Difference between revisions of "Cat scratch disease"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Cat_scratch_disease_-_low_mag.jpg
| Width      =
| Caption    = Cat scratch disease. [[H&E stain]].
| Micro      = necrotizing granulomas with neutrophils and star-shaped (stellate), +/-multinucleated giant cells, microorganisms consistent with ''B. henselae''
| Subtypes  =
| LMDDx      = [[sporotrichosis]], [[lymphogranuloma venereum]], [[tularemia]]
| Stains    = [[Warthin-Starry stain]] +ve
| IHC        = B. henselae +ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[lymph node]] - see ''[[lymph node pathology]]''
| Assdx      =
| Syndromes  =
| Clinicalhx = contact with cats
| Signs      = fever, lymphadenopathy
| Symptoms  =
| Prevalence = rare
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = other causes of lymphadenopathy, e.g. [[lymphoma]]
}}
'''Cat scratch disease''', also '''cat scratch fever''', is an uncommon [[lymph node pathology|pathology of the lymph node]].
'''Cat scratch disease''', also '''cat scratch fever''', is an uncommon [[lymph node pathology|pathology of the lymph node]].


==General==
==General==
*Infection caused ''[[Bartonella henselae]]'',<ref name=pmid19332922>{{Cite journal  | last1 = Jerris | first1 = RC. | last2 = Regnery | first2 = RL. | title = Will the real agent of cat-scratch disease please stand up? | journal = Annu Rev Microbiol | volume = 50 | issue =  | pages = 707-25 | month =  | year = 1996 | doi = 10.1146/annurev.micro.50.1.707 | PMID = 8905096 }}</ref> a gram-negative bacilla (0.3-1.0 x 0.6-3.0 micrometers) in chains, clumps, or singular.<ref name=Ref_ILNP110>{{Ref ILNP|110}}</ref>
*Infection caused ''[[Bartonella henselae]]'',<ref name=pmid19332922>{{Cite journal  | last1 = Jerris | first1 = RC. | last2 = Regnery | first2 = RL. | title = Will the real agent of cat-scratch disease please stand up? | journal = Annu Rev Microbiol | volume = 50 | issue =  | pages = 707-25 | month =  | year = 1996 | doi = 10.1146/annurev.micro.50.1.707 | PMID = 8905096 }}</ref> a gram-negative bacillus (0.3-1.0 x 0.6-3.0 micrometers) in chains, clumps, or singular.<ref name=Ref_ILNP110>{{Ref ILNP|110}}</ref>
*Treatment: antibiotics.
*Treatment: antibiotics.


==Clinical==
===Clinical===
Features:<ref name=Ref_ILNP113>{{Ref ILNP|113}}</ref>
Features:<ref name=Ref_ILNP113>{{Ref ILNP|113}}</ref>
*Usually unilateral.
*Usually unilateral lymphadenopathy.
**May be disseminated in individuals with immune dysfunction.
**May be disseminated in individuals with immune dysfunction.
*Contact with cats.
*Contact with cats.
==Gross==
*Lymphadenopathy - usu. unlitateral.
**Typically axillary or cervical (like [[tularemia]]).<ref name=pmid22706525>{{Cite journal  | last1 = Asano | first1 = S. | title = Granulomatous lymphadenitis. | journal = J Clin Exp Hematop | volume = 52 | issue = 1 | pages = 1-16 | month =  | year = 2012 | doi =  | PMID = 22706525 }}</ref>


==Micrograph==
==Micrograph==
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***Microabscesses often described as "stellate" (star-shaped).
***Microabscesses often described as "stellate" (star-shaped).
*+/-Multinucleated giant cells.
*+/-Multinucleated giant cells.
*Microorganism consistent with ''B. henselae''.


Notes:
Notes:
Line 38: Line 72:


==Stains==
==Stains==
*Warthin-Starry stain +ve.
*[[Warthin-Starry stain]] +ve -- bacilli.
*[[Gram stain]] -ve.


==IHC==
==IHC==
*B. henselae IHC stain +ve - '''diagnostic'''.
*B. henselae IHC stain +ve -- bacilli - '''diagnostic'''.


==See also==
==See also==

Latest revision as of 01:56, 4 January 2014

Cat scratch disease, also cat scratch fever, is an uncommon pathology of the lymph node.

Cat scratch disease
Diagnosis in short

Cat scratch disease. H&E stain.
LM necrotizing granulomas with neutrophils and star-shaped (stellate), +/-multinucleated giant cells, microorganisms consistent with B. henselae
LM DDx sporotrichosis, lymphogranuloma venereum, tularemia
Stains Warthin-Starry stain +ve
IHC B. henselae +ve
Site lymph node - see lymph node pathology
Clinical history contact with cats
Signs fever, lymphadenopathy
Prevalence rare
Prognosis benign
Clin. DDx other causes of lymphadenopathy, e.g. lymphoma

General

  • Infection caused Bartonella henselae,[1] a gram-negative bacillus (0.3-1.0 x 0.6-3.0 micrometers) in chains, clumps, or singular.[2]
  • Treatment: antibiotics.

Clinical

Features:[3]

  • Usually unilateral lymphadenopathy.
    • May be disseminated in individuals with immune dysfunction.
  • Contact with cats.

Gross

  • Lymphadenopathy - usu. unlitateral.

Micrograph

Features:[3]

  • Necrotizing granulomas with:
    • Neutrophils present in microabscess (necrotic debris) - key feature.
      • Microabscesses often described as "stellate" (star-shaped).
  • +/-Multinucleated giant cells.
  • Microorganism consistent with B. henselae.

Notes:

  • May involve capsule or perinodal tissue.

DDx of stellate abscess in lymph nodes - cat split:[5]

Images

www:

  • CSD - very low mag. - showing serpentine shaped microabscesses (WC)

  • CSD - low mag. - showing serpentine shaped microabscesses (WC)

  • CSD - high mag. - showing neutrophilic abscesses (WC)

Stains

IHC

  • B. henselae IHC stain +ve -- bacilli - diagnostic.

See also

References

  1. ↑ Jerris, RC.; Regnery, RL. (1996). "Will the real agent of cat-scratch disease please stand up?". Annu Rev Microbiol 50: 707-25. doi:10.1146/annurev.micro.50.1.707. PMID 8905096.
  2. ↑ Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 110. ISBN 978-0781775960.
  3. ↑ 3.0 3.1 Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 113. ISBN 978-0781775960.
  4. ↑ Asano, S. (2012). "Granulomatous lymphadenitis.". J Clin Exp Hematop 52 (1): 1-16. PMID 22706525.
  5. ↑ URL: http://www.dermpathmd.com/mnemonics/mnemonics_dermatopathology.htm. Accessed on: 23 September 2011.
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