervical mass of which the final diagnosis was LBACL. Exclusion criteria were: mycobacterial adenitis, Kawasaki disease, Cat-scratch disease, bilateral cervical lymph node involvement, congenital malformation, immunodeficiency or underlying neoplasia. Favorable evolution was defined as outpatient treatment or hospital stay of 48 hours or less without surgical drainage. To identify factors at initial consultation predictive of a favorable outcome, we performed univariate logistic regression models with several potential independent covariates, including, among others, age (years), size of lymph node (mm), fever (38,5°C), an antibiotic use prior to consultation, fluctuation, absolute white blood cell count (x10^9/L), and purulent material at ultrasonography (yes/no). RESULTS Our final study cohort was composed of 166 patients with a mean age of 4,5 years (3,5SD) and 62% male. Ultrasound was obtained in 139(83,7%) patients and cervical tomodensitometry in 31(18,7%). Surgical drainage was performed in 35(21,1%). Overall, 68(41,0%) patients presented a favorable evolution from which 27(16,9%) were treated as outpatient (figure1). Factors associated with favorable outcome were (OR; 95%CI): age (1.17; 1.06–1.29; p=0.002), absolute white blood cell count (0.91; 0.87–0.96; p=0.001), no antibiotic use prior to consultation (0.26; 0.07–0.92; p=0.037) and absence of purulent material on ultrasound (0.07; 0.02–0.29; p<0.001). Size of lymph node (0.98; 0.96–1.00; p=0,057) or fluctuation (0.71; 0.21–2.39; p=0.57) did not achieved statistical significance. CONCLUSION Older patients without prior antibiotic use, those with lower absolute white blood cell count and no purulent material on ultrasound seem to better evolve than other children with likely bacterial acute cervical lymphadenitis. A decision algorithm to identify patients eligible for conservative management should include those predictive factors.

Bartonella henselaeDNA in Seronegative Patients with Cat-Scratch Disease

We used real-time PCR to detect Bartonella henselae DNA in 7.9% (5/63) of blood specimens from seronegative patients in Japan suspected of having cat-scratch disease. The combined use of serologic tests and real-time PCR to analyze blood specimens is recommended for the prompt, noninvasive laboratory diagnosis of cat-scratch disease.

Bartonella henselae and Rickettsia felis Detected in Cat Fleas (Ctenocephalides felis) Derived from Eastern Austrian Cats.

Cats and cat fleas (Ctenocephalides felis) are vectors of the zoonotic bacterial pathogens Bartonella henselae and Rickettsia felis, which are the causative agents of "cat scratch disease" and "cat flea typhus," respectively. In the surroundings of Vienna (Austria), we identified 11 (10.5%; n = 105) B. henselae-positive fleas originating from 8 cats (20.5%; n = 39). One flea was positive for R. felis. There should be high levels of awareness among veterinarians and animal keepers as to the handling of cats, especially if free roaming, stray, or feral.