Cat scratch disease (felinoz): symptoms,treatment how infection occurs

Update: October 2018

Cat – is not only a source of emotion and removal of bad
mood naturally, without taking any herbs or
pills. This kind of wild predator, especially being in a small
age, through its bite or scrape can transmit felinosis –
cat scratch disease. This disease has a long
current, accompanied by inflammation, and sometimes suppuration
lymph nodes near the scratched site. If at the time of infection
human immunity has not been suppressed by disease or medication, disease
passes without complications. Otherwise may occur
complications of the liver, brain and spleen.

About the causative agent of the disease

Felinoz is caused by a very unusual bacterium – Bartonella
(Bartonella henselae). It is an intermediate form between the bacterium and
virus: in form it is not different from bacteria and even has
flagellum; destroyed by antibiotics. But, like a virus, she lives inside
cells and is grown not on nutrient media, but on living cells.
Her “cousins,” Rickettsia, are the causative agents of many
diseases, including typhus – a pathology that
appears in some people with lice on their heads.

The name of the disease – felinoz – comes from the word “Felis”,
which in Latin are called cats. �”Name” is the bacteria – Bartonella
Henzele – given to her in honor of the microbiologist who discovered the microbe and
described her properties, Diana Hensel.

How and from whom are infected

The main amount of bartonell “lives” in the body of domestic and
wild cats. To each other, bacteria are carried by cat fleas,
кишечнике которых микроб живет до 9 дher. These insects are for
humans are not dangerous.

According to statistics, almost half of the cats in the blood
this pathogen is detected, with no symptoms of the disease
animals do not experience, although sick for several years. There are even
the opinion that this bacterium inhabits the cats mouth is normal. They excrete
bacterium with urine and saliva, from where it falls on the paws of cats.

WITHледовательно, заразиться можно:

  • when biting an animal;
  • through cat claw damage;
  • through the ingress of saliva into the eye (conjunctiva) or
    damaged skin;
  • if the water / food that the cat drank got on the mucous membranes
    or injured skin;
  • if there was an injection with a fishing hook, splinter or prickles
    plants that cat’s saliva fell on.

The most dangerous in terms of contagion are kittens that are not
turned 1 more year. Adult cats are a little less dangerous. But
The source of infection can be dogs, monkeys and rodents.
You can even get infected by pricking yourself with a hedgehog needle or bird feather.

болезнь кошачих царапинIt usually affects:

  • arms;
  • leg skin;
  • head;
  • face;
  • neck;
  • rarely eyes.

A person cannot infect a person. And who suffered felinoz
once again the disease does not develop. 5% of people have immunity
to felinosis (of which 25% of owners of domestic cats).

Some statistics

In temperate climates most often infected since September
till March (almost 2/3 of all cases). This is explained closer to
cold season by contacting a person with pets. AT
tropics seasonality no.

About 90% of cases are children and adolescents under 20 years of age. Get sick more often
boys WITHемейные вспышки возникают редко: заболевает обычно
Only 1 child, although everyone was playing with the same kitten.

What increases the chance of a more severe course of felinosis

The man who contacted Bartonella Henzele,
a severe or even atypical form of felinosis develops in the following
situations:

  • there is a congenital pathology of the cellular link of the immune system;
  • after a serious illness or surgery;
  • when glucocorticoid therapy is needed (for the treatment of autoimmune
    diseases such as rheumatoid arthritis, autoimmune hepatitis,
    psoriasis and so on);
  • after treatment with cytostatic drugs (cyclophosphamide,
    cyclosporine, azathioprine);
  • in alcohol abusers;
  • in patients with diabetes;
  • у ATИЧ-инфицированных людей.

AT последнем случае фелиноз протекает очень тяжело и длительно;
sometimes its manifestations are so atypical that about this diagnosis
don’t even think about it.

How is the disease manifested

Scratch or bite the cat the first 3-10 days slowly
heals without causing anxiety on the part of the person: she
may hurt a little or sore like a normal skin injury. It –
incubation period; causative agent at this time overcomes barriers
integumentary tissue and reproduces. This period can be lengthened to 3
weeks, then at the time of the first symptoms of felinosis injury
skin no longer exists.

After the time it takes for the microbe to penetrate and
savings (3 days-3 weeks, on average – 7-14 days) at the place
where there was a scratch or remains a crust from it, a rash appears. She is
looks like a few knots in size from millet grain to
peas that do not itch and do not hurt.

After 2-3 days, the peak of the disease begins: such nodules
fester and open themselves, then become covered with a crust and
may begin to itch slightly (especially if a child has been scratched
allergic). AT течение 1-3 weeks the crusts dry and fall off after
what place the bite ceases to be noticeable: there is no
Scars, nor darker skin. This means that bartonella
multiplied in sufficient quantities, overcome local immunity
skin area and fell into the lymphatic bed.

After 10-14 days (less often – longer) from the moment the first
nodules, the microbe is captured by regional lymph nodes – local
filters that try to keep it off.

If the hand was bitten below the elbow, increase one or
several groups of lymph nodes: elbow, axillary, cervical. Order
appearance of lymphadenitis may be just that, but may
immediately increase the axillary nodes, and elbows remain
unchanged. Also, starting from the armpit, there will be
enlarged lymph nodes if damaged by claws or teeth
forearm or shoulder.

If the bite / scratch falls on the leg, the lymph nodes become inflamed in
femoral and groin area. When scratching the face first
can respond submandibular, anterior or posterior auric groups;
after which one or more lymph nodes from the cervical
groups.

Signs that say the lymph nodes have suffered due to
fellinoza:

  • lymph nodes gradually increase, reaching from 5 to 10 cm in
    diameter;
  • they are dense;
  • feel them hurt;
  • the skin over them is not red, not hot to the touch;
  • lymph nodes can be removed – they do not pull the skin behind them;
  • by increasing the entire group of nodes, probing them, you can “roll”
    they are independent of each other: they are not soldered to each other.

An increase in lymph nodes is accompanied by a deterioration in the overall
human condition. These symptoms appear:

  • temperature increase, sometimes up to 39 ° C or higher;
  • headache;
  • malaise;
  • weakness;
  • poor sleep;
  • sweating;
  • loss of appetite;
  • heartbeat.

Температура rises не у всех до столь высоких цифр: в
in some cases, it may be absent altogether. Boost
temperature lasts from a week to a month, the remaining symptoms
gradually pass over 2 weeks. Lymph nodes remain
increased to three months. AT половине случаев они нагнаиваются и
can spontaneously be opened: then it is released on the surface
thick pus of yellow-green color, which, being taken for
bacteriological examination shows no signs
bacterial infection (as you remember, Bartonella does not grow on
nutrient media).

AT этот же период на коже тела или конечностей человека может
appear rash of a reddish color, occupying larger or smaller
skin patches. She is не зудит и не болит, исчезает через несколько
дher.

AT период увеличения лимфоузлов могут также наблюдаться:

  • discomfort and pain in the right hypochondrium – it increases
    the liver, which is also a filter in the way Bartonelle, trapped
    by this point in the blood;
  • feeling of “needles” or discomfort in the left hypochondrium: this may
    manifest enlargement of the spleen, which may also suffer
    with felinosis. An enlarged liver and spleen can be detected and
    on abdominal ultrasound, without any symptoms;
  • heart pain, arrhythmias. These are signs of heart damage;
  • enlarged lymph nodes lying far from the point of entry
    infections.

ATышеуказанные симптомы болезни кошачьей царапины возникают у
people whose immunity is not active enough and allows infection
penetrate the blood. The same people who are called
�“Immunocompromised” (treated with drugs that suppress
immunity suffering from congenital diabetes
иммунодефицитом, ATИЧ, хроническим алкоголизмом), фелиноз протекает
and at all atypical. They may have an infection in the body.
forever, causing chronic disease.

Usually the disease ends in a month or less after
increase in the first lymph node: the temperature decreases, leaves
headache, sleep and appetite are restored, lymph nodes
gradually decrease and become dense little “balls”,
not welded to each other and skin. Very rare, with moderately weak
immunity, felinoz can last 1-2 years when its symptoms then
subside, then reappear.

Atypical forms of the disease

This term is called:

  1. a disease that has arisen in response to a microbe entering the skin,
    but to another place (for example, on the conjunctiva of the eye);
  2. Bartonella organ damage, characteristic of humans only
    with “compromised” immunity.

Atypical forms are not complications of felinosis, it is hard,
atypically current infection.

Eye damage

If the cat’s saliva falls on the conjunctiva of the eye, it can
develop:

  1. Conjunctivitis Parilo. AT этом случае страдает только один глаз.
    It is red, swollen, difficult to open. It does not hurt, and from
    nothing stands out. On examination, the oculist will see nodules and ulcers
    on conjunctiva.

Simultaneously with damage to the eye, the parotid lymph nodes are inflamed.
from the same side. The forearm is always affected: he
grows up to 5 cm or more, can suppurate and open,
after which a scar is formed. May also increase
submandibular, and cervical lymph nodes. It also worsens the overall
condition: weakness, palpitations, rises
body temperature, worsened sleep.

  1. Neuroretinitis. At the same time vision on one eye worsens.
    The state of health is not changed. Changes characteristic of felinosis
    Sees an oculist during the examination.

Nervous system damage

When bartonella enters the bloodstream, 2-3 weeks after
inflammation of the regional lymph nodes, signs may appear
damage to the nervous system. This and the decrease in sensitivity only
areas of socks and gloves, or extending above, this and
violation of motor function of one or several limbs, and
trembling, and poor coordination.

Also felinosis can cause seizures, inappropriate behavior,
impaired consciousness, paralysis of the facial nerve.

Atypical forms of immune deficiency

In people whose immunity is greatly reduced, feleenosis proceeds according to type.
bacillary angiomatosis or pelyotic hepatitis.

Bacillary angiomatosis

So called pathology (it often develops only in
HIV-infected people) when, in response to the presence of bacteria
of the Bartonella genus, the growth of vessels occurs

Here, after being damaged by a cat’s claw or teeth
incubation period of several weeks or even months, that is
wound heals. Skin manifestations of the disease do not appear in
the place where the cat scratched, and in arbitrary. Also affected
mucous membranes of the mouth, genitals, larynx.

The disease begins with the fact that not small ones appear on the skin.
red nodules, and red or purple spots not protruding above
her. Nodules appear only later, against the background of these spots. And the nodes
not small, but large, up to 3 cm in diameter, painful, covered
red, inflamed skin. They may be several, separate, but
there may be hundreds. Around each of them is marked “collar”
from thin, eroded (reddish and oozing) epidermis.

The disease is accompanied by indisposition, fever,
losing weight Other organs may be affected: liver, spleen,
heart, central nervous system, muscles, bone marrow.

Bacillary angiomatosis proceeds differently: it can pass
independently, but can – with severe damage to internal organs
– lead to death.

Hepatitis

In this case, cavities are formed in the liver, filled with blood,
which is why liver tissue takes the form of a sponge. Symptoms
liver damage in cat scratch disease:

  • prolonged fever;
  • chills appear periodically;
  • the stomach feels like “poddudy”, which is associated with accumulation in it
    gases;
  • skin takes on a pale yellow appearance;
  • rises кровоточивость десен;
  • hemorrhages may appear on the skin due to
    defeat of the blood coagulation system.

Complications

When bartonella, causing felinoz, is spread with blood in
various internal organs may occur:

  1. pleurisy;
  2. myocarditis;
  3. splenic abscess;
  4. osteomyelitis;
  5. arthritis;
  6. atypical pneumonia.

Also, bacteria can cause significant complications from
blood, consisting in the reduction of various blood cells:

  • platelet count (trmbicytopenic purpura);
  • erythrocytes (hemolytic anemia);
  • eosinophilic leukocytes (eosinophilia);
  • leukocytes (leucoclastic vasculitis).

Diagnostics

The treatment and diagnosis of fellinoz is carried out by an infectious diseases specialist.
This specialist is already in appearance distinguish feline disease
scratches from suppuration wounds. So, if a cat was scratched and swollen
hand, it is likely (although you need to inspect)
infection of the wound by ordinary (non-specific) flora: strepto-
or staphylococcus, proteins, maybe fungal flora. Such a
suppuration begins already on the second day after a scratch or bite,
the injury site is red, painful, it can stand out
light liquid, and later – pus. With felinosis, the same scratch
heals, and already against the background of a crust or even without it in this place
nodules appear that do not fester, do not hurt or itch.

�“Swelling” of a hand after a bite or scratch is most likely
phlegmon description (purulent fusion of tissues) or worse,
anaerobic infection such as gas gangrene. It needs urgent
the help of the surgeon, most likely, with hospitalization.

If an individual’s lymphadenopathy began to bother
consultation of the infectiologist is surely necessary. Best not a doctor
KIZ, and the doctor of the emergency department of the infectious hospital. Here
less likely to infect other patients, because similar
manifestations in the absence of nodules on the skin should be distinguished from
HIV infection, Hodgkin’s disease, infectious mononucleosis, and
also such dangerous diseases as plague and tularemia.

Suspecting felinoz through medical history (contact with a cat,
the appearance of nodules), the infectious disease physician will help confirm the diagnosis
using research for which he needs material from or
nodules, or from the abscess, or from the lymph node, for which the doctor must
pierce the pathological element and take its contents on such
types of research:

  1. polymerase chain reaction (PCR): so identified and
    particles of B.hanselae are recognized. Analyze perform paid
    laboratories;
  2. histological: characteristic changes are seen under the microscope
    fabrics as well bacteria.

Serological tests also help in the diagnosis –
determination of antibodies to bartonella. To do this, perform the reaction under
name or IFA, or RSK.

At 3-4 weeks of illness, you can spend a skin allergy test,
injecting a bartonella solution under the skin: in 90% of patients
Phelinosis of people the answer is redness and swelling in this place.
Such a исследование у детей не проводится.

Complete blood count, which increases the number of eosinophils and
accelerated ESR does not confirm the diagnosis, but leads to the conclusion that
severity of the disease. The determination of liver samples will help
find out if liver function is affected and how much, and abdominal ultrasound
cavities will reveal an enlargement of the liver and / or spleen, which will give
the basis to adjust the mode to half-bedded (a spleen –
the organ is tender, its capsule can be damaged when expressed
human activity).

Treatment of the disease

Felinoz is treated as follows: medicines are prescribed for
system reception, compresses, can be applied surgical
treatment.

Typical uncomplicated damage to the heart, liver, spleen,
The nervous system can be treated at home. Other forms require
hospitalization of a person.

Drug treatment

Appointed:

  • Antibiotics: doxycycline, erythromycin, tetracycline, ofloxacin,
    gentamicin, clarithromycin. They are applied in the form of tablets, and
    eye damage – also in the form of eye drops.
  • Anti-inflammatory and painkillers: ibuprofen,
    diclofenac, mefenamic acid.
  • Antihistamines: tsetrin, L-tset, zodak, Erius and
    others.
  • In severe cases, glucocorticoids can be prescribed:
    dexamethasone, prednisone.

Compresses

The area of ​​the inflamed lymph nodes is recommended to impose
compresses. Take 1 part dimethyl sulfoxide into 4 parts water
wet the gauze with this mixture, put it on the lymph node, put on top
polyethylene, and then fix with a bandage and warm with warm
cloth.

Physiotherapeutic methods

The area of ​​the inflamed lymph nodes is affected by UHF,
diathermy.

Surgery

If the affected lymph nodes are tense and painful,
their puncture for the purpose of drainage: so the pressure in the node decreases,
which helps in the relief of pain.

Cat scratch disease in children

Feline in children usually proceeds in the form of a typical form: scratch
from the cat’s claw passes, in its place there are nodules that
fester and open up. After that, 1 or
several nearby lymph nodes. The disease lasts about a month,
may even take place without treatment.

An atypical form may develop in an HIV-infected child,
a child undergoing chemotherapy or a transplant
organs. In this case, predict which body or system will be
amazed, impossible. Symptoms атипичных форм у детей соответствуют
described above.

Diagnostics у детей – такая же, ПЦР пунктата – ее основной
method.

The treatment is carried out with Sumamed at a dose of 10 mg / kg per day. WITH
Doxycycline or tetracycline can be used for 8 years. Type drugs
Ciprofloxacin or ofloxacin is allowed from 16-18 years old.

Prognosis of the disease

In most cases, the disease ends in complete
disappearance of all symptoms. With timely treatment can
cure even severe forms of pathology. WITHомнителен прогноз при
damage to the nervous system, since Bartonella can cause
brain irreversible changes.

Disease prevention

What to do if the cat scratched:

  1. wash the wound with laundry soap under running water;
  2. process 3% hydrogen peroxide;
  3. burn with alcohol or brilliant green.

Taking antibiotics is ineffective. Treat cats like
potential sources of infection is useless.

Автор: Кривега Мария WITHалаватовна врач-реаниматолог

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