Systemic Cat Scratch Disease: Report of 23 Patients with Prolonged or Recurrent Severe Bacterial Infection

Abstract

Over a seven-year period, we identified 23 patients who had prolonged or recurrent, severe, systemic, cat-scratch disease (CSD). Compared with the usual, benign course in 1,038 patients with typical CSD, the course in these 23 patients included prolonged (two or more weeks) morbidity (fever, malaise, fatigue, myalgia, arthralgia, skin eruptions, weight loss, and splenomegaly). Five patients with systemic CSD had either neuroretinitis, pleurisy, arthralgia or arthritis, splenic abscesses, and mediastinal masses or enlarged nodes of the head of the pancreas. Recurrent CSD in two of three adults was confirmed by finding typical CSD bacilli in lymph nodes removed during separate episodes. The majority of patients were adult males, and all patients recovered completely without sequelae. Histopathologic studies of five skin and 18 lymph node biopsy specimens were diagnostic. CSD bacilli were detected in lymph nodes from 15 patients and in the primary skin lesions of four patients. CSD bacilli were found in both skin and lymph nodes of three patients.

Comparison of In-House and Commercial Slides for Detection by Immunofluorescence of Immunoglobulins G and M againstBartonella henselaeandBartonella quintana

“…However, a number of patients (e.g., 14% in the study of Flexman et al [24]) with elevated anti-B. henselae antibody levels report no previous contact with a cat, and many patients present with clinically atypical cases of CSD (14,41,61). Use of a restrictive case definition for CSD may erroneously increase the sensitivity of a serological test because only patients with evident epidemiological and clinical findings suggestive of CSD will be considered.…”

Bartonella henselae IgG antibodies are prevalent in dogs from southeastern USA

“…One of the most important Bartonella species that causes a broad spectrum of clinical conditions in humans is Bartonella henselae [17]. In immunocompetent patients, cat scratch disease (CSD) caused by B. henselae is mainly characterized by a benign regional lympadenopathy, while a low proportion of CSD patients may develop atypical manifestations [12,48]. Bartonella henselae is also a frequent cause of prolonged fever in children [33,62].…”

Isolation of Bartonella henselae DNA from the Peripheral Blood of a Patient with Cat Scratch Disease up to 4 Months after the Cat Scratch Injury

“…Typical CSD represents 86 to 95% of all cases and is characterized by chronic regional lymphadenopathy following a cat scratch (8). Atypical manifestations of CSD include involvement of various organ systems, such as the liver, spleen, and central nervous system, or prolonged fever in children (7,9). Our patient presented with signs that were compatible with typical CSD, i.e., mild lymphadenopathy and a persistent skin lesion at the primary inoculation site.…”