Miscellaneous

Cat scratch disease: symptoms, photo, treatment in children and adults

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Cat-scratch disease (felinoz, benign limforetikulez, granuloma Mollyare) - serious illness of infectious type. It appears as a result of bites or cat scratches. Diseases characterized by inflammation of the regional lymph nodes - originally abscess papules, sometimes - conjunctivitis occurs, angiomatosis, affects the liver. Notes fever and a general poisoning of the body.

The source of a movable rod-shaped bacterium. Among its habitat is the oral cavity of mammals. Basically, cats, dogs, monkeys. The disease more susceptible to children and young people under the age of 20 years. Infection is ingested with licking, scratching, biting through the damaged skin. Often - through scratches.

That is why felinoz called cat scratch disease. However, it is worth remembering that you can get infected from any mammal infected with the disease in contact with the viral bacteria in the human body.

What it is?

Cat scratch disease (felinoz) - an acute infectious disease that refers to bartonellosises group, which has a clear relationship with scratches or bites of cats, is manifested appearance of the primary lesion (affect) or topical lesion, as well as inflammation of lymph nodes from the lesion, and rare appearance of intoxication of an organism and visceral authorities. The disease is considered to be non-severe and self-limiting.

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Causes and risk factors

The causative agent of cat-scratch disease - Rochalimaea henselae. Polymorphic fixed gram-negative bacterium; morphologically similar to the genus Rickettsia and exhibits similar properties Afipia felis. Movable non-fermenting Gram-negative rod-shaped bacterium. Whimsical to cultivation in vitro, more preferably cultivation on HeLa cells.

Risk factors for the disease:

  1. Violations of cellular immune responses
  2. HIV infection, especially in CD4 + lymphocytes content below 100 in 1 .mu.l
  3. Long reception of the CC, azathioprine, cyclophosphamide, cyclosporine, alcohol abuse.

The penetration of agent through intact skin or, more rarely, mucosal eye leads eventually to the development of inflammatory reactions in the form of primary affect. Then lymphatic microbe enters the regional lymph nodes, which is accompanied by the occurrence of lymphadenitis. Morphological changes in the lymph nodes characterized retikulokletochnoy hyperplasia, formation of granulomas, and later microabscesses. The disease is usually accompanied by hematogenous dissemination with involvement in pathological process other lymph nodes, liver, central nervous system infarction. Heavy and prolonged, and often atypical course of the disease is seen in patients with HIV infection.

Reservoir and source of infection is considered a variety of mammals (cats, dogs, monkeys and others.). The disease is recorded everywhere. In temperate regions, the incidence of the rise point from September to March. Given the nature of the infection, the main contingent - faces up to 21 years; 90% had a history of bites or scratches inflicted kittens. Studies conducted on animals have shown that the organism does not cause them any development pathology, and they do not meet the development of hypersensitivity reactions with intradermal administration of the antigen exciter. Incidence - 10: 100 000 (25 000 cases annually).

How does cat scratch disease - symptoms and signs of

Scratch or bite the cat first 3-10 days slowly heals, does not cause concern on the part of the person: it can be a little hurt or sadnit as normal skin injury. This - the incubation period; pathogen at this time overcomes the barriers of the coating tissue and multiplies. Lengthen this period can be up to 3 weeks, then at the time the first symptoms felinoza skin trauma no longer exists.

  • Over time, the need for a microbe penetration and accumulation (3 days, 3 weeks, on average - 7-14 days) in the place where there was a scratch or there is a crust from her rash appears. It looks like a few nodules ranging in size from a millet seed to a pea, which do not itch or hurt.
  • After 2-3 days, a period of height of disease: such nodules suppurate and opened themselves after which are covered by a crust and may start slightly scratched (especially if the child has been scratched - allergies). In 1-3 weeks the crust dry and fall, whereupon the bite ceases to be marked: it does not leave any scars or darker skin. This means that Bartonella multiplied in sufficient numbers, fought the local immunity of the skin area and hit the lymphatic channel.
  • After 10-14 days (at least - longer) after the onset of the first germ of nodules detected by regional lymph nodes - local filters that do not try to put it on.

If there was a bitten arm below the elbow, increasing one or more groups of lymph nodes: elbow, axillary, cervical. The order of appearance lymphadenitis can it be so, but it may increase once the axillary nodes, and elbow remain unchanged. Also, since the axillary fossa lymph nodes will increase if damaged teeth or claws of the forearm or upper arm.

If the bite / scratch fell on his leg, inflamed lymph nodes in the thigh and groin. When scratching person can first react submandibular, or antero zadneushnye group; then increasing one or more of the cervical lymph node groups.

Signs that say that the lymph nodes are affected due felinoza:

  • lymph nodes are gradually increased, reaching from 5 to 10 cm in diameter;
  • skin over them is not red, not hot to the touch;
  • lymph nodes can be shifted - they do not pull for a skin;
  • they are dense;
  • to probe their patients;
  • with an increase of the whole group of nodes, probing them, can "ride" independently of each other: they are not soldered together.

Swollen lymph nodes accompanied by a deterioration of the general condition. Symptoms such:

  • temperature rise, sometimes up to 39 ° C or higher;
  • weakness;
  • a bad dream;
  • sweating;
  • headache;
  • malaise;
  • appetite loss;
  • palpitations.

The temperature does not rise at all to such high numbers: in some cases it may be absent. Raising the temperature is kept between a week to a month, the other symptoms gradually disappear within 2 weeks. Lymph nodes are enlarged up to three months. In half the cases, they may suppurate and spontaneously opened: when the surface is released thick pus yellow-green color, which, being taken for bacteriological examination, does not show signs of bacterial infection (as you remember, Bartonella is not growing on nutrient environments).

In the same period in the body or human limbs skin rash may appear reddish in color, which occupies larger or smaller areas of the skin. It does not itch and does not hurt, it disappears after a few days.

During the increase of lymph nodes can also be observed:

  • a sense of "needles" or discomfort in the left upper quadrant: as can be shown an enlarged spleen, which can also be affected when felinoze. Increased liver and spleen may be detected and abdominal ultrasound is not accompanied by any symptoms;
  • discomfort and pain in the right upper quadrant - it increases the liver, which is also a filter on the path of Bartonella, got to this point in the blood;
  • pain in the heart, arrhythmias. These are signs of heart disease;
  • swollen lymph nodes that lie far from the place of infection.

The above-mentioned symptoms of cat scratch disease occur in people whose immune system is insufficiently active and allows the infection to enter the blood. Those same people who are called "immunocompromised" (treated with drugs that suppress the immune system, suffering from diabetes, congenital immunodeficiency, HIV, alcoholism), and all proceeds felinoz atypically. They have the infection can stay in the body forever, causing a chronic disease.

Typically, the disease ends in a month or a little less after the increase in the first lymph node: the temperature falls, the headache goes away, restores sleep and appetite, lymph nodes gradually decrease and become dense small "balls", not soldered to each other and skin. Very rarely, at a moderately low immunity, felinoz can last 1-2 years, when the symptoms subside, then reappear.

atypical form

After contact with infectious agents on the mucous eye, there is a high risk of conjunctivitis. Symptoms of contact with the skin:

  • fever;
  • sores;
  • festering injuries;
  • after healing scars are formed.

This form of felinoza found in 10% of cases. Usually it is diagnosed in children and the elderly (people whose reactivity is reduced). Duration of the disease is between 6 to 8 weeks.

Diagnostics

Diagnosis of the classic form of the disease does not difficult. The main importance is the presence of direct contact with a cat, the presence of primary affect, development of regional lymphadenitis, no response other lymph nodes.

To reinforce the diagnosis is carried out microbiological testing of blood, histological examination of biopsy of a lymph node or papules with staining of sections.

Differential diagnosis is carried out with the following diseases: progressive focal leukoencephalopathy, cryptococcal meningitis, cerebral toxoplasmosis, acute hepatitis, infectious mononucleosis, influenza, histoplasmosis, coccidioidomycosis, cryptococcosis, lymph node cancer, lymphoma, Streptococcal and staphylococcal infections, borrelioses, babeshioz, rickettsioses, mycobacterioses, pseudoerysipelas, tularemia, pasteurellosis, bubonic plague, sporotrichosis.

complications

If when the first symptoms felinoza not go to the doctor and not to conduct a full treatment of pathologies that may develop life-threatening complications. In the case of conjunctivitis progression possible loss of vision.

It is possible CNS involvement. This leads to the progression of meningitis, an inflammation of the brain and spinal cord.

Treatment of 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.

Medication:

  1. Nonsteroidal anti-inflammatory drugs for relief of the inflammatory response (ibuprofen, indomethacin, diclofenac and their advanced analogs).
  2. Antihistamines (Claritin, Zyrtec, tsetrin, erius and others).
  3. Causal treatment comprises administering antibacterial drugs: azithromycin, doxycycline and its derivatives, erythromycin and its derivatives, as set efficiency at felinoze ciprofloxacin, rifampicin, bactrim, gentamicin. It is believed that this therapy should be used only in severe forms of infection to the development of atypical forms, as well as felinoza occurs in immunoskompromentirovannyh persons (HIV, chronic diseases, transplant recipients and organ fabrics, etc.).

In the event of abscesses requiring surgical care in the lymph nodes (opening, the release of pus), which affects the duration of the healing and sclerosis.

prognosis

Basically, the majority of cases, the disease ends complete disappearance of all symptoms. With timely treatment of even severe forms of disease can be cured.

Doubtful prognosis with lesions of the nervous system, as Bartonella can cause irreversible changes in the brain.

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