Cat scratch disease ( felinoz ) - Causes, Symptoms and Treatment .MF .
One person from the list of communicable diseases that can be transmitted from animals is felinoz or cat scratch disease.First described over 80 years ago, the disease for a long time did not have a clear identification with respect to the pathogen, as cited one or other data on the causes of the disease.And only by 1983 finally identified microorganisms "guilty" in the occurrence of characteristic symptoms felinoza and managed to cultivate them in 1988.
Felinoz (from the Latin felinus - cat;. Cat scratch disease or benign limforetikulez or granuloma Mollyare) - an acute infectious disease that belongs to a group of bartonelloses having a clear relationship with scratches or bites of cats, is manifested appearance of the primary lesion (affect) or local lesions and inflammation of the lymph nodes from lesions, and rarely the appearance of intoxication of the body and visceral.The disease is considered to be non-severe and self-limiting.
reservoir of infection
little history: benign lymphadenopathy after a scratching cats first described in 1932 by scientists and A.Debre K.Foshey, then re-found the description in 1950 V.Mollyare et al;to determine the causative agents of disease at first it was hard: they thought and viruses, then chlamydia.In 1983 he discovered a gram-negative bacilli, which was called Alipia felis.However, later it was not possible to identify patients with felinozom blood, and there was no antibodies thereto.In this regard, the search for the causes continued.After a few years of the affected lymph nodes identified Bartonella henselae, which DNA is detected in the vast majority (96% or more) of patients felinozom.
Causes "cat scratch disease»
Pathogen "cat scratch disease" or felinoza.
main pathogen felinoza - Bartonella henselae - Gram (Gram staining is not stained in purple color, it is the concept of microbial) small bacillus, which has a different shape (polymorphism).For cultivation whimsical enough: growing slowly - in 10-15 days on special nutrient media at the optimal growth temperature 35-37º, a certain ratio of carbon dioxide - 5.10%, humidity 40%.Select two of the genotype of the pathogen, but in both cases the disease runs the same way.The pathogen is not resistant to heat, but vyderzhvaet low temperatures.Also, the agent can be felinoza Bartonella quintana with similar properties.
in 15% of patients with the disease felinozom connection with the causative agent is not installed (it makes sense to think that the etiology into play Alipia felis, open earlier).
main reservoir of infection - infected cats.According to the literature up to 45-50% of wild and domestic cats are infected, that is found in the blood of B. henselae.The disease in cats continues for a long time for several years, has little or no symptoms.It is believed that B. henselae is part of the normal flora of the oral cavity of cats.Carriers B. henselae among cats - a cat flea (Ctenocephalides felis), in which intestinal contents and live pathogen filinoza for 9 days from the time of their infection.Direct transmission of B. henselae from fleas excluded person.The literature describes other pathogen reservoirs - dog, rodents, monkeys, but human infection is rare.From human infection is not transmitted to humans.
mechanism of infection felinozom - traumatic personal contact through the skin and mucous membranes (bites or scratches of infected cats).Also infected saliva of infected cats, especially when in contact with mucous membrane of eyes.
Scratches from cats
Typical summer-autumn season, which is determined by the cycle of the flea and parasite.
Susceptibility general population, however, often fall ill young people to 18-20 years.Up to 5% of the population have antibodies to B. henselae, which indicates a certain population of immune layer, typically cat owners (up to 25% of the total number immunized).
outcomes of infection associated with the initial state of human immunity.In immunocompromised may be a common form of the infection, if the immune system in the normal range, the symptoms of the disease can restrict the local process.
after diseases formed a strong immunity.
Symptoms "cat scratch disease»
The site of the bite or scratch in 50-55% of patients there is a "primary affect": cutaneous form elements (papules), which will soon acquire the character of festering.Simultaneously, inflammatory changes occur in the regional (close) to the primary tumor lymph nodes.Histologically, lymph node cell hyperplasia occurs, the formation of granulomas, abscesses, typical "stellate" necrosis and sometimes fistulas.Over time, the inflammation resolves, and sclerosing lesions are formed at the site of granulomas.With inadequate activity pathogen immunity can penetrate into the bloodstream and spread throughout the body, may be affected with various internal organs (liver, heart, vascular system, and others) in which the development of such granulomas.
Clinical forms "cat scratch disease»
The incubation period (time from infection to appearance of symptoms) felinoze at an average of 1-2 weeks, but can be shortened to 3 days and be extended up to 4-6ti weeks.
The disease can occur in the typical and atypical forms.
typical form of infection has a certain cyclical - there are three periods:
1) of the initial period;
2) during the height of the disease;
3) The period of convalescence (recovery).
initial period characterized by the appearance of so-called "primary affect" - on the site of the bite or scratch
often after healing of rash appears - rash of papules (small bundle size to a pea) is red, not itchy or painful sensations.In most cases, these patients do not pay any attention.
After some time (2-3 days) during the height comes : on-site papules appear festering elements which are opened and subsequently the appearance of crusts.Crusts dry up and disappear, after which no remains of any defects or skin pigmentation.This process can last from 1 to 3 weeks.
primary affect with felinoze
After 10-14 days after the appearance of papules appear inflammatory changes in lymph nodes close to the site of the local damage (regional lymphadenitis): involved in the process of either one or a group of nodes that are increasing in size (up to5 cm to 10 cm less in diameter), become painful, compacted.Most inflamed lymph nodes groin, armpits, thighs and other areas.Tissues around the affected lymph nodes remain unchanged.The defeat of the lymph nodes can be lengthy - from 1 week to 2 months.Sometimes the only symptom felinoza.The regional lymphadenitis accompanied by fever varying severity, symptoms of intoxication (weakness, headache, malaise, sweating).The duration of fever before 2 weeks.In a typical course in the midst of disease may increase the liver and spleen.
Axillary lymphadenitis at felinoze
felinoza Most cases end in spontaneous recovery : temperature normalizes, inflammation in the lymph nodes gradually passes, they are creating sclerosis.
Atypical forms felinoza:
1) Eye shape felinoza , which arises in the case of agent contact with the mucous membrane of eyes.Most often it is a one-sided defeat in the form of ulcerative granulomatous conjunctivitis.Patients expressed puffiness century affected eye, redness or flushing of the eyes of the conjunctiva, the formation of ulcers, granulomas, difficulties with the opening of the century.Inflamed parotid and submandibular lymph nodes.
2) Neyroretinit - papilledema in one eye, a symptom of "makulyanoy stars" - star-shaped spots on the retina, the emergence of nodules on the retina, vascular changes fundus.In patients with a relatively satisfactory state of health of the violation of visual acuity in one eye.
3) Neurological form felinoza occurs infrequently.Manifested in the form of polyneuritis, radiculitis, neuropathy, myelitis, rarely encephalitis, meningitis may develop cerebral ataxia.Neurological disorders appear 2-3 weeks after lymph node.
4) Liver and spleen - characterized by the appearance of granulomas in these organs and the development of the inflammatory process in them.In such cases, the patient's temperature several waves, enlarged liver and spleen, changes in blood biochemical parameters: bilirubin, enzymes - ALT, AST, GGT, alkaline phosphatase.Ultrasound detected hypoechoic lesions.Typically, such patients are affected various groups of lymph nodes (generalized lymphadenopathy).
5) bacillary angiomatosis (often registered in HIV-infected patients).On the skin appear red or purple spots, papules, followed by the formation of larger units of up to 3 cm in diameter, around the node "collar" of erosive skin epidermis.It can also affect the liver, spleen, lymph nodes.
6) Other less common forms of atypical include: endocarditis, pleural effusion, erythema nodosum, osteomyelitis, and others.
most favorable prognosis of the disease and the outcome - recovery.
preliminary diagnosis is based on characteristic symptoms and epidemiological history (the fact that contact with a cat and a violation of the integrity of the skin or mucous membranes).At this stage it is necessary to conduct a differential diagnosis (to exclude similar disease): need to eliminate infectious mononucleosis or EBV infection, lymphoma, tularemia, plague.In all these diseases is also an increase in the lymph nodes.For differences need to remember characteristic felinoza "primary affect" and the increase in the majority of the group only regional lymph nodes.
final diagnosis confirmed by laboratory tests .
1) Can be used microbiological method of planting material on nutrient media, but the result should be expected duration of 2 weeks to 1.5 months.
2) biopsy lymph nodes inflamed papules or content with subsequent histological examination: granulomatous features and the accumulation of germs of various shapes.
3) Serological diagnosis (detection of antibodies to the pathogen by ELISA), not available in all areas.
4) PCR diagnostics (gene detection of 16S RNA rabosom B. henselae) in punctate lymph nodes.
5) In general, the analysis of the blood an increase in the number of eosinophils, increased erythrocyte sedimentation rate.
Treatment "cat scratch disease»
Therapy in the typical form of an outpatient.Infection refers to the category of self-limiting (can pass without treatment), but medication can help the body to quickly deal with the causative agent of the disease and alleviate the symptoms.
• antihistamines (Claritin, Zyrtec, tsetrin, erius, etc.).
• Nesterroidnye anti sredsta for relief of the inflammatory response (ibuprofen, indomethacin, diclofenac and their modern counterparts).
• Causal treatment includes prescription of antibacterial drugs: azithromycin, doxycycline and its derivatives, erythromycin and its derivatives, is also set efficiency at felinoze ciprofloxacin, rifampicin, Bactrim, gentamicin.It is believed that such therapy should be administered only in severe forms of infection to the development of atypical forms, as well as in the event of felinoza in immunoskompromentirovannyh persons (HIV, chronic diseases, transplant recipients of organs and tissues, etc.).
If you have abscesses in the lymph nodes is required surgical care (opening, the release of pus), which affects the duration of the healing and sclerosis.
Prevention Prevention is reduced to limit the contact with cats.No specific prevention.
infectious disease doctor Bykov NI