Cat scratch syndrome

A cat scratch syndrome (or benign lymphoreticulosis) is an infectious disease that develops as a result of a cat bite or a scratch. The disease is characterized by an increase in lymph nodes, located close to the site of injury, and a moderate total intoxication. In some cases, an adverse effect of the infection may be damage to the nervous system. Most children or teenagers get sick, most often in the winter or in the fall. Sometimes there are family outbreaks, when all family members become infected within 2-3 weeks. The disease is not transmitted from the infected person.

Causes of the cat scratch syndrome

The causative agent of the infection is a stick called bartonella (Bartonella henselae). Parasitize this rod in dogs, cats, small rodents, is contained in the microflora of the oral cavity. Infection occurs as a result of human contact with the animal - with a bite or scratch.

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Pathogenesis

Bacteria Bartonella henselae, entering the human body through a damaged skin or (occasionally) through the eye mucosa, causes a local inflammatory reaction, in the form of primary affect. After this, the bacteria through the lymphatic channels penetrate into the local lymph nodes, resulting in the development of lymphadenitis. The morphological changes occurring in the lymph nodes lead to the development of reticulocyte hyperplasia, the formation of granulomas and, later, microabscesses.

The spread of infection occurs through hematogenous dissemination, involving new target organs in the infectious process - other lymph nodes, as well as the central nervous system, liver and myocardium. Prolonged period and difficult (and often atypical) cat scratch syndrome occurs in people with HIV infection. 

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Symptoms of the cat scratch syndrome

After 3-10 days. On a damaged as a result of a scratch or a bite, a plaque or pustule forms, which often goes unnoticed and does not cause any particular inconvenience. After 2 weeks, inflammation of the lymphatic vessels and lymph nodes begins. Most often, knots at the back of the neck or neck, sometimes in the region of the thighs, groin, armpits, etc., increase. Only one node increase is observed in about 80% of cases. There may also be some additional signs that depend on the location of the enlarged lymph node - this may be pain in the groin, underarms or in the throat. Approximately 1/3 of the infected people experience headaches and fever. All these symptoms are manifested for 2-3 months, after which they spontaneously disappear.

[8], [9]

Complications and consequences

Among complications of the disease - atypical symptoms, which begin to appear after 1-6 weeks. After inflammation of the lymph nodes:

• Parino syndrome - usually unilateral conjunctivitis, in which nodules and ulcers are formed; the disease is accompanied by an increase in lymph nodes in the parotid and submandibular area, as well as the state of fever;
• predominantly one-sided neuroretinitis with reduced visual acuity. Disappears spontaneously, vision is restored almost completely;
• damage to brain structures;
• increased spleen, as well as liver;
• osteomyelitis.

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Diagnostics of the cat scratch syndrome

Diagnosis of the classic form of cat scratch syndrome is not difficult. If the reaction of other lymph nodes is absent, it is important to know that in recent times there has been contact with the cat, as well as signs of primary affect and local lymphadenitis (usually after 2 weeks).

[13], [14], [15], [16], [17], [18]

Analyzes

Confirm the diagnosis can be using a microbiological blood test, which is carried out with seeding on blood agar. In addition, a histological examination of the biopsy of the papule or lymph node with the coloring of the sections (using silver) is performed and the bacterial clusters are searched through a microscope. Another method is the molecular genetic analysis of the DNA of the source of infection from the patient's biopsy.

In some patients, an increase in the index of ESR and eosinophilia is observed in the hemogram. Taken 3-4 weeks after infection, the skin test, which has a characteristic antigen, gives a positive result in 90% of patients.

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Differential diagnosis

Differential diagnosis is performed with such diseases as tuberculosis of lymph nodes, skin-bubonic type of tularemia, bacterial lymphadenitis, and also lymphogranulomatosis.

Treatment of the cat scratch syndrome

Usually cat scratch syndrome after about 1-2 months is cured spontaneously. In some cases, to reduce pain in the inflamed lymph node, puncture can be performed, followed by removal of pus from it.

Medications

If the disease occurs without complications, the following medicines may be taken orally: erythromycin (500 mg four times a day), doxycycline (100 mg twice per day), or ciprofloxacin (500 mg twice daily). Preparations should be taken for 10-14 days if the patient's immune system is in order, or 8-12 weeks if immunodeficiency is observed (rifampicin can additionally be prescribed).

If complications occur in the form of endocarditis or osteomyelitis or any pathology of internal organs, administration of erythromycin (500 mg four times a day) or doxycycline (100 mg twice per day) is given parenterally for 2-4 weeks. After the end of this course, you must take the same drugs at the same dosage inside within 8-12 weeks.

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

Physiotherapeutic treatment

The area of inflamed lymph nodes can be treated with the help of physiotherapy methods - such as UHF or diathermy.

Alternative treatment

Among the alternative treatments one of the most effective is the use of the juice of calendula flowers (note that only fresh juice is suitable). This medicine has disinfectant properties, and also helps to speed up the wound healing process. The juice is applied to a clean cotton swab, through which a scratch or bite treatment is performed. The same curative properties and has a fresh juice celandine.

A good remedy is the yarrow, the fresh juice of which heals very effectively the various damages of the skin. Immediately after receiving a bite or a scratch, you should treat the damaged area with yarrow juice.

Also as a healing agent can be used nettle juice - it needs to moisten a piece of clean bandage, then attach it to a scratched or bitten place. Change compresses should be at least 10 times a day.

[21], [22]

Prevention

Methods of prevention of catnip scratch syndrome does not exist. To prevent the risk of infection, you need to withdraw the fleas from the cat and regularly cut her claws. In addition, you must follow the rules of hygiene and use caution with a pet. The resulting scratches and bites should immediately be treated with antiseptic drugs.

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Forecast

The cat scratch syndrome in classical form is usually spontaneously cured after 2-4 months. In the presence of complications, a full recovery comes if the correct and timely treatment was performed. If a relapse occurs, a re-therapeutic course is prescribed.

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