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LA ENFERMEDAD POR ARAÑAZO DE GATO
THE CAT-SCRATCH DISEASE
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****** DERMAGIC-EXPRESS No.44 ******* 
****** 11 MARZO DE 1.999 ********* 
11 MARCH 1.999
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EDITORIAL ESPAÑOL
=================
Hola amigos de la red, DERMAGIC de nuevo con ustedes. El gatito, bella
mascota que muchos cuidamos y tenemos en nuestros hogares y que ocasiona la
bien conocida ENFERMEDAD POR ARAÑAZO DE GATO. Espero que estas 32
referencias nos ilustren bien el tema,,,, y,,,, cuidado con los gatitos. 

Én el attach 1 lamina ilustrativa del tema: lesion inicial, el gatito y
linfadenopatia regional producto del arañazo. 

Bienvenidos a DERMAGIC: Dr. Mehmet Salih Gurel (Turquia), and Dr. Emad
Elgamel (Egipto), Kelly J. Warren, M.D., Gail G.Drayton, M.D., Steve A.
McClain, M.D (Estados Unidos A.)

Proxima edición: LA MINOCICLINA: LO BUENO LO MALO Y LO FEO 

Saludos a TODOS,,, 

Dr. Jose Lapenta R.,,,

EDITORIAL ENGLISH
=================
Hello friends of the net, DERMGIC again with you. The kitten, beautiful pet
of that many take care and we have in our homes and that it causes the very
well-known CAT-SCRATCH DISEASE. I hope these 32 references illustrate us
well the topic,,,, and,,,, care with the kittens. !!! 

In the attach 1 illustrative sheet of the topic: initial lesion, the
kitten, and regional lymphadenopathy product of the scratch. 

Welcome to DERMAGIC: Dr. Mehmet Salih Gurel (Turkey), and Dr. Emad Elgamel
(Egypt) Kelly J. Warren, M.D., Gail G.Drayton, M.D., Steve A. McClain, M.D
(USA) 

Next edition: THE MINOCYCLINE: THE GOOD, THE BAD, AND THE UGLY. 

Greetings to ALL, 

Dr. Jose Lapenta R.,,,
======================================================================
DERMAGIC/EXPRESS(44)
======================================================================
LA ENFERMEDAD POR ARAÑAZO DE GATO / THE CAT-SCRATCH DISEASE
======================================================================
1.) The Cat-Scratch Disease.
2.) Cat scratch disease: detection of Bartonella henselae DNA in archival
biopsies from patients with clinically, serologically, and histologically
defined disease. 
3.) [A case of cat scratch disease identified by an elevated Bartonella
henselae antibody level using enzyme immunoassay] 
4.) Will the real agent of cat-scratch disease please stand up? 
5.) [Cat scratch disease caused by Bartonella henselae] 
6.) Hypercalcemia due to endogenous overproduction of active vitamin D in
identical twins with cat-scratch disease. 
7.) Cat-scratch disease caused by Bartonella henselae: the first case
report in Taiwan. 
8.) [Cat-scratch disease and other infections caused by Bartonella species] 
9.) Bartonella spp. as emerging human pathogens.
10.) [Bartonella henselae infection in immunocompetent patients: cat
scratch disease] 
11.) Cat-scratch disease and related clinical syndromes. 
12.) Cat-scratch disease and bacillary angiomatosis. 
13.) Detection of antibodies to Bartonella henselae in clinically diagnosed
cat scratch disease. 
14.) The expanding spectrum of Bartonella infections: II. Cat-scratch disease.
15.) Evaluation of serological response to Bartonella henselae, Bartonella
quintana and 
Afipia felis antigens in 64 patients with suspected cat-scratch disease.
16.) [Cat scratch disease and associated infections] 
17.) Cat-scratch disease simulating Histiocytosis X. 
18.) [Atypical cat-scratch disease: a case report of splenic granulomatosis] 
19.) [2 patients with atypical manifestations of cat-scratch disease]
20.) [Visceral localizations of cat-scratch disease in an immunocompetent
patient] 
21.) Serous retinal detachment of the macula associated with cat scratch
disease. 
22.) Cat scratch disease in Greece. 
23.) Cat-scratch disease--an overlooked disease in Denmark?]
24.) Prolonged Bartonella bacteremia in cats associated with cat-scratch
disease patients. 
25.) Application of polymerase chain reaction assay in the diagnosis of
orbital granuloma complicating atypical oculoglandular cat scratch disease. 
26.) Systemic cat scratch disease: hepatic and splenic involvement about 3
pediatric cases. 
27.) Bartonella clarridgeiae, a newly recognized zoonotic pathogen causing
inoculation papules, fever, and lymphadenopathy (cat scratch disease). 
28.) Coinfection with Bartonella clarridgeiae and Bartonella henselae and
with different Bartonella henselae strains in domestic cats.
29.) [Cat-scratch disease: historical, clinical, phylogenetic and taxonomic
aspects]
30.) Molecular diagnosis of cat scratch disease: a two-step approach.
31.) Antibiotic therapy for cat-scratch disease: clinical study of
therapeutic outcome in 268 patients and a review of the literature.
32.) Successful treatment of cat-scratch disease with ciprofloxacin [see
comments]
=========================================================================
=========================================================================
1.) The Cat-Scratch Disease
=========================================================================
Source: Harrison's 14

DEFINITION AND ETIOLOGY

Typical CSD is manifested by painful regional lymphadenopathy persisting
for several weeks or months after a cat scratch. Occasionally, infection
may disseminate and produce more generalized lymphadenopathy and systemic
manifestations, which may be confused with the manifestations of lymphoma.
B. henselae is the causative agent of CSD. There is no evidence that B.
quintana or Afipia felis (originally proposed as the agent of CSD) can
cause this disease, nor are those two species carried by cats.

EPIDEMIOLOGY

Approximately 60 percent of cases of CSD in the United States occur in
children. Exposure to bacteremic young cats that either are flea-infested
or have been in contact with another cat carrying fleas poses a significant
risk of infection. Most infections are caused by a scratch and only rare
cases by a bite or by licking. Most cases occur in the warmer months, when
fleas are active. Regions of the United States where fleas are endemic have
higher rates of infection. The flea may serve to transmit infection between
cats; it is not known whether humans can be infected through the bite of an
infected flea.

CLINICAL MANIFESTATIONS

A localized papule (Fig. 165-CD3), progressing to a pustule that often
crusts over, develops 3 to 5 days after a cat scratch. Tender regional
lymphadenopathy (Fig. 165-CD4) develops within 1 to 2 weeks after
inoculation; by this time, the papule may have healed spontaneously.
Scratches are most often sustained on the hands or face, producing
epitrochlear, axillary, pectoral, and cervical lymph node involvement. The
involved nodes occasionally become suppurative; bacterial superinfection
with staphylococci or other cutaneous pathogens may develop. Although most
patients do not have fever, systemic symptoms are frequent and include
malaise, anorexia, and weight loss. Without treatment, lymphadenopathy
persists for weeks or even months and may be confused with lymphatic
malignancy. Other manifestations in apparently immunocompetent patients
include encephalitis, seizures and coma (especially in children),
meningitis, transverse myelitis, granulomatous hepatitis and splenitis,
osteomyelitis, and disseminated infection. Conjunctival inoculation may
cause Parinaud's oculoglandular syndrome, with conjunctivitis and
preauricular lymphadenopathy.

PATHOLOGY

The histopathologic hallmark of CSD is granulomatous inflammation with
stellate necrosis but no evidence of angiogenesis. Thus, infection by B.
henselae can produce two entirely different pathologic reactions, depending
on the immune status of the host: CSD or bacillary angiomatosis.

DIAGNOSIS

CSD should be suspected if the patient has a history of exposure to cats
and develops lymphadenopathy and a skin lesion. The diagnosis can be
confirmed by pathologic examination of the involved nodes. Tiny bacilli in
clusters can sometimes be seen in biopsy samples stained with
Warthin-Starry silver. The CSD skin test, in which lymph node material
obtained from patients with CSD serves as an antigen, is no longer used for
diagnosis because of concerns about the transmission of viral agents. A
specific serologic test has been developed recently and may produce a
positive result in 70 to 90 percent of patients with intact immunity. The
identification of B. henselae 16S ribosomal RNA genes in biopsy material by
PCR amplification with specific oligonucleotide primers can also be
diagnostically useful; however, these methods are not yet commercially
available. Cultures of lymph nodes, cerebrospinal fluid, or other tissues
are rarely positive.

TREATMENT

Although CSD is generally self-limited, tender regional lymphadenopathy and
systemic symptoms may be debilitating. Patients with encephalitis or other
serious manifestations should be treated with antibiotics, even though the
efficacy of such therapy is unclear. No comparative trials of antibiotic
treatment have been performed, and no anecdotal reports of treatment
failures have appeared. Several reports suggest that aminoglycoside
treatment (e.g., intravenous gentamicin at standard doses calculated to
result in therapeutic levels) is effective in patients with encephalitis
and other systemic infections. The oral agents that appear to be useful are
those that also are most effective for the treatment of bacillary
angiomatosis; they include ciprofloxacin, doxycycline, and possibly
erythromycin (at the dosages recommended for bacillary angiomatosis). Many
patients with established CSD have no apparent response to antibiotics; the
necessary duration of therapy is variable.

=========================================================================
2.) Cat scratch disease: detection of Bartonella henselae DNA in archival
biopsies from patients with clinically, serologically, and histologically
defined disease. 
=========================================================================
Author 
Scott MA; McCurley TL; Vnencak-Jones CL; Hager C; McCoy JA; Anderson B;
Collins RD; Edwards KM 
Address 
Department of Pathology, Vanderbilt University Medical Center, Nashville,
Tennessee 37232, USA. 
Source 
Am J Pathol, 149(6):2161-7 1996 Dec 
Abstract 
Serological and epidemiological studies suggest that Bartonella henselae is
the etiological agent of cat scratch disease. We designed a study to detect
B. henselae in archival biopsies by polymerase chain reaction amplification
of the 16S rRNA gene followed by Southern blot hybridization. Forty-two
histologically defined cat scratch disease biopsies and eighteen controls
were selected for blinded analysis. After testing, charts were reviewed for
clinical, immunological, and microbial evidence of infection. Results were
correlated with duration of illness and antimicrobial therapy. B. henselae
DNA was identified in 27 of 42 (64%) histologically defined patients and 23
of 34 (68%) patients defined both clinically and histologically. There were
no false positives (0 of 18). A small subset (n = 14) had cat scratch
disease serological tests performed. B. henselae was identified in 8 of 10
serologically positive patients. Polymerase chain reaction detected 50% of
our DNA-positive cases (most of these early in the clinical course).
Southern blotting of amplicons both doubled sensitivity (detecting patients
> 4 weeks into illness) and confirmed B. henselae as the causative species.
Our study strongly associates B. henselae with cat scratch disease,
suggesting that it may be the most likely etiological agent in the majority
of patients with cat scratch disease. 

=========================================================================
3.) [A case of cat scratch disease identified by an elevated Bartonella
henselae antibody level using enzyme immunoassay] 
=========================================================================
Author 
Kusaba N; Nakamura H; Yoshimoto K; Ogata H; Sata M; Tanikawa K; Kusaba A;
Yoshida H 
Address 
Second Department of Medicine, Kurume University School of Medicine. 
Source 
Kansenshogaku Zasshi, 71(10):1075-9 1997 Oct 
Abstract 
A 68-year-old male was admitted to our hospital because of fever and a
2-week history of inguinal adenomegaly. Since he owned a cat, cat scratch
disease was suspected. But it was necessary to distinguish cat scratch
disease from lymphoma type adult T-cell leukemia because he showed a high
level of antibody against HTLV-1. An excisional biopsy of the inguinal node
was performed. Histopathologic examination revealed abscess-forming
granulomatous lymphadenitis compatible with cat scratch disease. A
Warthin-Starry silver stain showed pleomorphic bacilli in the lymph node.
So we confirmed a serological response to Bartonella henselae, the
causative agent of cat scratch disease, using enzyme immunoassay (EIA). The
IgG antibody level to B. henselae was positive at 42 EIA Unit before
treatment. After treatment with intravenous cefepime and oral tosufloxacin,
his physical symptoms improved and the antibody level decreased to less
than 12 EIA Unit. EIA was very useful for diagnosis of this case. Serology
to B. henselae may replace traditional diagnostic criteria for cat scratch
disease. 

=========================================================================
4.) Will the real agent of cat-scratch disease please stand up? 
=========================================================================
Author 
Jerris RC; Regnery RL 
Address 
Emory University, Department of Pathology and Laboratory Medicine, Atlanta,
Georgia 30322, USA. 
Source 
Annu Rev Microbiol, 50():707-25 1996 
Abstract 
Cat-scratch disease has been recognized since 1889 in association with the
oculoglandular syndrome of Parinaud. The epidemiologic association with
cats was first made in 1931 and further substantiated throughout the years,
refining the interaction predominantly to kittens. Putative infectious
agents have included numerous species of bacteria, chlamydiae, and viruses.
The cultivation of Afipia spp. in the late 1980s appeared to answer the
mystery of the identity of the agent. However, even more recent analysis,
which has combined traditional microbiology, molecular methods, and
additional epidemiology, has demonstrated that Bartonella (Rochalimaea)
henselae is the definitive agent of cat-scratch disease. Our understanding
of the pathogenesis of cat-scratch disease and other diseases caused by
Bartonella species is incomplete and the spectrum of diseases continues to
emerge. We review historic and modern efforts to understand the etiology of
cat-scratch disease and related syndromes. 

=========================================================================
5.) [Cat scratch disease caused by Bartonella henselae] 
=========================================================================
Author 
S¨older B; Allerberger F; Covi B; Maurer K; Scheminzky C; Kreczy A; Sch¨on
G; Dierich MP 
Address 
Klinik f¨ur Kinder- und Jugendheilkunde, Universit¨at Innsbruck. 
Source 
Immun Infekt, 23(6):228-31 1995 Dec 
Abstract 
Bartonella henselae is an etiologic agent of cat-scratch disease and, in
immunocompromised patients, of bacillary angiomatosis and other severe
syndromes. Cat-scratch disease usually presents as lymphadenopathy, which
resolves spontaneously within 2-4 months. The utility of antibiotic therapy
remains controversial. In Tyrol four cases of human cat-scratch disease
were diagnosed in children in 1994, yielding a prevalence of 0.7/100,000
per year. A 3-year-old boy had lymphadenitis coli since one year despite
antituberculosis therapy which was initiated because of the
histopathological picture and a positive tuberculin reaction (despite
negative mycobacteria-cultures and -PCR). Two girls, age 9 and 13 years,
had lymphadenitis at upper or lower extremities after cat-scratches from
kittens. A 13-year-old boy presented with febrile illness and right hip
pain, computer tomography revealed an osteolytic lesion; symptoms subsided
within 3 weeks. Diagnosis of cat-scratch disease is based on cat contact,
negative studies for other similar diseases, characteristic histopathologic
features (if available), and results of an indirect immunofluorescence test
(antigen: Houston-1 isolate, ATCC 49882). We believe that the availability
of this serological test will increase the number of diagnosed cases of
human Bartonella henselae infections. 

=========================================================================
6.) Hypercalcemia due to endogenous overproduction of active vitamin D in
identical twins with cat-scratch disease. 
=========================================================================
Author 
Bosch X 
Address 
Internal Medicine Unit, Hospital Casa Maternitat, Corporaci´o Sanit`aria
Clinic, Barcelona, Spain. 
Source 
JAMA, 279(7):532-4 1998 Feb 18 
Abstract 
CONTEXT: The extrarenal synthesis of active vitamin D sterols has a central
causative role in the hypercalcemia associated with various granulomatous
diseases. OBJECTIVE: To study the calcium metabolism in patients with
cat-scratch disease who have hypercalcemia. DESIGN: Case report. SETTING:
University hospital in Barcelona, Spain. PATIENTS: Two identical twins who
developed asymptomatic hypercalcemia during the acute phase of cat-scratch
disease. MAIN OUTCOME MEASURES: Serial measures of calcium homeostasis and
metabolism over a 2-month period. RESULTS: On admission and 6 and 7 days
later, both patients were found to have increased levels of serum and
urinary calcium, serum phosphate, and serum 1,25-dihydroxyvitamin D
[1,25(OH)2D], whereas they had normal values of serum 25-hydroxyvitamin D
and urinary cyclic adenosine monophosphate and decreased serum
concentrations of intact parathyroid hormone. Sixteen and 20 days after
admission, these abnormalities had resolved without treatment. A direct
correlation was observed between the serum 1,25(OH)2D levels and both the
serum and 24-hour urinary calcium concentrations. Also, the concentrations
of calcium and 1,25(OH)2D paralleled the clinical activity of the
infectious disease over the period these parameters were measured.
CONCLUSIONS: Our cases provide evidence that cat-scratch disease can
produce hypercalcemia through the unregulated production of the metabolite
1,25(OH)2D. Cat-scratch disease should be added to the list of
granuloma-forming diseases that are responsible for 1,25(OH)2D-mediated
hypercalcemia. 

=========================================================================
7.) Cat-scratch disease caused by Bartonella henselae: the first case
report in Taiwan. 
=========================================================================
Author 
Lee SC; Fung CP; Lee N; Shieh WB 
Address 
Department of Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan. 
Source 
J Formos Med Assoc, 97(8):569-72 1998 Aug 
Abstract 
We report a typical case of cat-scratch disease caused by Bartonella
henselae, in Taiwan. A 20-year-old man developed right axillary
lymphadenopathy 2 weeks after being scratched on his right hand by a
kitten. The axillary lymphadenopathy resolved gradually and spontaneously
after 10 weeks without specific treatment. Serologic tests were not done
during the acute stage of the event. However, an immunofluorescent antibody
test performed during the convalescent stage was positive for B. henselae
antibodies, and the concentration dropped by fourfold 2 months later.
Histopathologic examination of a biopsy specimen from the right axillary
lymph node revealed findings characteristic of cat-scratch disease
including multiple foci of microabscesses surrounded by histiocytes and
infiltration by plasma cells and lymphocytes. This is the first reported
case of cat-scratch disease in Taiwan, with a history of contact with a
cat, a positive serologic test for B. henselae infection and characteristic
histopathologic findings of cat-scratch disease which met the criteria for
diagnosis. 

=========================================================================
8.) [Cat-scratch disease and other infections caused by Bartonella species] 
=========================================================================
Author 
Schellekens JF 
Address 
Rijksinstituut voor Volksgezondheid en Milieu, Laboratorium voor
Bacteriologie en Antimicrobi¨ele Middelen, Bilthoven. 
Source 
Ned Tijdschr Geneeskd, 140(3):144-7 1996 Jan 20 
Abstract 
Bartonella henselae, the causative agent of cat-scratch disease, was
identified recently by DNA amplification techniques. Several other
Bartonellae (most of which were called Rochalimaea before) cause disease in
humans: B. bacilliformis (Carrion's disease), B. elizabethae (endocarditis)
and B. quintana (bacillary angiomatosis and peliosis, chronic bacteraemia
and endocarditis, trench fever). B. henselae is transmitted to humans by
scratch or bite of a bacteraemic, but asymptomatic, cat, which event may be
followed by regional lymphadenitis (classical cat-scratch disease),
bacillary angiomatosis or peliosis of liver and spleen (in immune
compromised, e.g. HIV-infected individuals) or chronic bacteraemia and
endocarditis (in elderly individuals). The incidence in the Netherlands of
cat-scratch disease is > 2/100,000/year. If a Bartonella infection is
suspected, specific immuno-assays and polymerase chain reaction assay may
be applied for diagnosis. Culture of the organism is difficult. Macrolides
and tetracyclines have been shown to be effective in treatment of
disseminated infections. The natural (self-limiting) course of regional
lymphadenitis however is not affected by antibiotic treatment. 

=========================================================================
9.) Bartonella spp. as emerging human pathogens.
=========================================================================
Anderson BE; Neuman MA
Department of Medical Microbiology and Immunology, College of Medicine,
University 
of South Florida, Tampa 33612, USA. [email protected]
Clin Microbiol Rev (UNITED STATES) Apr 1997 10 (2) p203-19 ISSN:
0893-8512
Contract/Grant No.: R29-AI38178--AI--NIAID
Language: ENGLISH
Document Type: JOURNAL ARTICLE; REVIEW; REVIEW, ACADEMIC 
Journal Announcement: 9709
Subfile: INDEX MEDICUS
Members of the genus Bartonella (formerly Rochalimaea) were virtually
unknown to 
modern-day clinicians and microbiologists until they were associated with 
opportunistic infections in AIDS patients about 6 years ago. Since that
time, 
Bartonella species have been associated with cat scratch disease, bacillary 
angiomatosis, and a variety of other disease syndromes. Clinical
presentation of 
infection with Bartonella ranges from a relatively mild lymphadenopathy
with few 
other symptoms, seen in cat scratch disease, to life-threatening systemic
disease in 
the immunocompromised patient. In some individuals, infection manifests as
lesions 
that exhibit proliferation of endothelial cells and neovascularization, a
pathogenic 
process unique to this genus of bacteria. As the spectrum of disease
attributed to 
Bartonella is further defined, the need for reliable laboratory methods to
diagnose 
infections caused by these unique organisms also increases. A brief
summary of the 
clinical presentations associated with Bartonella infections is presented,
and the 
current status of laboratory diagnosis and identification of these
organisms is 
reviewed. (205 References)

=========================================================================
10.) [Bartonella henselae infection in immunocompetent patients: cat
scratch disease] 
=========================================================================
Author 
Abarca K; Vial PA; Rivera M; Garc´ia C; Odd´o D; Prado P; Ferr´es M 
Address 
Departamentos de pediatr´ia, de Radiolog´ia y Anatom´ia Patol´ogica,
Facultad de Medicina, Pontificia Universidad Cat´olica de Chile, Santiago,
Chile. 
Source 
Rev Med Chil, 124(11):1341-9 1996 Nov 
Abstract 
BACKGROUND: Cat scratch disease, whose etiologic agent is Bartonella
henselae, is a benign disease in immunocompetent subjects, characterized by
lymphadenopathy of prolonged course and occasional involvement of other
organs such as liver, spleen, central nervous system, eye and lung. In
immunocompromised patients, the infection is bacteremic and disseminated.
AIM: To report Chilean cases of cat scratch disease. PATIENTS AND METHODS:
Ten children (seven male, aged between 6 and 13 years old) with
histologically or serologically confirmed cat scratch disease are reported.
RESULTS: Lymphadenopathy location was pre auricular in four cases, axillary
in two, inguinal in two and epitrochlear in two. Three children had fever
over 39 degrees C and two had a parinaud syndrome. Nine children had a
history of cat scratch and one of a cat byte. Six had an erythrocyte
sedimentation rate over 40. Lymph node ultrasound examination was a useful
diagnostic tool. Two patients had splenic granulomas. Lymph node biopsies
were obtained in four cases, showing a suppurative granulomatous
lymphadenitis in all and a positive Warthin-Starry stain in two. Serology,
done in patients without histological confirmation was positive with titles
ranging from 1:64 to 1:8192. All patients had a satisfactory outcome with
regression of lymphadenopathy. CONCLUSIONS: Infections by Bartonella
hemselae occur in the Chilean population and must be considered in the
differential diagnosis of regional lymph node enlargement. 

=========================================================================
11.) Cat-scratch disease and related clinical syndromes. 
=========================================================================
Author 
Smith DL 
Address 
West Jersey Family Practice Residency, Voorhees, New Jersey, USA. 
Source 
Am Fam Physician, 55(5):1783-9, 1793-4 1997 Apr 
Abstract 
Bartonella (Rochalimaea) henselae is a common cause of cat-scratch disease.
This newly identified bacterium is also the cause of several other clinical
syndromes, including bacillary angiomatosis, bacillary peliosis hepatitis
and splenitis, and acute and relapsing bacteremia. A high percentage of
young cats carry B. henselae. Fortunately, serious complications of B.
henselae infections are rare in immunocompetent patients. Cat-scratch
disease is usually a self-limited illness that does not necessarily require
antibiotic therapy. Severe or persistent cases respond well to several
antibiotics, including erythromycin and doxycycline. Cat-scratch disease
should be included in the differential diagnosis of serious neurologic
disease, particularly when regional lymphadenopathy develops suddenly in a
previously healthy patient who owns a cat. Treatment of uncomplicated
central nervous system disease is generally supportive. Antibiotic therapy
is reserved for patients with atypical or severe involvement, including
encephalopathy and retinitis. Other internal and cutaneous manifestations
of B. henselae infection have recently been described. These potentially
life-threatening infections respond well to antibiotic therapy, even in
immunocompromised patients. 

=========================================================================
12.) Cat-scratch disease and bacillary angiomatosis. 
=========================================================================
Author 
Chomel BB 
Address 
Department of Population Health and Reproduction, School of Veterinary
Medicine, University of California, Davis 95616, USA. 
Source 
Rev Sci Tech, 15(3):1061-73 1996 Sep 
Abstract 
Cat-scratch disease (CSD) was first described by Debr´e in 1950, yet the
causative bacterial agent of CSD remained obscure until 1992, when
Bartonella (formerly Rochalimaea) henselae was implicated in CSD by
serological and microbiological studies. B. henselae had initially been
linked to bacillary angiomatosis (BA), a vascular proliferative disease
most commonly associated with long-standing human immunodeficiency virus
(HIV) infection or other significant immunosuppression. B. henselae has
also been associated with bacillary peliosis, relapsing bacteraemia and
endocarditis in humans. Cats are healthy carriers of B. henselae, and can
be bacteraemic for months or years. It has recently been demonstrated that
B. henselae can be transmitted from cat to cat by the cat flea, but not by
direct contact between animals. The author discusses the present state of
knowledge on the aetiology, clinical features and epidemiological
characteristics of cat-scratch disease and bacillary angiomatosis. 

=========================================================================
13.) Detection of antibodies to Bartonella henselae in clinically diagnosed
cat scratch disease. 
=========================================================================
Author 
Flexman JP; Chen SC; Dickeson DJ; Pearman JW; Gilbert GL 
Address 
Department of Clinical Microbiology and Infectious Diseases, Royal Perth
Hospital, WA. [email protected] 
Source 
Med J Aust, 166(10):532-5 1997 May 19 
Abstract 
OBJECTIVE: To determine the usefulness of an indirect immunoflourescence
antibody test for antibodies to Bartonella henselae in diagnosing cat
scratch disease (CSD). DESIGN AND SETTING: Retrospective case survey of 354
patients whose sera were tested for antibodies to B. henselae at Royal
Perth Hospital, Perth, and the Institute of Clinical Pathology and Medical
Research, Sydney. In 1994; and measurement of the background prevalence of
antibodies to B. henselae. MAIN OUTCOME MEASURES: Prevalence of antibodies
to B. henselae, odds of a positive titre (> or = 64) in patients with and
without specific risk factors for CSD and clinical features of the disease;
prevalence of antibodies to B. henselae in randomly selected blood donors.
RESULTS: Demographic, clinical and cat contact data were available for 303
patients. Sixty-four (21.1%) had a positive titre, as did 53 of 98 (54%)
patients with a history of cat contact and lymphadenopathy. This proportion
increased to 62% (38 of 61 patients) in patients with a history of cat
scratch or bite and to 90.3% (28 of 31) in those with cat contact,
lymphadenopathy and histological evidence of granulomatous lymphadenitis.
Patients who developed lymphadenopathy after cat contact were significantly
more likely to have a positive titre than those without this history (odds
ratio [OR], 20.8; 95% confidence interval [95% Cl], 9.6-46; P < 0.0001).
Inclusion of a history of a cat scratch or bite significantly raised the
odds of being seropositive (OR, 13.7; 95% Cl, 6.8-28.1; P < 0.0001), and
the presence of granulomas on lymph node biopsy further increased the odds
(OR, 124.4; 95% Cl, 19.4-1073; P < 0.0001). The prevalence of antibodies to
B. henselae in random blood donors in New South Wales was about 5% (five of
102 sera samples). CONCLUSIONS: The immunofluorescence antibody test for B.
henselae can be expected to be positive in just over half the patients with
clinically suspected CSD, and it has a positive predictive value of 83%. In
a significant number of cases the diagnosis cannot be made on the basis of
the results of immunofluorescence antibody testing alone and further
investigations, including lymph node biopsy, may be required. 

=========================================================================
14.) The expanding spectrum of Bartonella infections: II. Cat-scratch disease.
=========================================================================
Bass JW; Vincent JM; Person DA
Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI
96859-5000, 
USA. [email protected]
Pediatr Infect Dis J (UNITED STATES) Feb 1997 16 (2) p163-79 ISSN:
0891-3668
Language: ENGLISH
Document Type: HISTORICAL ARTICLE; JOURNAL ARTICLE; REVIEW; REVIEW,
ACADEMIC 
Journal Announcement: 9706
Subfile: INDEX MEDICUS
Recent advancements and developments in molecular biotechnology have
allowed more 
precise reclassification of many microorganisms. With the use of these new
taxonomy 
tools, several organisms previously thought to belong to other genera have
been 
recently described as bartonellae. Of the 11 organisms now described as
Bartonella 
spp., only four have been shown to be pathogenic for humans. Table 1 lists
the four 
Bartonella human pathogens along with the their known epidemiology and the
scope and 
range of disease associated with each. All are now considered to be
bacteria and can 
be grown on blood-enriched agar although primary isolation in some may best
be 
achieved in cell tissue culture. B. bacilliformis infection is limited to
certain 
geographic regions in South America where the only human reservoir and the
sandfly 
vector(s) that spreads the disease reside together. Specific antibiotic
treatment is 
dramatically effective in treating the highly fatal, acute intraerythrocytic 
hemolytic form of the disease, but their effectiveness in treating the
vascular 
proliferative forms (verruga peruana) or the chronic asymptomatic,
bacteremic, 
carrier state of the disease has not been effective. This disease should
remain 
confined to its present endemic geographic areas in South American unless 
asymptomatic bacteremic persons from these areas migrate to areas where
sandflies and 
humans exist that are capable of establishing this infection in new endemic
areas. 
B. quintana and B. henselae cause a wide range of clinical diseases in
humans, the 
type and extent of which varies significantly with the immune status of the
host. In 
immunocompetent hosts the pathologic response is granulomatous, suppurative, 
extracellular and intracellular, generally self-limited and usually
unresponsive to 
antibiotic treatment, even to those drugs to which the organism is shown to
be 
sensitive in vitro. In contrast, in immunocompromised hosts the pathologic
response 
is vasculoproliferative, organisms may be seen intracellularly but they are
often 
seen in abundance in extracellular clumps and infection is usually
progressive and 
fatal unless treated. In these patients clinical response to treatment
with drugs 
that are effective in vitro against these organisms has usually been
dramatic. Of 
these agents those that penetrate cells and are found in high concentrations 
intracellularly, such as erythromycin, clarithromycin, azithromycin,
rifampin, 
doxycycline and gentamicin, appear to be most effective. These agents not
only 
appear to provide the most dramatic treatment response in patients with BA,
BP and 
PRFB and other manifestations of B. henselae (and B. quintana as well) in 
immunocompromised persons, they appear to be the most promising agents for
treatment 
of persons with both typical and atypical CSD. Further studies will be
necessary to 
more clearly elucidated the mechanisms responsible for the diverse clinical 
presentations of infection with these organisms in human hosts relative to
their 
immune status. In addition clarification of the epidemiology of B.
elizabethae 
infections in humans may be helpful in understanding the nature of
infection with 
Bartonella organisms. (215 References)

=========================================================================
15.) Evaluation of serological response to Bartonella henselae, Bartonella
quintana and 
Afipia felis antigens in 64 patients with suspected cat-scratch disease.
=========================================================================
Dupon M; Savin De Larclause AM; Brouqui P; Drancourt M; Raoult D; De
Mascarel A; 
Lacut JY
Service de Maladies Infectieuses et Medecine Interne, Hopital Pellegrin,
France.
Scand J Infect Dis (SWEDEN) 1996 28 (4) p361-6 ISSN: 0036-5548
Language: ENGLISH
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9704
Subfile: INDEX MEDICUS
The serological response to Bartonella henselae, B. quintana, and Afipia
felis was 
assessed by an indirect fluorescence antibody test (IFAT) in 64 patients with 
suspected cat-scratch disease (CSD) recruited from the Bordeaux area in
France. 
Blood samples were collected from 57 patients with chronic lymphadenopathy
who 
underwent lymph-node biopsy with suggestive histopathologic features of
CSD, and from 
an additional 7 patients with suspected CSD who underwent surgical incision
and 
drainage because of lymph-node tenderness. Of the patients, 31 were male
and 33 
female, with a median age of 27 years (range 2-89). 69.8% reported cat
and/or dog 
contact. Of the 26/64 (40.6%) patients, serum samples were positive at a
titer of 
1:100 or more for immunoglobulin G (IgG) antibodies (17 only to B.
henselae, 1 only 
to B. quintana, 3 only to Afipia felis, and 5 to both B. henselae and B.
quintana). 
IgM or IgA antibodies were also detected in 10 patients with IgG antibodies
to B. 
henselae. 11 (17.2%) of the 64 patient serum samples were positive at a
low titer of 
1:50. These data suggested that serological response assessed by standard
IFAT is 
not enough to confirm a CSD diagnosis.

=========================================================================
16.) [Cat scratch disease and associated infections] 
=========================================================================
Author 
Chomel BB; Boulouis HJ; Gurfield AN; Heller R; Pi´emont Y; Pilet C 
Address 
Department of Population Health and Reproduction, School of Veterinary
Medicine, University of California, Davis, USA. 
Source 
Bull Acad Natl Med, 181(3):441-50; discussion 451-4 1997 Mar 18 
Abstract 
Cat scratch disease (CSD) was first described in France by Debr´e et al. in
1950, yet the causative bacterial agent of CSD remained obscure until 1992,
when Bartonella (formerly Rochalimaea) henselae was implicated in CSD by
serological and microbiologic studies. B. henselae had been linked
initially to bacillary angiomatosis (BA), but also bacillary peliosis,
relapsing bacteremia and endocarditis. Cats are healthy carriers of B.
henselae and B. clarridgeiae, and can be bacteremic for months to years.
Cat to cat transmission of the organism involves the cat flea in absence of
direct contact transmission. Present knowledge on the etiology, clinical
features and epidemiological characteristics of cat scratch
disease/bacillary angiomatosis are presented. 

=========================================================================
17.) Cat-scratch disease simulating Histiocytosis X. 
=========================================================================
Author 
Berg LC; Norelle A; Morgan WA; Washa DM 
Address 
Department of Pathology, Gunderson Clinic, Ltd, LaCrosse, WI 45601, USA. 
Source 
Hum Pathol, 29(6):649-51 1998 Jun 
Abstract 
Cat-scratch disease is a self-limited condition commonly causing a benign
chronic lymphadenopathy in children. Osteolytic lesions are a rare
complication, but have been previously reported. We report a case of a
solitary osteolytic lesion of the skull whose clinical, radiographic and
pathological features were initially interpreted as being consistent with
Histiocytosis X. Subsequently, positive serological titers for Bartonella,
a history of a cat-scratch antecedent to the onset of clinical symptoms and
review of the original histopathology confirmed the diagnosis of
cat-scratch disease. We reviewed the English language literature on
osteolytic lesions associated with cat-scratch disease and compare the
current case with those previously reported. 

=========================================================================
18.) [Atypical cat-scratch disease: a case report of splenic granulomatosis] 
=========================================================================
Author 
Dodi I; Iughetti L; Nasi S; Rossi C; Caselli G; Malvicini R 
Address 
Divisione di Pediatria, Ospedale Civile di Fidenza PR, Italia. 
Source 
Pediatr Med Chir, 19(2):143-4 1997 Mar-Apr 
Abstract 
Generally cat-scratch disease is a benign inflammatory adenopathy. The
Authors describe an atypical form of this disease, characterized by
persistent fever and splenic granulomatosis requiring a diagnostic and
therapeutic prolonged effort. They point out the important role of new
immuno-fluorescent techniques to exactly identify the bacterium--Bartonella
henselae--causing cat-scratch disease and suggest to include cat-scratch
disease among the causes of unknown origin fever. 

=========================================================================
19.) [2 patients with atypical manifestations of cat-scratch disease]
Twee patienten met atypische manifestaties van kattenkrabziekte.
=========================================================================
Kusumanto YH; Veenhoven RH; Bokma JA; Schellekens JF
Spaarne Ziekenhuis, afd. Kindergeneeskunde, Haarlem.
Ned Tijdschr Geneeskd (NETHERLANDS) Feb 22 1997 141 (8) p385-7 ISSN:
0028-2162
Language: DUTCH Summary Language: ENGLISH
Document Type: 
JOURNAL ARTICLE English Abstract
Journal Announcement: 9707
Subfile: INDEX MEDICUS
In 2 boys aged 8 years and 10 months, respectively, uncommon
manifestations of cat 
scratch disease were seen. The first patient had acute encephalopathy:
coma and 
generalized tonic-clinic convulsions. The second patient was presented
with fever 
and peripheral lymphadenopathy in combination with hypodense lesions in the
liver on 
ultrasound. Diagnosis was established on the clinical picture and the
positive 
results of serological testing of antibody titres for Bartonella henselae.
Both 
patients recovered completely within 2 months.

=========================================================================
20.) [Visceral localizations of cat-scratch disease in an immunocompetent
patient] 
=========================================================================
Author 
Bouchard O; Bosseray A; Leclercq P; Micoud M 
Address 
H^opital Michallon, CHU de Grenoble. 
Source 
Presse Med, 25(5):199-201 1996 Feb 10 
Abstract 
Locoregional expression of cat scratch disease is well known, but despite
advances in microbiology over the last 10 years leading to the description
of two new bacteria (Afipia felis, Bartonella henselae) the infective agent
responsible for cat scratch syndrome remains unknown. Until the 80s, only
one systemic disease was attributed to infection with a germ in the
Bartonella genus: trench fever. With the onset of the AIDS epidemic, new
clinical syndromes caused by Bartonella bacteria have been described:
bacillary angiomatosis, hepatic peliosis, cases of recurrent septicemia,
cases of endocarditis, etc. More recently, atypical forms of cat scratch
disease including systemic diseases have been reported in immunocompetent
subjects. Although quite rare (1% of the cases), such types of expression
can raise questions as to diagnosis both in terms of clinical signs and in
terms of bacteriological findings. Clinical and experimental data do not
provide a clear direction for treatment but would suggest that prolonged
use of aminoglycosides is useful. 

=========================================================================
21.) Serous retinal detachment of the macula associated with cat scratch
disease. 
=========================================================================
Author 
Zacchei AC; Newman NJ; Sternberg P 
Address 
Department of Ophthalmology, Emory University School of Medicine, New York,
New York, USA. 
Source 
Am J Ophthalmol, 120(6):796-7 1995 Dec 
Abstract 
PURPOSE: We studied an unusual ocular manifestation of cat scratch disease.
METHODS: We examined a patient who had a serous retinal detachment of the
macula with vision loss out of proportion to her retinal findings. RESULTS:
The patient was found to have cat scratch disease by antibody titers.
CONCLUSION: Cat scratch disease should be considered in patients with a
serous neurosensory retinal detachment of the macula and a history of cat
exposure or systemic signs or symptoms consistent with the disease. 

=========================================================================
22.) Cat scratch disease in Greece. 
=========================================================================
Author 
Karpathios T; Golphinos C; Psychou P; Garoufi A; Papadimitriou A;
Nicolaidou P 
Address 
Second Department of Paediatrics, P and A Kyriakou Children's Hospital,
Athens, Greece. 
Source 
Arch Dis Child, 78(1):64-6 1998 Jan 
Abstract 
An indirect fluorescent antibody test for Bartonella henselae, B quintana,
and B elizabethae was performed in all 18 children who presented to our
paediatric outpatient clinic with cat scratch disease over a six year
period. Serum samples were taken on admission, after 15 days, and after six
months. Diagnosis was confirmed in 15 patients (83%) and was based on
seroconversion or a fourfold change of the antibody titre to B henselae in
12 patients and on a single high titre (> 128) in three patients.
Lymphadenopathy was present in all patients, erythema nodosum in one,
osteomyelitis in one, hepatitis in one, transverse myelitis in one, and
liver or spleen granulomata, or both, in three patients. Cat scratch
disease developed in autumn or winter in 12 patients. All had a history of
physical contact with a cat. Our study shows that our clinical suspicion
was accurate in the diagnosis of cat scratch disease in a high percentage
of patients presenting to a hospital and that indirect fluorescent antibody
testing for B henselae is a useful diagnostic tool. 

=========================================================================
23.) Cat-scratch disease--an overlooked disease in Denmark?]
=========================================================================
Kattekradssygdom--en overset sygdom i Danmark?
Blomgren M; Hardt-Madsen M
Organkirurgisk afdeling K, Sygehus Fyn.
Ugeskr Laeger (DENMARK) May 5 1997 159 (19) p2876-7 ISSN: 0041-5782
Language: DANISH Summary Language: ENGLISH
Document Type: 
JOURNAL ARTICLE English Abstract
Journal Announcement: 9708
Subfile: INDEX MEDICUS
Only one patient with cat-scratch disease (CSD) has been reported in
Denmark. A 
case and retrospective investigation among patients admitted to the ward is
presented. 
Over a period of 3.5 years, six patients were found to have suffered from
CSD. The 
yearly incidence was calculated to 2.6/100,000. The patients were tested for 
antibodies against Bartonella (Rochalimaea) henselae with a new test
developed at the 
Danish Serum Institute. Only two of the patients with CSD had titres of
antibodies 
higher than 400 (positive). Tested again with an improved test five of the
six 
patients were found to have antibodies against B. henselae. It is assumed
that CSD 
is found with the same incidence as the USA and Holland. It is recommended
that 
examination for chronic lymphadenopathy includes questions about cat
contact and 
testing for antibodies against Bartonella henselae.

=========================================================================
24.) Prolonged Bartonella bacteremia in cats associated with cat-scratch
disease patients. 
=========================================================================
Author 
Kordick DL; Wilson KH; Sexton DJ; Hadfield TL; Berkhoff HA; Breitschwerdt EB 
Address 
Department of Companion Animal and Special Species Medicine, College of
Veterinary Medicine, North Carolina State University, Raleigh 27606, USA. 
Source 
J Clin Microbiol, 33(12):3245-51 1995 Dec 
Abstract 
Recent evidence supports a causal relationship between Bartonella
(Rochalimaea) henselae, cat-scratch disease (CSD), and bacillary
angiomatosis. Cats appear to be the primary reservoir. Blood from 19 cats
owned by 14 patients diagnosed with CSD was cultured. Blood samples from
cats owned by veterinary students (n = 25) having no association with CSD
or bacillary angiomatosis were cultured as controls. Eighty-nine percent
(17 of 19) of cats associated with CSD patients and 28% (7 of 25) of
controls were bacteremic with Bartonella species (chi-square = 16.47; P <
0.001). Twenty-three isolates were characterized as B. henselae, while one
isolate from the cat of a CSD patient appeared to be a new Bartonella
species. Thirteen cats remained culture positive during the ensuing
12-month period. Our results support the conclusion that B. henselae is the
predominant species involved in CSD and is transmitted by cats. The
incidence of Bartonella bacteremia in control cats suggests that B.
henselae bacteremia is prevalent among the domestic cat population in the
United States. 

=========================================================================
25.) Application of polymerase chain reaction assay in the diagnosis of
orbital granuloma complicating atypical oculoglandular cat scratch disease. 
=========================================================================
Author 
Dondey JC; Sullivan TJ; Robson JM; Gatto J 
Address 
Oculoplastics Clinic, Department of Ophthalmology, Royal Brisbane Hospital,
Herston, Australia. 
Source 
Ophthalmology, 104(7):1174-8 1997 Jul 
Abstract 
BACKGROUND: Parinaud oculoglandular syndrome is uncommon. Most cases are
caused by cat scratch disease (CSD), recently discovered to be associated
with the pathogen Bartonella henselae. Before isolation of the
micro-organism, diagnosis relied on the presence of characteristic clinical
features. However, atypical cases could cause diagnostic problems. With the
development of an indirect fluorescent antibody test and polymerase chain
reaction (PCR) assay, oculoglandular CSD can be diagnosed readily. METHODS:
The authors report a case of atypical Parinaud oculoglandular syndrome in a
51-year-old woman who presented with an inferior conjunctival forniceal
mass extending into anterior orbital tissues. Blood and operative tissue
specimens were obtained for routine screening and histopathologic analysis
but more specifically for serologic analysis, culture, and PCR assay for B.
henselae. Computed tomography was performed to delineate the mass. RESULTS:
Cultures for B. henselae were negative. Initial serologic analysis
demonstrated a low IgG response without detectable IgM, but 1 month later
had undergone a fourfold rise in IgG, again without detectable IgM.
Histopathologic analysis showed a nonspecific necrotizing granulomatous
inflammation consistent with but not diagnostic of CSD. Polymerase chain
reaction assay for B. henselae was strongly positive. Computed tomographic
scan showed a preseptal and anterior orbital inflammatory process.
CONCLUSIONS: Cat scratch disease due to B. henselae should be suspected in
patients with atypical conjunctival inflammation associated with regional
lymphadenopathy. PCR assay is extremely useful in establishing the
diagnosis. The PCR assay offers the additional advantage of early diagnosis
because the test is positive early in the disease. Antibiotic therapy
remains controversial. In this case, surgical excision hastened resolution
of the conjunctival inflammation. However, the lymphadenopathy responded
poorly to antibiotics. 

=========================================================================
26.) Systemic cat scratch disease: hepatic and splenic involvement about 3
pediatric cases. 
=========================================================================
Author 
Destuynder O; Vanlemmans P; Mboyo A; Destuynder R; Aubert D; DeBilly B;
Colin P; Leroy J; Estavoyer JM; Viennet G 
Address 
Department of Pediatric Surgery, Saint-Jacques Hospital Besan¸con, France. 
Source 
Eur J Pediatr Surg, 5(6):365-8 1995 Dec 
Abstract 
Numerous diseases can lead to multinodular lesions of liver and spleen;
surgical biopsy can be required for the etiologic diagnosis. Among these
diseases, systemic cat scratch disease has been recently described.
Macroscopical appearance of the lesions is evocative and must be known by
surgeons. Three children with systemic cat scratch disease involving liver
and spleen are reported. 
Language 

=========================================================================
27.) Bartonella clarridgeiae, a newly recognized zoonotic pathogen causing
inoculation papules, fever, and lymphadenopathy (cat scratch disease). 
=========================================================================
Author 
Kordick DL; Hilyard EJ; Hadfield TL; Wilson KH; Steigerwalt AG; Brenner DJ;
Breitschwerdt EB 
Address 
Department of Companion Animal and Special Species Medicine, College of
Veterinary Medicine, North Carolina State University, Raleigh 27606, USA. 
Source 
J Clin Microbiol, 35(7):1813-8 1997 Jul 
Abstract 
Shortly after adopting a 6-week-old cat, a veterinarian was bitten on the
left index finger. Within 3 weeks, he developed headache, fever, and left
axillary lymphadenopathy. Initial blood cultures from the cat and
veterinarian were sterile. Repeat cultures from the cat grew
Bartonella-like organisms with lophotrichous flagella. Sera from the
veterinarian were not reactive against Bartonella henselae, B. quintana, or
B. elizabethae antigens but were seroreactive (reciprocal titer, 1,024)
against the feline isolate. Sequential serum samples from the cat were
reactive against antigens of B. henselae (titer, 1,024), B. quintana
(titer, 128), and the feline isolate (titer, 2,048). Phenotypic and
genotypic characterization of this and six additional feline isolates,
including microscopic evaluation, biochemical analysis, 16S rRNA gene
sequencing, DNA-DNA hybridization, and PCR-restriction fragment length
polymorphism of the 16S gene, 16S-23S intergenic spacer region, and citrate
synthase gene identified the isolates as B. clarridgeiae. This is the first
report of cat scratch disease associated with B. clarridgeiae. 

=========================================================================
28.) Coinfection with Bartonella clarridgeiae and Bartonella henselae and
with different Bartonella henselae strains in domestic cats.
=========================================================================
Gurfield AN; Boulouis HJ; Chomel BB; Heller R; Kasten RW; Yamamoto K;
Piemont Y
Department of Population Health and Reproduction, School of Veterinary
Medicine, 
University of California, Davis, 95616, USA.
J Clin Microbiol (UNITED STATES) Aug 1997 35 (8) p2120-3 ISSN: 0095-1137
Language: ENGLISH
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9711
Subfile: INDEX MEDICUS
Bartonella clarridgeiae and several strains of Bartonella henselae, the
agent of 
cat scratch disease, with variations in the 16S rRNA gene have been found
to infect 
the blood of cats. An epidemiologic study of Bartonella infection in
domestic French 
cats revealed that of 436 cats sampled, 5 cats (1.1%) were coinfected with B. 
henselae and B. clarridgeiae and 2 cats (0.5%) were coinfected with two
strains of B. 
henselae with variations in the 16S rRNA gene, B. henselae type I and type
II. In an 
indirect immunofluorescence assay, coinfected cats tested positive for both 
Bartonella species at titers of > or = 128. Identification of the colonies
was 
achieved by preformed enzyme analysis, PCR-restriction fragment length
polymorphism 
analysis of the citrate synthase gene, and 16S rRNA gene sequencing.
Colony size 
differences in mixed culture allowed differentiation of the Bartonella
species. The 
coinfection of cats with two Bartonella species or variants of the same
species 
raises concern about the possibility of dual infection in humans. The
development of 
a polyvalent vaccine targeted against the most pathogenic or invasive
strains may be 
a means of protecting cats and man from infection.

=========================================================================
29.) [Cat-scratch disease: historical, clinical, phylogenetic and taxonomic
aspects]
Katzenkratzkrankheit: historische, klinische, phylogenetische und
taxonomische 
Aspekte.
=========================================================================
Muller HE
Tierarztl Prax (GERMANY) Apr 1997 25 (2) p94-9 ISSN: 0303-6286
Language: GERMAN Summary Language: ENGLISH
Document Type: 
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL English Abstract
Journal Announcement: 9708
Subfile: INDEX MEDICUS
The cat-scratch disease (CSD) is known as a nosological entity since
1950. It was 
diagnosed by the clinical symptoms, epidemiologic data, and the
intracutaneous test 
of Hanger and Rose. The aetiologic agent is Bartonella (formerly
Rochalimaea) 
henselae occurring in thirty to fifty percent of healthy cats. The
gramnegative 
alpha-2-proteobacteria cause the CSD but also fever in healthy humans.
Patients 
suffering from AIDS show bacillary angiomatosis, bacillary peliosis hepatis, 
endocarditis, and septicemia. There is an open question for other
aetiologic agents 
causing CSD as cofactors. For example, Afipia felis is found to a certain
extent 
from patients suffering from CSD. Furthermore, Rothia dentocariosa was
isolated in 
lymphnodes of CSD patients, and also other grampositive rods may play an
important 
role together with B. henselae in CSD. (30 References)

=========================================================================
30.) Molecular diagnosis of cat scratch disease: a two-step approach.
=========================================================================
Avidor B; Kletter Y; Abulafia S; Golan Y; Ephros M; Giladi M
The Bernard Pridan Laboratory for Molecular Biology of Infectious
Diseases, Ichilov 
Hospital, Tel-Aviv Sourasky Medical Center, Israel.
J Clin Microbiol (UNITED STATES) Aug 1997 35 (8) p1924-30 ISSN:
0095-1137
Language: ENGLISH
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9711
Subfile: INDEX MEDICUS
Amplification of Bartonella henselae DNA has been proposed as a
diagnostic test for 
cat scratch disease (CSD). The sensitivities of the following three PCR
assays were 
compared. PCR/rRNA with universal primers amplifies part of the 16S rRNA
gene, 
followed by hybridization with a specific B. henselae probe; PCR/CS and
PCR/HSP 
amplify portions of the gltA and the htrA genes, respectively, each
followed by 
restriction fragment length polymorphism analysis. The threshold of
detection of B. 
henselae DNA in pus was 10(-4), 10(-3), and 10(-2) ng for PCR/rRNA, PCR/CS,
and 
PCR/HSP, respectively. By these three assays, B. henselae DNA was detected
in 100, 
94, and 69% of 32 pus and lymph node specimens from CSD patients,
respectively. The 
similar sensitivities of the PCR/rRNA and the PCR/CS assays for detecting
B. henselae 
DNA in clinical specimens are in contrast to the 10-fold difference in
sensitivities 
in favor of PCR/rRNA demonstrated with purified B. henselae DNA in sterile
pus, 
suggesting that in the majority of cases, the bacterial load in clinical
specimens is 
large enough to be identified by the PCR/CS assay. A two-step approach is
suggested 
to achieve maximal sensitivity for detecting B. henselae in clinical
specimens: 
initial testing by PCR/CS (which does not require hybridization), followed by 
PCR/rRNA with PCR/CS-negative specimens when CSD is strongly suspected.

=========================================================================
31.) Antibiotic therapy for cat-scratch disease: clinical study of
therapeutic outcome in 268 patients and a review of the literature.
=========================================================================
Author(s) Margileth AM
Address Department of Pediatrics, University of Virginia Health Sciences
Center, Charlottesville.
Source Pediatr Infect Dis J 1992;11:474.
Abstract 
During 24 months in an uncontrolled, retrospective study of 268 patients
with cat-scratch disease (CSD), 202 were treated with 18 different
antimicrobial agents. Criteria for antibiotic effectiveness were
established. One or two antibiotics were taken separately for at least 3 to
5 days by 202 patients with CSD. Outcome was determined by follow-up
examinations and telephone. Effectiveness of antibiotic therapy was based
upon 3 or more days of therapy and clinical improvement of the patient with
absence of and/or a decrease in malaise, fatigue, fever, headache,
anorexia, lymphadenopathy and, in 90 patients, a declining or normal
sedimentation rate. Of 18 different antimicrobials prescribed, 14 commonly
used antibiotics were judged to be of little or no value in treatment of
CSD. Four antimicrobials were efficacious. Efficacy of the three oral drugs
in decreasing order was: rifampin 87%, ciprofloxacin 84%,
trimethoprim-sulfamethoxazole 58%. Gentamicin sulfate intramuscular was 73%
effective. Antibiotic therapy can be considered for patients with severe
cat scratch disease. Conservative, symptomatic treatment is recommended for
the majority of patients with mild or moderate CSD.

=========================================================================
32.) Successful treatment of cat-scratch disease with ciprofloxacin [see
comments]
=========================================================================
Author(s) Holley HP Jr
Address Division of Infectious Diseases, Medical University of South
Carolina, Charleston 29425.
Source JAMA 1991;265:1563 - 5.
Abstract 
Cat-scratch disease is usually a benign, self-limited disease. Infection
may be asymptomatic but is commonly associated with painful regional
lymphadenitis. Occasionally, disease may result in systemic symptoms and
dissemination. Five adult patients, aged 24 to 57 years, were diagnosed as
having cat-scratch disease, based on a positive history of cat scratches
followed by typical symptoms including painful regional lymphadenitis,
malaise, and positive cat-scratch skin tests. Diagnostic evaluations
revealed no other cause for the lymphadenitis. Three patients had not
received prior treatment with antibiotics, and two patients had failed to
improve on other antibiotics. All five were treated with oral
ciprofloxacin, 500 mg by mouth, twice daily. All patients had dramatic
improvement in symptoms within a few days and none has relapsed during
follow-up. This is the first report of successful treatment of cat-scratch
disease with ciprofloxacin, which appears to be an effective therapy for
cat-scratch disease in adults.
=====================================================================
DATA-MEDICOS/DERMAGIC-EXPRESS No (44) 11/03/99 DR. JOSE LAPENTA R. 
======================================================================