CAT-SCRATCH DISEASE

Background: Cat scratch disease (CSD) is a relatively common cause of chronic lymphadenopathy in the USA. In the present paper the authors d escribe recent advances in the understanding of this disorder focusing on etiology, clinical aspects, diagnostic management, and therapy. Et iology: Rochalimaea henselae and Afipia felis, two gram-negative bacte ria, have recently been isolated from lymphnode tissue of patients suf fering from CSD. The current literature reveals that Rochalimaea hense lae seems to be the most probable agent responsible for CSD. Serum sam ples from CSD patients' cats have shown titers of 1:64 or higher for a ntibodies to Rochalimaea henselae. Epidemiology: The incidence of CSD in the USA is between 0.77 and 9.3 per 100,000 per year. The incidence of CSD in Europe is unknown, but the prevalence of antibodies to Roch alimaea henselae among cats is comparable. Clinical manifestations: Mo st common symptoms of CSD are regional lymphadenopathy, fever, and mal aise. Other manifestations occur in about 5% of patients and include e ncephalitis. granulomatous hepatitis, and Parinaud's oculoglandular sy ndrome. Fatal complications and irreversible sequalae have not been re ported. Diagnosis: To establish the diagnosis of CSD, the presence of regional lymphadenopathy, cat contact, and papula are required. Additi onal procedures include indirect fluorescent antibody assays and PCR. Therapy: Up to now there is no standard therapy for CSD. Antibiotic tr eatment, however, might be considered for CSD patients with severe sym ptoms. Rifampicin, ciprofloxacin, trimethoprim sulfamethoxazole, and g entamicin are known to be effective antibiotic agents.