Microbiology, epidemiology, clinical manifestations, and diagnosis of cat scratch disease
- David H Spach, MD
David H Spach, MD
- Professor of Medicine
- Division of Infectious Diseases
- University of Washington
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Section Editors
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
Cat scratch disease (CSD) is an infectious disease that is typically characterized by self-limited regional lymphadenopathy. The manifestations of CSD, however, can include visceral organ, neurologic, and ocular involvement [1,2].
The microbiology, epidemiology, clinical features, and diagnosis of CSD will be reviewed here. The treatment of CSD is discussed separately. (See "Treatment of cat scratch disease".)
Although clinical descriptions of cat scratch disease (CSD) existed for more than 50 years, the first convincing evidence of an infectious cause of CSD came in 1983 when investigators at the Armed Forces Institute of Pathology, using a Warthin-Starry stain, demonstrated small, pleomorphic organisms in the lymph nodes of 29 of 34 patients with CSD .
Afipia felis first was believed to be the cause of CSD after investigators isolated this organism from patients with CSD [4,5]. However, current serologic and culture data provide convincing evidence that Bartonella henselae is the etiologic agent in most cases of CSD [6-8]. In humans and cats, two main B. henselae genotypic groups have been identified based on molecular analysis: the Houston-1 serotype and Marseille serotype . One report also described a case of CSD caused by Bartonella clarridgeiae . In addition, scattered, uncommon cases of CSD may result from A. felis, B. clarridgeiae, and perhaps other, as yet unidentified, fastidious organisms .
Among HIV-infected persons (and less commonly other immunocompromised individuals), B. henselae can cause bacillary angiomatosis (BA), peliosis hepatis, and splenitis (see "Epidemiology and clinical manifestations of Bartonella infections in HIV-infected patients"). Rare reports have also documented BA among immunocompetent individuals .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Bass JW, Vincent JM, Person DA. The expanding spectrum of Bartonella infections: II. Cat-scratch disease. Pediatr Infect Dis J 1997; 16:163.
- Spach DH, Koehler JE. Bartonella-associated infections. Infect Dis Clin North Am 1998; 12:137.
- Wear DJ, Margileth AM, Hadfield TL, et al. Cat scratch disease: a bacterial infection. Science 1983; 221:1403.
- English CK, Wear DJ, Margileth AM, et al. Cat-scratch disease. Isolation and culture of the bacterial agent. JAMA 1988; 259:1347.
- Brenner DJ, Hollis DG, Moss CW, et al. Proposal of Afipia gen. nov., with Afipia felis sp. nov. (formerly the cat scratch disease bacillus), Afipia clevelandensis sp. nov. (formerly the Cleveland Clinic Foundation strain), Afipia broomeae sp. nov., and three unnamed genospecies. J Clin Microbiol 1991; 29:2450.
- Regnery RL, Olson JG, Perkins BA, Bibb W. Serological response to "Rochalimaea henselae" antigen in suspected cat-scratch disease. Lancet 1992; 339:1443.
- Zangwill KM, Hamilton DH, Perkins BA, et al. Cat scratch disease in Connecticut. Epidemiology, risk factors, and evaluation of a new diagnostic test. N Engl J Med 1993; 329:8.
- Szelc-Kelly CM, Goral S, Perez-Perez GI, et al. Serologic responses to Bartonella and Afipia antigens in patients with cat scratch disease. Pediatrics 1995; 96:1137.
- La Scola B, Liang Z, Zeaiter Z, et al. Genotypic characteristics of two serotypes of Bartonella henselae. J Clin Microbiol 2002; 40:2002.
- Kordick DL, Hilyard EJ, Hadfield TL, et al. Bartonella clarridgeiae, a newly recognized zoonotic pathogen causing inoculation papules, fever, and lymphadenopathy (cat scratch disease). J Clin Microbiol 1997; 35:1813.
- Giladi M, Avidor B, Kletter Y, et al. Cat scratch disease: the rare role of Afipia felis. J Clin Microbiol 1998; 36:2499.
- Tappero JW, Koehler JE, Berger TG, et al. Bacillary angiomatosis and bacillary splenitis in immunocompetent adults. Ann Intern Med 1993; 118:363.
- Jacomo V, Kelly PJ, Raoult D. Natural history of Bartonella infections (an exception to Koch's postulate). Clin Diagn Lab Immunol 2002; 9:8.
- Dehio C. Molecular and cellular basis of bartonella pathogenesis. Annu Rev Microbiol 2004; 58:365.
- Jackson LA, Perkins BA, Wenger JD. Cat scratch disease in the United States: an analysis of three national databases. Am J Public Health 1993; 83:1707.
- Ben-Ami R, Ephros M, Avidor B, et al. Cat-scratch disease in elderly patients. Clin Infect Dis 2005; 41:969.
- Apalsch AM, Nour B, Jaffe R. Systemic cat-scratch disease in a pediatric liver transplant recipient and review of the literature. Pediatr Infect Dis J 1993; 12:769.
- Bonatti H, Mendez J, Guerrero I, et al. Disseminated Bartonella infection following liver transplantation. Transpl Int 2006; 19:683.
- Thudi KR, Kreikemeier JT, Phillips NJ, et al. Cat scratch disease causing hepatic masses after liver transplant. Liver Int 2007; 27:145.
- Bhatti Z, Berenson CS. Adult systemic cat scratch disease associated with therapy for hepatitis C. BMC Infect Dis 2007; 7:8.
- Windsor JJ. Cat-scratch disease: epidemiology, aetiology and treatment. Br J Biomed Sci 2001; 58:101.
- Ridder GJ, Boedeker CC, Technau-Ihling K, et al. Role of cat-scratch disease in lymphadenopathy in the head and neck. Clin Infect Dis 2002; 35:643.
- Nelson CA, Saha S, Mead PS. Cat-Scratch Disease in the United States, 2005-2013. Emerg Infect Dis 2016; 22:1741.
- Florin TA, Zaoutis TE, Zaoutis LB. Beyond cat scratch disease: widening spectrum of Bartonella henselae infection. Pediatrics 2008; 121:e1413.
- Tan TQ, Wagner ML, Kaplan SL. Bartonella (Rochalimaea) henselae hepatosplenic infection occurring simultaneously in two siblings. Clin Infect Dis 1996; 22:721.
- Koehler JE, Glaser CA, Tappero JW. Rochalimaea henselae infection. A new zoonosis with the domestic cat as reservoir. JAMA 1994; 271:531.
- Chomel BB, Kasten RW, Floyd-Hawkins K, et al. Experimental transmission of Bartonella henselae by the cat flea. J Clin Microbiol 1996; 34:1952.
- Chomel BB, Abbott RC, Kasten RW, et al. Bartonella henselae prevalence in domestic cats in California: risk factors and association between bacteremia and antibody titers. J Clin Microbiol 1995; 33:2445.
- Pennisi MG, Marsilio F, Hartmann K, et al. Bartonella species infection in cats: ABCD guidelines on prevention and management. J Feline Med Surg 2013; 15:563.
- Foley JE, Chomel B, Kikuchi Y, et al. Seroprevalence of Bartonella henselae in cattery cats: association with cattery hygiene and flea infestation. Vet Q 1998; 20:1.
- Bouhsira E, Franc M, Lienard E, et al. The efficacy of a selamectin (Stronghold ®) spot on treatment in the prevention of Bartonella henselae transmission by Ctenocephalides felis in cats, using a new high-challenge model. Parasitol Res 2015; 114:1045.
- Bradbury CA, Lappin MR. Evaluation of topical application of 10% imidacloprid-1% moxidectin to prevent Bartonella henselae transmission from cat fleas. J Am Vet Med Assoc 2010; 236:869.
- Lappin MR, Davis WL, Hawley JR, et al. A flea and tick collar containing 10% imidacloprid and 4.5% flumethrin prevents flea transmission of Bartonella henselae in cats. Parasit Vectors 2013; 6:26.
- Moriarty RA, Margileth AM. Cat scratch disease. Infect Dis Clin North Am 1987; 1:575.
- Carithers HA. Cat-scratch disease. An overview based on a study of 1,200 patients. Am J Dis Child 1985; 139:1124.
- Sander A, Frank B. Paronychia caused by Bartonella henselae. Lancet 1997; 350:1078.
- Lenoir AA, Storch GA, DeSchryver-Kecskemeti K, et al. Granulomatous hepatitis associated with cat scratch disease. Lancet 1988; 1:1132.
- Delahoussaye PM, Osborne BM. Cat-scratch disease presenting as abdominal visceral granulomas. J Infect Dis 1990; 161:71.
- Fretzayas A, Papadopoulos NG, Moustaki M, et al. Unsuspected extralymphocutaneous dissemination in febrile cat scratch disease. Scand J Infect Dis 2001; 33:599.
- Arisoy ES, Correa AG, Wagner ML, Kaplan SL. Hepatosplenic cat-scratch disease in children: selected clinical features and treatment. Clin Infect Dis 1999; 28:778.
- Margileth AM, Wear DJ, English CK. Systemic cat scratch disease: report of 23 patients with prolonged or recurrent severe bacterial infection. J Infect Dis 1987; 155:390.
- Hipp SJ, O'Shields A, Fordham LA, et al. Multifocal bone marrow involvement in cat-scratch disease. Pediatr Infect Dis J 2005; 24:472.
- Tsujino K, Tsukahara M, Tsuneoka H, et al. Clinical implication of prolonged fever in children with cat scratch disease. J Infect Chemother 2004; 10:227.
- Jacobs RF, Schutze GE. Bartonella henselae as a cause of prolonged fever and fever of unknown origin in children. Clin Infect Dis 1998; 26:80.
- Cunningham ET, Koehler JE. Ocular bartonellosis. Am J Ophthalmol 2000; 130:340.
- Ormerod LD, Dailey JP. Ocular manifestations of cat-scratch disease. Curr Opin Ophthalmol 1999; 10:209.
- Kalogeropoulos C, Koumpoulis I, Mentis A, et al. Bartonella and intraocular inflammation: a series of cases and review of literature. Clin Ophthalmol 2011; 5:817.
- Wear DJ, Malaty RH, Zimmerman LE, et al. Cat scratch disease bacilli in the conjunctiva of patients with Parinaud's oculoglandular syndrome. Ophthalmology 1985; 92:1282.
- Ridder GJ, Boedeker CC, Technau-Ihling K, Sander A. Cat-scratch disease: Otolaryngologic manifestations and management. Otolaryngol Head Neck Surg 2005; 132:353.
- Grando D, Sullivan LJ, Flexman JP, et al. Bartonella henselae associated with Parinaud's oculoglandular syndrome. Clin Infect Dis 1999; 28:1156.
- Bhatti MT, Asif R, Bhatti LB. Macular star in neuroretinitis. Arch Neurol 2001; 58:1008.
- Suhler EB, Lauer AK, Rosenbaum JT. Prevalence of serologic evidence of cat scratch disease in patients with neuroretinitis. Ophthalmology 2000; 107:871.
- Reed JB, Scales DK, Wong MT, et al. Bartonella henselae neuroretinitis in cat scratch disease. Diagnosis, management, and sequelae. Ophthalmology 1998; 105:459.
- Marra CM. Neurologic complications of Bartonella henselae infection. Curr Opin Neurol 1995; 8:164.
- Selby G, Walker GL. Cerebral arteritis in cat-scratch disease. Neurology 1979; 29:1413.
- Baylor P, Garoufi A, Karpathios T, et al. Transverse myelitis in 2 patients with Bartonella henselae infection (cat scratch disease). Clin Infect Dis 2007; 45:e42.
- Maman E, Bickels J, Ephros M, et al. Musculoskeletal manifestations of cat scratch disease. Clin Infect Dis 2007; 45:1535.
- Giladi M, Maman E, Paran D, et al. Cat-scratch disease-associated arthropathy. Arthritis Rheum 2005; 52:3611.
- Hajjaji N, Hocqueloux L, Kerdraon R, Bret L. Bone infection in cat-scratch disease: a review of the literature. J Infect 2007; 54:417.
- Maggi RG, Mozayeni BR, Pultorak EL, et al. Bartonella spp. bacteremia and rheumatic symptoms in patients from Lyme disease-endemic region. Emerg Infect Dis 2012; 18:783.
- Ridder GJ, Technau-Ihling K, Sander A, Boedeker CC. Spectrum and management of deep neck space infections: an 8-year experience of 234 cases. Otolaryngol Head Neck Surg 2005; 133:709.
- Angelakis E, Pulcini C, Waton J, et al. Scalp eschar and neck lymphadenopathy caused by Bartonella henselae after Tick Bite. Clin Infect Dis 2010; 50:549.
- Bandyopadhyay A, Burrage LC, Gonzalez BE. Pulmonary nodules in an immunocompetent child with cat scratch disease. Pediatr Infect Dis J 2013; 32:1390.
- Bosch X. Hypercalcemia due to endogenous overproduction of active vitamin D in identical twins with cat-scratch disease. JAMA 1998; 279:532.
- Margileth AM. Recent Advances in Diagnosis and Treatment of Cat Scratch Disease. Curr Infect Dis Rep 2000; 2:141.
- Rolain JM, Lepidi H, Zanaret M, et al. Lymph node biopsy specimens and diagnosis of cat-scratch disease. Emerg Infect Dis 2006; 12:1338.
- Bergmans AM, Peeters MF, Schellekens JF, et al. Pitfalls and fallacies of cat scratch disease serology: evaluation of Bartonella henselae-based indirect fluorescence assay and enzyme-linked immunoassay. J Clin Microbiol 1997; 35:1931.
- Dupon M, Savin De Larclause AM, Brouqui P, et al. Evaluation of serological response to Bartonella henselae, Bartonella quintana and Afipia felis antigens in 64 patients with suspected cat-scratch disease. Scand J Infect Dis 1996; 28:361.
- Sander A, Posselt M, Oberle K, Bredt W. Seroprevalence of antibodies to Bartonella henselae in patients with cat scratch disease and in healthy controls: evaluation and comparison of two commercial serological tests. Clin Diagn Lab Immunol 1998; 5:486.
- Zbinden R, Michael N, Sekulovski M, et al. Evaluation of commercial slides for detection of immunoglobulin G against Bartonella henselae by indirect immunofluorescence. Eur J Clin Microbiol Infect Dis 1997; 16:648.
- Koehler JE, Quinn FD, Berger TG, et al. Isolation of Rochalimaea species from cutaneous and osseous lesions of bacillary angiomatosis. N Engl J Med 1992; 327:1625.
- Jensen WA, Fall MZ, Rooney J, et al. Rapid identification and differentiation of Bartonella species using a single-step PCR assay. J Clin Microbiol 2000; 38:1717.
- Vermeulen MJ, Diederen BM, Verbakel H, Peeters MF. Low sensitivity of Bartonella henselae PCR in serum samples of patients with cat-scratch disease lymphadenitis. J Med Microbiol 2008; 57:1049.
- Edouard S, Nabet C, Lepidi H, et al. Bartonella, a common cause of endocarditis: a report on 106 cases and review. J Clin Microbiol 2015; 53:824.
- Klein JD. Cat scratch disease. Pediatr Rev 1994; 15:348.
- CLINICAL MANIFESTATIONS
- Cutaneous manifestations
- Visceral organ involvement
- Fever of unknown origin
- Ocular manifestations
- - Parinaud oculoglandular syndrome
- - Neuroretinitis
- Neurologic manifestations
- Musculoskeletal manifestations
- Other atypical manifestations
- APPROACH TO DIAGNOSIS
- DIAGNOSTIC TESTS
- Polymerase chain reaction
- Skin testing
- DIFFERENTIAL DIAGNOSIS
- Fever and lymphadenopathy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS