HistoryThis section has been translated automatically.
Parinaud, 1889; Petzetakis, 1935; Debré, 1950; Mollaret, 1950
DefinitionThis section has been translated automatically.
Worldwide occurring bacterial infectious disease with acute or sub-acute course and spontaneous healing, which is counted among the Bartonellosis. Inoculation of the pathogen often through cat scratches or bites.
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PathogenThis section has been translated automatically.
Occurrence/EpidemiologyThis section has been translated automatically.
EtiopathogenesisThis section has been translated automatically.
Infection with Bartonellae (formerly Rochalimaea) henselae (small pleomorphic bacteria). Pathogenetically, infection with cutaneous lymphonodermal primary complex occurs by exogenous inoculation, especially by cat scratch or bite injuries; infection but also by flea and tick bites is possible. Infected target cells (endothelial cells) induce release of growth factors (VEGF vascular endothelial growth factor), which lead to endothelial cell proliferation.
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Incubation period usually 10 days (3-60 days).
General symptoms: Subfebrile temperature or fever, headache, muscle and joint pain, fatigue, loss of appetite; generalized lymphadenopathy, splenomegaly.
Integument: inconspicuous primary effect at the entry site of the pathogen: inflammatory reddening, ulcerous nodules. After about 6 weeks lymph node enlargement in the lymph drainage area, rarely melting and perforation of the affected lymph node = primary complex.
Ectopic and atypical course: Oral and pharyngeal involvement with acute tonsillitis and fever, swelling of the cervical lymph nodes and occasionally retropharyngeal and peritonsillar abscesses.
Conjunctival (oculo-glandular) form (Parinaud syndrome): Unilateral (follicular) conjunctivitis and indolent ipsilateral preauricular lymphadenitis and fever.
Mesenteric form: Adenitis mesenterica, granulomatous abscessed hepatitis and splenitis.
Thoracic form: Mediastinal lymph node swelling.
HistologyThis section has been translated automatically.
(primary lesion and lymph nodes): Focal necroses with neutrophilic abscesses and surrounding granulomatous reaction. Later tuberculoid granulomas with star-shaped cystic necrosis.
Whartin-Starry silver impregnation and tissue gram staining according to Brown-Hopps: pleomorphic, comma-shaped to coccoid gram-negative bacterial clusters.
DiagnosisThis section has been translated automatically.
Clinic, histology (skin or lymph nodes), PCR diagnostics (serum, skin), ELISA (serum).
Culture from skin swabs: B. henselae shows good growth on anaerobic blood agar and chocolate plates. Small, non-hemolytic, rough, dry, yellow to grey colonies grow there.
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Occurrences may include encephalitis, encephalomyelitis, neuritis, neuroretinitis with acute amaurosis, pneumonia, splenomegaly, osteolytic changes, thyroiditis, glomerulonephritis, generalized swelling of lymph nodes.
Life-threatening courses can occur in immunocompromised patients.
TherapyThis section has been translated automatically.
For immunocompromised patients, intravenous therapy with 2x1g erthromycin over 3 weeks is recommended.
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Note(s)This section has been translated automatically.
A special form of manifestation is the oculoglandular Parinaud syndrome. Here, inoculation takes place at the conjunctiva. Clinically, conjunctival granulomas and a preauricular adenopathy are clinically impressive (Domínguez I et al. 2019).
Case report(s)This section has been translated automatically.
Unilateral lymphadenitis in cat scratch disease
Bartonella henselae is a relatively rare pathogen that can be the cause of a severe infection in immunocompromised patients.
A 76-year-old man with stable chronic lymphatic leukemia (CLL) presented with right-axillary, moderately painful lymphadenitis. At the same time he complained of general complaints such as: fever (up to 38.5C°), tiredness and headache. This was preceded by a cat bite on the ipsilateral finger.
Sonographically, an irregular, circumscribed 5 cm x 4 cm, low-echo mass with discrete blood flow was visible.
Lymph node biopsy: The histological findings were a granulomatous inflammation with central necrosis. Antibody detection of Bartonella antigen by PCR.
Laboratory: Non-specific increase of inflammation values (CRP↑ Leukocytosis) detectable.
The patient was treated with diagnosed cat scratch disease with erythromycin 1g/2x/day i.v. for 3 weeks. Thus a complete healing could be achieved.
This case underlines the classical presentation of this rare disease in an immunocompromised patient with cat contact. Early antibiotic use should be made at an early stage in patients considered at risk.
LiteratureThis section has been translated automatically.
- Balakumar A et al (2019) Isolated Axillary Lymphadenitis Due to Bartonella Infection in an Immunocompromised Patient. Cureus. 2019 Aug 21;11:e5456.
- Brenner DJ et al (1991) Proposal of Afipia gen. nov., with Afipia felis sp. nov. (formerly the cat scratch disease bacillus). J Clin Microbiol 29: 2450-2460
- Debré R et al (1950) Le maladie des griffes de chat. Bull med Soc Hôp Paris 66: 76-79
- Dolan ML et al (1993) Syndrome of Rochalimaea henselae adenitis suggesting cat scratch disease. Ann Internal Med 118: 331-336
- Domínguez I et al (2019) Isolated conjunctival granuloma as a first manifestation of Parinaud's
- oculoglandular syndrome: A case report. On J Ophthalmol Case Rep 14:58-60.
- Gonzalez BE et al (2003) Cat-scratch disease occurring in three siblings simultaneously. Pediatric Infect Dis J 22: 467-468
- Mirakhur B et al (2003) Cat scratch disease presenting as orbital abscess and osteomyelitis. J Clin Microbiol 41: 3991-3993
- Mollaret P et al (1950) Sur une adénopathie régionale subaiguë et spontanément curable, avec intradermo-réaction et lésions ganglionnaires particulières. Bull méd Soc Hôp Paris 66: 424-449
- Parinaud H (1889) Conjonctivite infectieuse transmise par les animaux. Ann Oculistique 101: 252-253
- Petzetakis M (1935) Monoadénite subaiguë multiple de nature inconnue. Soc méd Athènes, Seatzg of 16. 3. 1935, p 229
- Rolain JM et al (2003) Cat scratch disease with lymphadenitis, vertebral osteomyelitis, and spleen abscesses. Ann N Y Acad Sci 990: 397-403
- Wear DJ, Margileth AM, Hadfield TL et al (1983) Cat scratch disease: A bacterial infection. Science 221: 1403-1405
- Welch DF et al (1992) Rochalimaea henselae sp. nov., a cause of septicemia, bacillary angiomatosis, and parenchymal bacillary peliosis. J Clin Microbiol 30: 275-280
Incoming links (16)Angiomatosis bacillary; Benign inoculative lymphoreticulosis; Cat scratch disease; Cat scratch disease or fever; Cat scratch fever; Cat scratching lymphadenitis; Erythema nodosum; Granuloma, pseudotuberculoids; Inoculation lymphoreticulosis, benign; Lung diseases, skin changes; ... Show all
Outgoing links (14)Actinomycosis; Bartonelless (overview); Brucellosis (overview); Ciprofloxacin; Cotrimoxazole; Cutaneous tuberculosis (overview); Doxycycline; Erythema multiforme; Erythema nodosum; Erythromycin; ... Show all
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