Cat scratch disease - an infectious, benign, samoizlechivayuscheesya disease, which is almost 90% of cases is preceded by damage to the skin a cat (cat scratch, bite) or contact with her. The disease occurs at any age, although the observations of the above 75% occurring in children, since children often play with the cats.The disease tend to increase long-term sustainability of lymph nodes with a relatively good general condition. In addition to the main title, can be found in the literature, and other signs of the disease: REGIONAL benignlymphadenopathy , felinoz (from Lat. felinus - cat), benign limforetikulez. Infection local lymph nodes is a Gram-negative rod-shaped bacterium Afipia felis, recently named as the agent by the Centers for Control and Disease Prevention (CDC), as well as the bacterium Bartonella Henselae. Swollen lymph nodes usually starts a week after the bite.For the first time the disease has described the French doctor Henri Parinaud in 1889. In 1931, Dr. Robert DESVRES suggested that the reason is the cat's bite, and secured the disease known as "cat scratch disease."
Limited survey conducted by CDC, found that each year about 22,000 cases, though, most likely, a large number of cases, just not diagnosed. Every year more than 2,000 people admitted to the hospital with the disease. The peak incidence occurs in autumn and early winter as in summer, the light appears more kittens.
The disease occurs worldwide in all age groups, with prevalence in children. The ratio of disease in both men and women - approximately 3:1. Cats become infected with this disease, not only are the bearers of it, and intermediaries in the transfer of a person. The disease develops, usually sporadic, although outbreaks are described and the family.
Typically, the penetration of infection occurs through direct contact, as the disease develops after a scratch, bite or lick the cat skin or mucous membranes of humans. Note that this phenomenon is more likely to cause kitten or young cat. This form of infection occurs in 55-95% of cases of the disease. We describe the cases of the disease after being bitten by a dog, or scratching. Occasionally, the disease is the result of a splinter or fish bone piercing the skin. Cat scratch disease are also subject to, and animals - monkeys, guinea pigs, etc. Attempts to isolate the infectious agent from the saliva of cats failed.Transmission from person to person has not been described. In this regard, neither isolation nor quarantine is required. Get rid of the cat is also optional.
Brief description
Bartonella Henselae
From the bite pathogen is presumed to penetrate into lymphatic regional lymph nodes, where it is intense multiplication of the corresponding reaction in the form of higher nodes. In some cases, is the generalization of infection, leading to its atypical manifestation.
There are three stages of development of pathological changes. In the very early stages (up to a week of illness onset) in lymph node biopsies are nonspecific changes - hyperplasia of reticular cells (elongated cells mnogootrostchatye), rarely - the giant cells.Later, the formation of granulomas. Still later (several weeks of illness) joined abscesses. Within 3-4 weeks the changes regress, there is a hardening of the tissue site, or resorption of altered cells.
The disease
In a typical course of the incubation period can range from 3-12 days to weeks after contact with a cat or scratches. On the skin, in some cases it can be seen very inflamed scratch or if it has healed, the traces of her. The most characteristic is the formation at the site of the bite papules rather compact (knots). In the area of induration may be slight itching, scratching when it may be ulceration. Unfortunately, not so rare is the lack of primary cutaneous elements, making it difficult to diagnose. Subsequently, some patients may experience skin or scarlet fever, morbilliform rash. A number of patients there may be moderate signs of systemic destruction - fatigue, headache, flu-like syndrome with temperature. The temperature rises to 38 ° C or more and is normalized in the range from 3 to 9 days. In a typical course of the internal organs revealed no changes in the liver and spleen were not enlarged, sometimes described bowel dysfunction.
The primary manifestations are held usually from 1 to 3 weeks and take place without scarring. Can grow a variety of lymph nodes. Thus, the described increase in the axillary, cervical, parotid, submandibular, inguinal, femoral lymph nodes. As a rule, lymphadenopathy occurs in the immediate area of the scratch, it is unilateral and asymmetric. Size of units range from 1 to 5 or even 10 cm in diameter. Nodes are often visible to the eye, the skin may be red on them. At the touch of nodes moderately dense, sedentary, although they are not welded together, insensitive, often painful. Lymphadenopathy, usually lasts from 2 to 4 months, and sometimes from six months to two years.
A number of patients, especially in children, cat scratch disease may be atypical - in the form of encephalitis, meningitis, polyneuritis, atypical pneumonia, osteomyelitis, etc. However, such cases are the exception rather than the rule. In general, the symptoms are mild: slight fever, nausea, fatigue, and headaches.
Treatment
The disease leads to the development of life-long immunity. Extremely rare lymphadenopathy may last 1-2 years, or recur after apparent cure.
Treatment of the disease is usually benign.Temperature returned to normal within 1-2 weeks.Regression of adenita begins with a two-third of the week and usually ends with a 4-6-week illness. A node is opened on their own or with surgical care, as soon as the phenomenon of softening. At autopsy the lymph node is allocated a thick pus. Opened or revelations lymph node heals quickly without the formation of large scars. Possible recurrence of the disease with recurrent suppuration.
In the ordinary course of antibiotics, the disease is not appointed. The effectiveness of corticosteroids has not been proved. Used: anti-pyretic and pain killers and warm. Incisions and drainage of the inflamed lymph nodes are not recommended because they can cause scarring, not speeding up the recovery. Suctioning of soft nodes may relieve the pain.
In the case of lymph node suppuration and breaking antibiotics may be prescribed for 4-5 days. 5-day course of Azithromycin drug resolves knots.
People with shattered immune system need to be aware of antibiotics because they are easy prey for the bacteria. Some of the more or less effective antibiotics include: Trimethoprim, Gentamicin, Ciprofloxacin, Rifampin, Doxycycline
The bacterium Bartonella Henselae, usually resistant to penicillin, amoxicillin, and naftsilinu.
After 2-6 months should undergo re-examination.
In the case of scratches should be immediately to prevent: a place to handle scratches with iodine, then rinse thoroughly with warm soapy water and repeat the treatment with iodine.
Ibrahim Shamov
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