CAT SCRATCH DISEASE Definition:

An infectious disorder that begins in the skin. But

clinically spread to the adjuacent lymphnodes.

This disease is most commonly cause of chronic

regional lymphadenopathy .

Causitive agent:
Rochalimaea henselae (initially) reclassified as Bartonella henselae

Portal of entry:
Skin through scratch , bite on previous site of injury. Clinical feature: incubalion period 3-14 days Age site of injury
After 1to3 week later lymphadenopathy without

: 8% - our in under 21yr. of age

Cat scratch disease begins as a papule on pustules at the

lymphangitis is develops.
Lymphadenopathy appears to be out of all proportion to

the relatively innocuous skin wound.

The infection can appears as an intra oral mass in buccal

mucosa when lymphoid aggregate become involved from an adjacent cutaneous primary site. Scratch in the pre auricular area may localized in parotid lymphoid tissue and can cause significant parotid pain or even temporary facial paralysis.

 Less common problem: Encephalopathy Erythematous Maculo popular rashes Spleenomegaly Hepetic lesion Thrombocytopenia Pneumonia Anaemia Pleural effusion Recurrent bacterial infection. Primarry lesion adjacent to eye may cause conjuctival granuloma associate with pre auricular lymphedinopathy. During the past decade ,an unusual sub cutaneous vascular proliferation ,histopathologically similar to histiocytoid haemangioma (in AIDS patient).This proliferation termed boullary angiomatosis(associated with bartonella hensalae commonly and B.quintona minorly) The effected area often resemble Kaposis sarcoma and appears as variable number of red to purple lesion which may be macular,papulaer or pedunculated an exhibit widespread distribution on the skin. Pain and tenderness are common.

 Larger lesion are friable and bleed easily.

PATHOLOGICAL FEATURE:
Lymph node enlarge because of significant cortical hyperplasia contain area of shellac supportive neurosis surrounded by a band of histolate & neutrophil Area of karyorrhexis tnt around proliferation of plump vascular Channels that often exhisit thickened eosin public wall (without Neurosis)

Later focal granuloma , suppuration & neurosis develop with capsules thickening of lymph node epitheloid & multi nucleafed giant all are occasionally seen .

Prognosis: good Treatment: incision and drainage of involved node

Antibiotic

Diagnosis: based on finding 3on 4 following criteria

1.

Contaet with a cat , presence of scratch on primary derma1or ocular lision Posetivecat scrah diseas skin test finding (hanger rose skin test not ured widely) Negatine result of pfhes caure of lymph adenspathy

Chara cterishic his to pathe logically finding of infected tirslal espeeially if pleomeerphic baeilli can be found on staining with warthin starry method.

b)

senological test : (senritine & speificith)

indireet fluorosunt antibody arsay defeeting antibody to bartonella hensilae elisa for I G M PCR (not used widely)