Disease of cat's scratches
Disease of cat's scratches - the sharp zoonozny infection caused by a gramotritsatelny bacterium of Bartonella henselae which gets into a human body with stings or with scratches of cats. The typical form of a disease of cat's scratches proceeds with primary affect in the form of papular and pustulous rashes, regionarny lymphadenitis, fever, a gepatosplenomegaliya. Emergence of atypical forms of a disease - eye, anginozny, abdominal, pulmonary, cerebral and so forth is possible. The clinical diagnosis is confirmed by microbiological crops, a histologic research of lymph nodes, IFA and PTsR-diagnostics separated . Etiotropny therapy of a disease of cat's scratches is carried out by antibacterial means.
Disease of cat's scratches
Disease of cat's scratches (good-quality , , Mollare's granuloma) - the infectious disease of the person developing as a result of penetration of the activator through the damaged integuments (scratches and stings of cats). Felinoz is widely and everywhere extended zoonozy; annually 25 thousand cases of a disease of cat's scratches are registered. 80% among the diseased - it the person are younger than 21 years; children prevail – boys, than girls are ill more often. Usually meets in the form of sporadic cases, however also the outbreaks of an infection in families when they serially get sick several children and adults are also possible. The greatest danger at a disease of cat's scratches is constituted by the atypical forms of a disease demanding involvement not only of infectiologists, but also experts from the field of neurology, ophthalmology, pulmonology, etc.
Etiologies of cat's scratches
The disease of cat's scratches in most cases (more than 96%) is caused by a gramotritsatelny stick bartonelly Bartonella henselae. The etiologichesky role of Alipia felis, Bartonella clarridgeiae, Bartonella quintana is in some cases noted. Cats are only asymptomatic carriers of activators and seldom have symptoms of a disease in the erased form. The carriage comes to light at kittens and young individuals up to 2 years more often. Between cats activators extend from bloyokha. More rare rodents, dogs, birds act as tanks of an infection. The mechanism of infection of the person with a disease of cat's scratches is connected with penetration of the activator through the injured skin or mucous membranes (usually at stings and scratches) together with saliva of the infected cat. The disease of cat's scratches has seasonal dependence and more often arises in the fall and in the winter. After the postponed infection resistant immunity usually develops.
In the place of introduction inflammatory reaction in the form of primary affect from where in the limfogenny way activators get into regionarny lymph nodes where intensively breed develops, emitting toxins and causing lymphadenitis. Morphological changes in lymphoid fabric are presented by a retikulokletochny giperplaziya with transformation to granulomas, and then - microabscesses. At an atypical course of disease of cat's scratches the hematogenic dissemination of an infection with involvement of a liver, spleen, heart, lungs, TsNS, eyes, a bone tissue, etc. is possible.
Symptoms of a disease of cat's scratches
The disease of cat's scratches can proceed in typical and atypical forms. In development of a disease allocate the incubatory period, an initial stage, the period of a heat of a disease and the convalescence period.
The typical form of a disease of cat's scratches is characterized by a triad of clinical signs: primary affect, regionarny lymphadenitis, fever. The incubatory period at a felinoza on average lasts 10-14 days (from 3 days to 2 months). As a reference point of an initial stage serves emergence in the place of entrance gate of an infection of a reddish papule with a diameter of 2-5 mm. By this time cat's stings and scratches in most cases already begin to live therefore patients do not pay attention to a painless small knot. Primary affect is usually localized on hands, the lower extremities, the person, a neck.
In 2-3 days, in the period of a heat of a disease of cat's scratches the papule is transformed to a pustula which is opened in a small sore. After drying of an element and falling off of a crust on skin there is no defect left. In the same time the lymph nodes, next to the defeat center, inflame, condensed and increase in sizes – regionarny lymphadenitis develops (usually axillary and cervical area; more rare – submaxillary, supraclavicular, inguinal area). Lymphadenitis is the most constant sign of a typical form of a disease of cat's scratches and remains within 2 one or 2nd weeks of months. Increase in lymph nodes is followed by fever and an intoksikatsionny syndrome: perspiration, weakness, muscular and headaches, indisposition. Also in the period of a heat of a felinoz increase in a liver and spleens (gepatosplenomegaliya) can be noted. In most cases the disease of cat's scratches comes to an end with recovery in 2-4 months. Perhaps recidivous, wavy current.
Treat atypical forms of a felinoz eye, cerebral, abdominal, pulmonary, etc. The eye form of a disease of cat's scratches (3-7%) develops at hit of a bartonella on a mucous membrane of eyes and proceeds as an ulcer granulematoznogo of conjunctivitis. At the same time puffiness of a century, conjunctiva hyperaemia with formation of ulcers and granulomas, submaxillary and parotid lymphadenitis is noted. In certain cases damage of eyes takes the form of the neyroretinit which is clinically shown violation of visual acuity of one eye.
Defeat of the central and peripheral nervous system at an atypical course of disease of cat's scratches can be expressed by development of encephalitis, meningitis, a cerebellar ataxy, encephalopathy, a miyelit, polyneuritis. At an abdominal form the gepatosplenomegaliya is noted, mezadenit, spleen abscesses. In more exceptional cases proceeds with development of an endocarditis, myocarditis, pleurisy, pneumonia, tonsillitis, zaglotochny abscess, a knotty eritema, osteomyelitis, etc. At HIV-positive patients danger of emergence of a generalized form of a disease of cat's scratches - a bacillar angiomatoz is high. Fever, intoxication, skin, a gepatosplenomegaliya, an endocarditis, lymphadenitis are characteristic of it.
Diagnosis of a disease of cat's scratches
The preliminary diagnosis is based on data of the epidemiological anamnesis indicating development of clinical symptoms of a felinoz after contact with a cat and violations of integrity of integuments or mucous membranes. For confirmation of the clinical diagnosis the methods of laboratory diagnostics directed to identification of Bartonella henselae in samples of fabrics are used. For this purpose microbiological sowing of contents of lymph nodes and abscesses, a biopsy and a histologic research of the changed lymph nodes, PTsR, IFA and RIF can be carried out. As a highly sensitive and specific method of diagnosis of a disease of cat's scratches serves skin test on .
The typical form of a disease of cat's scratches in the period of a heat needs to be differentiated with an infectious mononukleoz, limfogranulematozy, a lymphoma, a tulyaremiya, a brucellosis, histoplasmosis, koktsidioidozy, toxoplasmosis, a Cytomegaloviral infection, sarkoidozy and other diseases. At atypical forms of a disease of cat's scratches patients can need consultation of the dermatovenerologist, neurologist, ophthalmologist, pulmonologist, cardiologist and other narrow-purpose experts.
Treatment and prevention of a disease of cat's scratches
Typical forms of a disease of cat's scratches can independently be stopped, without treatment, however at the diagnosed cases of a felinoz medicamentous therapy is appointed. The standard scheme of treatment of a disease of cat's scratches consists of use of antibacterial medicines (, erythromycin, doxycycline, ), NPVS, antihistamines. Physiotherapeutic impact (a diathermy, UVCh) on area of the changed lymph nodes is shown. In case of suppuration of a lymph node punktsionny aspiration of pus or opening of abscess is carried out; more rare - removal of the affected lymph node.
Specific prevention of a felinoz is not developed. For the purpose of the prevention of a disease of cat's scratches it is necessary to take care of removal of claws and removal of fleas at cats, respect for care and rules of hygiene at contact with pets. Scratches and wounds from cat's stings need to be processed antiseptics.