Cat‐Scratch Disease

Published on 10/06/2015 by admin

Filed under Pediatrics

Last modified 10/06/2015

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Cat-Scratch Disease

Mary T. Caserta, MD

Basic Information

Definition

Cat-scratch disease (CSD) is a subacute to chronic regional lymphadenitis syndrome that occurs after cutaneous, ocular, or mucous membrane inoculation in a person who has contact with a cat.

Synonym

Cat-scratch fever

ICD-9-CM Code

078.3 Cat-scratch disease

Epidemiology & Demographics

• There are 22,000 to 24,000 cases per year of CSD in the United States (9.3 per 100,000 population).
• Approximately 2000 patients are hospitalized per year in the United States (0.77 to 0.86 per 100,000 hospital discharges).
• Distribution is worldwide, but it is most prevalent in warm and humid climates.
• The incidence is more common in fall and winter (60% of cases identified from September to January).
• 50% of patients are younger than 15 years of age.
• A zoonotic disease of cats, especially kittens. Asymptomatic cats may be persistently bacteremic with the causative organism for long periods of time.
• Fleas maintain the zoonotic infection among cats.

Clinical Presentation

• A papule or pustule at the site of the scratch precedes the appearance of regional lymphadenopathy by 1 to 6 weeks in 60% to 93% of patients.
• Gradual enlargement of a single, tender lymph node is observed in 80% of patients (20% have multiple node enlargements clinically, but up to 90% have multiple enlarged nodes in one site by ultrasonography).
• Most nodes (80%) are 1 to 5 cm in size and appear on the axilla, head, neck, or upper extremity.
• A papule or pustule at a distal site is drained by the enlarged node.
• Fever is usually absent or low-grade (10% with temperature higher than 39°C).
• From 10% to 30% of nodes spontaneously suppurate, but most resolve over 2 to 6 months.
• Atypical presentations include encephalopathy with seizures, hepatosplenic granulomas, multiple bone lesions, Parinaud’s oculoglandular syndrome (conjunctival granuloma with ipsilateral preauricular adenopathy), neuroretinitis, endocarditis, or a prolonged febrile illness, seen in 10% to 25% of infections.
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