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 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 .
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- CLINICAL MANIFESTATIONS
- Cutaneous manifestations
- Visceral organ involvement
- Fever of unknown origin
- Ocular manifestations
- - Parinaud's oculoglandular syndrome
- - Neuroretinitis
- Neurologic manifestations
- Musculoskeletal manifestations
- Other atypical manifestations
- Elderly patients
- APPROACH TO DIAGNOSIS
- DIAGNOSTIC TESTS
- Polymerase chain reaction
- Skin testing
- DIFFERENTIAL DIAGNOSIS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS