Cat scratch syndrome.

Cat scratch syndrome (or benign lymphoreticulosis) is an infectious disease that develops as a result of a cat bite or scratch. The disease is characterized by enlarged lymph nodes located close to the site of the lesion and moderate general intoxication. In some cases, an adverse effect of the infection may be damage to the nervous system. Mostly children or adolescents become ill, most often in winter or autumn. Sometimes family outbreaks occur, when all family members become infected within 2-3 weeks. The disease is not transmitted from an infected person.

Causes cat scratch syndrome.

The causative agent of the infection is a bacterium called Bartonella henselae. This bacterium parasitizes dogs, cats, small rodents, and is found in the microflora of the oral cavity. Infection occurs as a result of human contact with an animal - through a bite or scratch.

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Pathogenesis

Bartonella henselae bacteria, entering the human body through damaged skin or (rarely) through the eye mucosa, cause a local inflammatory reaction in the form of a primary affect. After this, the bacteria penetrate into local lymph nodes through the lymphatic pathways, resulting in lymphadenitis. Morphological changes occurring in the lymph nodes lead to the development of reticulocellular hyperplasia, the formation of granulomas and later - microabscesses.

The infection spreads by hematogenous dissemination, involving new target organs in the infectious process - other lymph nodes, as well as the central nervous system, liver and myocardium. The cat scratch syndrome is prolonged and severe (and often atypical) in people with HIV infection.

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Symptoms cat scratch syndrome.

After 3-10 days, a plaque or pustule forms on the site damaged by a scratch or bite, which often goes unnoticed and does not cause any particular discomfort. After 2 weeks, inflammation of the lymphatic vessels and lymph nodes begins. Most often, the nodes on the back of the head or neck increase in size, sometimes in the thighs, groin, armpits, etc. An increase in only one node is observed in about 80% of cases. Some additional symptoms may also be observed, which depend on the location of the enlarged lymph node - this may be pain in the groin, armpits or throat. About 1/3 of infected people experience headaches and fever. All these symptoms appear over the course of 2-3 months, after which they spontaneously disappear.

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Complications and consequences

Among the complications of the disease are atypical symptoms that begin to appear 1-6 weeks after inflammation of the lymph nodes:

• Parinaud's syndrome - usually unilateral conjunctivitis, in which nodules and ulcers form; the disease is accompanied by enlarged lymph nodes in the parotid and submandibular region, as well as a fever;
• predominantly unilateral neuroretinitis with decreased visual acuity. Disappears spontaneously, vision is restored almost completely;
• damage to brain structures;
• enlargement of the spleen and liver;
• osteomyelitis.

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Diagnostics cat scratch syndrome.

Diagnosis of the classic form of cat scratch syndrome is not difficult. If there is no reaction of other lymph nodes, it is important to know that there was recent contact with a cat, and signs of primary affect and local lymphadenitis are observed (usually after 2 weeks).

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Tests

The diagnosis can be confirmed by a microbiological blood test, which is carried out with seeding on blood agar. In addition, a histological examination of a papule or lymph node biopsy is performed with section staining (silver is used) and searching for bacterial clusters through a microscope. Another method is molecular genetic analysis of the DNA of the infection source from the patient's biopsy.

Some patients show an increase in the ESR and eosinophilia in the hemogram. A skin test taken 3-4 weeks after the infection appears, which has a characteristic antigen, gives a positive result in 90% of patients.

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Differential diagnosis

Differential diagnosis is carried out with diseases such as tuberculosis of the lymph nodes, cutaneous bubonic tularemia, bacterial lymphadenitis, and lymphogranulomatosis.

Treatment cat scratch syndrome.

Cat scratch syndrome usually resolves spontaneously in about 1-2 months. In some cases, a puncture may be performed to relieve pain in the inflamed lymph node, followed by removal of pus from it.

Medicines

If the disease proceeds without complications, the following medications can be used orally: erythromycin (500 mg four times a day), doxycycline (100 mg twice a day), or ciprofloxacin (500 mg twice a day). The drugs must be taken for 10-14 days if the patient's immune system is normal, or 8-12 weeks if there is immunodeficiency (in this case, rifampicin may be additionally prescribed).

If complications such as endocarditis or osteomyelitis or any pathologies of internal organs occur, erythromycin (500 mg four times a day) or doxycycline (100 mg twice a day) are administered parenterally for 2-4 weeks. After completing this course, the same drugs should be taken orally in the same dosage for 8-12 weeks.

Alternative drugs include azithromycin, ofloxacin, chloramphenicol, tetracyclines, and clarithromycin.

Physiotherapy treatment

The area of inflamed lymph nodes can be treated using physiotherapeutic methods such as UHF or diathermy.

Folk remedies

Among folk methods of treatment, one of the most effective is the use of calendula flower juice (keep in mind that only fresh juice is suitable). This medicine has disinfectant properties and also helps speed up the wound healing process. The juice is applied to a clean cotton swab, with which the scratch or bite is treated. Fresh celandine juice has the same healing properties.

Yarrow is also considered a good remedy, the fresh juice of which very effectively heals various skin injuries. Immediately after receiving a bite or scratch, the damaged area should be treated with yarrow juice.

Nettle juice can also be used as a healing agent - soak a piece of clean bandage in it, then apply it to the scratched or bitten area. Compresses should be changed at least 10 times a day.

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Prevention

There are no methods for preventing cat scratch syndrome. To prevent the risk of infection, you need to remove fleas from your cat and trim its claws regularly. In addition, you need to follow hygiene rules and handle your pet with care. Any scratches or bites should be treated with antiseptics immediately.

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Forecast

Classic cat scratch syndrome usually heals spontaneously after 2-4 months. In the presence of complications, full recovery occurs if the correct and timely treatment was carried out. If a relapse occurs, a repeated therapeutic course is prescribed.

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