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Cat scratch disease

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Cat scratch disease
BY / Dr :- AHMED ABDEL_RAHMAN MOHAMED ESMAIL

Published in: Education
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Cat scratch disease

  1. 1. SADAT CITY UNIVERSITY FACULTY OF VETRINARY MEDICINE ZOONOSES DEPT CAT SCRATCH DISEASE “ C S D ”
  2. 2. CAT SCRATCH DISEASE “ C S D ”
  3. 3. PREPARED BY :- Dr / AHMED ABDEL_RAHMAN MOHAMED ESMAIL
  4. 4. Well you might just want to take a step back……
  5. 5. Cat Scratch Fever/Disease
  6. 6. About Disease  Cat scratch disease is a disease caused by bartonella bacteria. It is believed to be transmitted by cat scratches and bites, or exposure to cat saliva.
  7. 7. The Organism
  8. 8. MORPHOLOGY  B. henselae is a small Gram negative bacillus measuring 2.0-2.5 X 0.5-0.6µ.  Like other Bartonella species, it can grow on chocolate agar or Columbia agar supplemented with 5% sheep or rabbit blood.  B. henselae produces 2 morphological types of colonies:  1. Irregular, raised,rough, dry white cauliflower-like colonies.  2. Small, circular, tan & moist, tending to pit the agar and adhere to the agar after 5-15 days of incubation at 35-37°C in the presence of 5% CO 2 .
  9. 9. Presence of B. henselae ) arrow) within naturally infected cat erythrocytes, as seen by confocal microscopy. Natural History of Bartonella Infections (an Exception to Koch’s Postulate) CVI, 2002
  10. 10. History
  11. 11. History  1950: Clinical syndrome described  1889: Similar disease reported  1983: Bacterial cause described  Gram negative bacillus  Found in lymph nodes of patients  1988: Organism successfully isolated and cultured
  12. 12. History  1991: CSD bacillus named Afipia felis  1992: Rochalimaea henselae isolated  Patients with bacillary angiomatosis  Refuted role of A. felis in CSD  1993: Genera Rochalimaea and Bartonella united  B. henselae currently recognized as causative agent of CSD
  13. 13. Epidemiology
  14. 14. EPIDEMIOLOGY  Worldwide distribution Prevalence in warm/humid climates  ~ 20,000 cases annually in US 80% under the age of 20yrs  30% of domestic cats are infected
  15. 15. Geographic Distribution  Worldwide  B. henselae type I  Eastern U.S.  Asia  B. henselae type II  Europe  Temperate climates  Seasonal variation  Peak August to October (North)
  16. 16. Transmission
  17. 17. Cat contact (scratch, bite, ? cat flea bite) 1 - 3 weeks Resolution in weeks to months Dissemination in immuno- compromised hosts
  18. 18. Human Infections  Vascular endothelial cells Monocytes/macrophages  Immunocompenent host Self-limiting CSD Swollen lymph nodes and fever  Immunocompromised host Bacilliaryangiomatosis-peliosis (BAP) Tumour-like vasoproliferative lesions
  19. 19. Symptoms  Bump (papule) or blister (pustule) at site of injury (usually the first sign occurs 3-10 days after infected)  Fatigue  Fever (in some patients)  Headache  Lymph node swelling near the scratch or bite (occurs 1 to 4 weeks after infected)  Overall discomfort (malaise) Less common symptoms:  Draining lymph nodes'  Enlarged spleen  Loss of appetite  Sore throat  Weight loss
  20. 20. Cat-scratch disease
  21. 21. Worst Case Scenario  It is usually worse with those who have weaker immune systems and those with AIDS. Also with younger children symptoms can be worse. Causing bigger bumps, lymph nodes to swell bigger, wider spread of lesions, and sometimes bumps can appear on eyes (Parinaud oculoglandular syndrome). Plus an inflammation of the brain can occur causing seizures. In any of these cases it is recommended to take antibiotics.
  22. 22. PATHOGENESIS Endothelial Cell Invasion and Colonization:  Human umbilical endothelial cells (HUVECs)  Bacterial adhesion and invasion  Actin-dependant mechanisms  Intracellular membrane-bound compartments  B. henselaeinfection leads to:  Secretion of vascularproliferative compounds  Inhibition of host cell apoptosis  Host cell proliferation
  23. 23. Morbidity and Mortality  Humans  22,000 to 24,000 annual cases in U.S.  3 to 6% of general population seropositive  Higher in veterinarians  Most cases in children  Most infections self-limiting  Death is rare
  24. 24. Morbidity and Mortality  Seroprevalence in cats  14 to 55% in U.S.  40 to 70% in warm, humid climates  30% of captive wild felids  Higher in feral cats vs. pets  No reported morbidity or mortality
  25. 25. Cat Scratch Disease: Complications  Parinaud’s oculoglandular syndrome  Encephalitis  Endocarditis  Disseminated disease  AIDS patients  Rashes  Bone/joint lesions  Pneumonia
  26. 26. Disease in Animals
  27. 27. Species Affected  Cats, felids are reservoir hosts  Experimental infection  Dog  Armadillo  Mice
  28. 28. Feline Infections  Erythrocytes  Firm bacterial adhesion  Internalization  Membrane-bound compartments  Bacteria replicate within erythrocytes  Circulate in the bloodstream (weeks to months)  Long-lasting intraerythrocytic infection  Specific adaption to the mode of transmission
  29. 29. Disease in Other Animals  Experimental infections  Dogs  No bacteremia  Rodents  Asymptomatic  Granulomatous hepatitis  Non-human primates  Asymptomatic  Fever  Subcutaneous skin lesions at inoculation site
  30. 30. Post Mortem Lesions  Lymphadenomegaly  Multiple histopathologic lesions  Blood-filled cysts and cavities in the liver Peliosis hepatitis  Granulomatous hepatitis
  31. 31. Diagnosis  Diagnosis Culture Time consuming, used mainly in research Serology Cross reactions possible PCR
  32. 32. Cure Usually the disease does not need medical treatment, but in severe cases treatment with antibiotics such as azithromycin can be helpful.
  33. 33. Prevention  Avoid bites and scratches  Kittens  Wash wounds immediately  Flea control?  Clip nails  Keep cats indoors  Antimicrobials?
  34. 34. Disinfection  Susceptibility of B. henselae not specifically known  Closely related organism B. bacilliformis  Susceptible to:  70% ethanol  1% sodium hypochlorite  2% formaldehyde

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