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Cat-scratch Disease

Disease Details

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Description: Cat-scratch disease is a bacterial infection caused by Bartonella henselae, typically resulting from a scratch or bite from an infected cat, leading to swollen lymph nodes, fever, and fatigue.
Type: Cat-scratch disease is a bacterial infection. It is not genetically transmitted. The disease is typically caused by the bacterium Bartonella henselae, which is transmitted to humans through the scratch or bite of an infected cat.
Signs And Symptoms: Cat-scratch disease commonly presents as tender, swollen lymph nodes near the site of the inoculating bite or scratch or on the neck, and is usually limited to one side. This condition is referred to as regional lymphadenopathy and occurs 1–3 weeks after inoculation. Lymphadenopathy most commonly occurs in the axilla, arms, neck, or jaw, but may also occur near the groin or around the ear. A vesicle or an erythematous papule may form at the site of initial infection.Most people also develop systemic symptoms such as malaise, decreased appetite, and aches. Other associated complaints include headache, chills, muscular pains, joint pains, arthritis, backache, and abdominal pain. It may take 7 to 14 days, or as long as two months, for symptoms to appear. Most cases are benign and self-limiting, but lymphadenopathy may persist for several months after other symptoms disappear. The disease usually resolves spontaneously, with or without treatment, in one month.
In rare situations, CSD can lead to the development of serious neurologic or cardiac sequelae such as meningoencephalitis, encephalopathy, seizures, or endocarditis. Endocarditis associated with Bartonella infection has a particularly high mortality. Parinaud's oculoglandular syndrome is the most common ocular manifestation of CSD, and is a granulomatous conjunctivitis with concurrent swelling of the lymph node near the ear. Optic neuritis or neuroretinitis is one of the atypical presentations.People who are immunocompromised are susceptible to other conditions associated with B. henselae and B. quintana, such as bacillary angiomatosis or bacillary peliosis. Bacillary angiomatosis is primarily a vascular skin lesion that may extend to bone or be present in other areas of the body. In the typical scenario, the patient has HIV or another cause of severe immune dysfunction. Bacillary peliosis is caused by B. henselae that most often affects people with HIV and other conditions causing severe immune compromise. The liver and spleen are primarily affected, with findings of blood-filled cystic spaces on pathology.
Prognosis: The prognosis for cat-scratch disease is generally excellent. Most individuals recover fully without long-term complications. The infection is usually self-limiting and resolves within 2 to 4 months. Antibiotics can speed up recovery in some cases. Rarely, complications can occur, particularly in immunocompromised individuals, but these are uncommon.
Onset: Cat-scratch disease typically has an onset of 3 to 14 days after a cat scratch, bite, or lick. Symptoms usually include a small, raised bump or blister at the site of the injury followed by swollen, tender lymph nodes, often near the site of the scratch or bite.
Prevalence: The prevalence of cat-scratch disease (CSD) is estimated to be between 9.3 to 13.2 cases per 100,000 people annually in the United States. However, the actual prevalence may vary by region and other factors such as cat ownership and exposure to cats.
Epidemiology: Cat-scratch disease has a worldwide distribution, but it is a nonreportable disease in humans, so public health data on this disease are inadequate. Geographical location, present season, and variables associated with cats (such as exposure and degree of flea infestation) all play a factor in the prevalence of CSD within a population. In warmer climates, the CSD is more prevalent during the fall and winter, which may be attributed to the breeding season for adult cats, which allows for the birth of kittens. B henselae, the bacterium responsible for causing CSD, is more prevalent in younger cats (less than one year old) than it is in adult cats.To determine recent incidence of CSD in the United States, the Truven Health MarketScan Commercial Claims and Encounters database was analyzed in a case control study from 2005 to 2013. The database consisted of healthcare insurance claims for employees, their spouses, and their dependents. All participants were under 65 years of age, from all 50 states. The length of the study period was 9 years and was based on 280,522,578 person-years; factors such as year, length of insurance coverage, region, age, and sex were used to calculate the person-years incidence rate to eliminate confounding variables among the entire study population.A total of 13,273 subjects were diagnosed with CSD, and both in- and outpatient cases were analyzed. The study revealed an incidence rate of 4.5/100,000 outpatient cases of cat-scratch disease. For inpatient cases, the incidence rate was much lower at 0.19/100,000 population. Incidence of CSD was highest in 2005 among outpatient cases and then slowly declined. The Southern states had the most significant decrease of incidence over time. Mountain regions have the lowest incidence of this disease because fleas are not commonly found in these areas.Distribution of CSD among children aged 5–9 was of the highest incidence in the analyzed database, followed by women aged 60–64. Incidence among females was higher than that among males in all age groups. According to data on social trends, women are more likely to own a cat over men; which supports higher incidence rates of this disease in women. Risk of contracting CSD increases as the number of cats residing in the home increases. The number of pet cats in the United States is estimated to be 57 million. Due to the large population of cats residing in the United States, the ability of this disease to continue to infect humans is vast. Laboratory diagnosis of CSD has improved in recent years, which may support an increase in incidence of the disease in future populations.
Intractability: Cat-scratch disease is typically not intractable. Most cases resolve on their own without the need for extensive medical treatment. Antibiotics, such as azithromycin, can be prescribed to speed recovery, especially in severe cases. However, complications are rare, and the disease generally has a favorable prognosis.
Disease Severity: Cat-scratch disease is usually mild to moderate in severity. Most individuals experience localized symptoms such as a small bump or blister at the site of the scratch or bite, swollen and tender lymph nodes, fever, fatigue, and headache. Severe complications are rare but can include infection of the liver, spleen, bones, eyes, or brain, primarily in immunocompromised individuals.
Healthcare Professionals: Disease Ontology ID - DOID:11258
Pathophysiology: Cat-scratch disease (CSD) is primarily caused by the bacterium *Bartonella henselae*. The pathophysiology involves the bacterium being transmitted to humans through scratches, bites, or potentially the saliva of infected cats. Upon entering the human body, the bacteria target endothelial cells and macrophages, leading to localized infection and inflammation. This typically manifests as a small bump or blister at the site of the scratch or bite, followed by regional lymphadenopathy (swollen lymph nodes). In some cases, the bacteria can disseminate, causing more systemic symptoms and complications such as fever, fatigue, and, rarely, organ involvement.
Carrier Status: Cat-scratch disease is primarily caused by the bacterium Bartonella henselae. Cats, especially kittens, are the main carriers of this bacterium. They can harbor the bacteria in their blood without showing signs of illness. The disease is typically transmitted to humans through scratches or bites from an infected cat.
Mechanism: Cat-scratch disease (CSD) is caused by the bacterium *Bartonella henselae*. The primary mechanism involves transmission through a scratch or bite from an infected cat, or via exposure to cat fleas.

**Mechanism:**
1. **Transmission**: *Bartonella henselae* enters the human body through skin breaks or mucous membranes.
2. **Incubation**: After entry, the bacterium incubates for about 3-14 days.
3. **Localized Infection**: Infected individuals often develop a papule or pustule at the site of inoculation.
4. **Lymph Node Involvement**: *Bartonella henselae* migrates to regional lymph nodes, causing them to swell.

**Molecular Mechanisms:**
- **Adhesion and Invasion**: *Bartonella henselae* possesses adhesins that help it attach to host cells, particularly endothelial cells and macrophages.
- **Virulence Factors**: The bacterium secretes multiple virulence factors, including a type IV secretion system (T4SS) that injects effector proteins into host cells to manipulate cellular pathways.
- **Immune Evasion**: It can evade the immune system by residing within endothelial cells and creating a protective niche.
- **Endothelial Cell Proliferation**: *Bartonella henselae* induces angiogenesis-like responses that contribute to the formation of granulomas in lymph nodes.

These interactions facilitate the establishment and persistence of infection, ultimately leading to the characteristic symptoms of CSD, such as fever and lymphadenopathy.
Treatment: Most healthy people clear the infection without treatment, but in 5 to 14% of individuals, the organisms disseminate and infect the liver, spleen, eye, or central nervous system. Although some experts recommend not treating typical CSD in immunocompetent people with mild to moderate illness, treatment of all people with antimicrobial agents (Grade 2B) is suggested due to the probability of disseminated disease. The preferred antibiotic for treatment is azithromycin, since this agent is the only one studied in a randomized controlled study.Azithromycin is preferentially used in pregnancy to avoid the teratogenic side effects of doxycycline. However, doxycycline is preferred to treat B. henselae infections with optic neuritis due to its ability to adequately penetrate the tissues of the eye and central nervous system.
Compassionate Use Treatment: Cat-scratch disease is primarily caused by the bacterium Bartonella henselae. Treatment mostly involves supportive care and sometimes antibiotics, such as azithromycin, especially for severe cases. There are no well-documented compassionate use, off-label, or experimental treatments specifically established for cat-scratch disease. Management focuses on symptom relief and addressing complications if they arise. Standard treatments typically suffice without the need for experimental approaches.
Lifestyle Recommendations: For cat-scratch disease, lifestyle recommendations include the following:

1. **Avoid Scratches and Bites**: Minimize rough play with cats, especially kittens, to reduce the risk of scratches and bites.
2. **Clean Wounds Immediately**: If scratched or bitten, wash the affected area thoroughly with soap and water.
3. **Control Fleas**: Implement flea control measures for your pets to prevent the spread of Bartonella henselae, the bacteria causing the disease.
4. **Hygiene**: Wash your hands after handling cats, particularly if you have open wounds or cuts.
5. **Supervise Cat Interactions**: Monitor the interactions between children and cats closely.
6. **Consult a Veterinarian**: Ensure your cat receives regular veterinary care to maintain overall health and wellness.

Nan does not apply in this context as it is not relevant to lifestyle recommendations for cat-scratch disease.
Medication: Cat-scratch disease (CSD) is commonly treated with antibiotics. While it sometimes resolves on its own, antibiotics such as azithromycin are often prescribed to speed up recovery. In some cases, other antibiotics like doxycycline, ciprofloxacin, or rifampin may be used. Always consult with a healthcare provider for the most appropriate treatment.
Repurposable Drugs: For cat-scratch disease, antibiotics are the primary treatment. Azithromycin, doxycycline, and rifampin are commonly used. There are no widely recognized repurposable drugs specifically approved for cat-scratch disease at this time.
Metabolites: There is limited information on specific metabolites associated with cat-scratch disease (CSD), which is caused by the bacterium Bartonella henselae. The disease primarily affects the lymphatic system, and diagnostics are usually based on serologic tests, culture, or polymerase chain reaction (PCR) assays. Metabolic profiling specific to CSD is not commonly detailed in medical literature.
Nutraceuticals: Nutraceuticals are not standard treatments for cat-scratch disease. This condition, caused by Bartonella henselae, generally requires supportive care and sometimes antibiotics. The role of nutraceuticals in managing cat-scratch disease has not been established or validated by clinical research. If considering any supplement, consult a healthcare professional.
Peptides: Cat-scratch disease, caused by *Bartonella henselae*, is not characterized by specific peptides associated with the pathogen that are typically discussed in the context of treatment or diagnosis. Hence, there are no peptides used for specific diagnostic or therapeutic purposes in standard clinical practice for this disease. Nanotechnology is also not currently a standard part of managing cat-scratch disease. Treatment usually involves antibiotics like azithromycin and managing symptoms.