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For further information, see CMDT Part 33-29: Bartonella Species

Key Features

  • An acute infection caused by Bartonella henselae

  • Seen in children and young adults

  • It is transmitted from cats to humans as the result of a scratch or bite

  • Disseminated forms of the disease occur in immunocompromised patients, such as persons with late stages of HIV or solid organ transplant recipients

    • Bacillary angiomatosis

    • Peliosis hepatis

    • Retinitis

  • Endocarditis can occur (usually due to Bartonella quintana)

Clinical Findings

  • A papule or ulcer will develop at the inoculation site within a few days in one-third of patients

  • Fever, headache, and malaise occur 1–3 weeks later

  • The regional lymph nodes become enlarged, often tender, and may suppurate

  • Lymphadenopathy resembles that resulting from neoplasm, tuberculosis, lymphogranuloma venereum, and bacterial lymphadenitis

  • Encephalitis occurs rarely

Diagnosis

  • Clinical

  • Special cultures for Bartonella, serology (high antibody titer in an indirect immunofluorescence assay), nucleic acid amplification assay, or excisional biopsy, although rarely necessary, confirm the diagnosis

  • Lymph node biopsy revealing necrotizing lymphadenitis is not specific for cat-scratch disease

Treatment

  • Usually self-limited, requiring no specific therapy

  • For bacteremia and endocarditis, a 6-week course of doxycycline (200 mg orally or intravenously in two divided doses per day) plus either gentamicin 3 mg/kg/day intravenously or rifampin 600 mg/day orally in two divided doses is effective

  • Disseminated forms of the disease (bacillary angiomatosis, peliosis hepatis, and retinitis) require a prolonged course of often double antibiotic therapy

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