Difference between revisions of "Cat scratch disease"

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#redirect [[Lymph_node_pathology#Cat-scratch_disease]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Cat_scratch_disease_-_low_mag.jpg
| Width      =
| Caption    = Cat scratch disease. [[H&E stain]].
| Micro      = necrotizing granulomas with neutrophils and star-shaped (stellate), +/-multinucleated giant cells, microorganisms consistent with ''B. henselae''
| Subtypes  =
| LMDDx      = [[sporotrichosis]], [[lymphogranuloma venereum]], [[tularemia]]
| Stains    = [[Warthin-Starry stain]] +ve
| IHC        = B. henselae +ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[lymph node]] - see ''[[lymph node pathology]]''
| Assdx      =
| Syndromes  =
| Clinicalhx = contact with cats
| Signs      = fever, lymphadenopathy
| Symptoms  =
| Prevalence = rare
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = other causes of lymphadenopathy, e.g. [[lymphoma]]
}}
'''Cat scratch disease''', also '''cat scratch fever''', is an uncommon [[lymph node pathology|pathology of the lymph node]].
 
==General==
*Infection caused ''[[Bartonella henselae]]'',<ref name=pmid19332922>{{Cite journal  | last1 = Jerris | first1 = RC. | last2 = Regnery | first2 = RL. | title = Will the real agent of cat-scratch disease please stand up? | journal = Annu Rev Microbiol | volume = 50 | issue =  | pages = 707-25 | month =  | year = 1996 | doi = 10.1146/annurev.micro.50.1.707 | PMID = 8905096 }}</ref> a gram-negative bacillus (0.3-1.0 x 0.6-3.0 micrometers) in chains, clumps, or singular.<ref name=Ref_ILNP110>{{Ref ILNP|110}}</ref>
*Treatment: antibiotics.
 
===Clinical===
Features:<ref name=Ref_ILNP113>{{Ref ILNP|113}}</ref>
*Usually unilateral lymphadenopathy.
**May be disseminated in individuals with immune dysfunction.
*Contact with cats.
 
==Gross==
*Lymphadenopathy - usu. unlitateral.
**Typically axillary or cervical (like [[tularemia]]).<ref name=pmid22706525>{{Cite journal  | last1 = Asano | first1 = S. | title = Granulomatous lymphadenitis. | journal = J Clin Exp Hematop | volume = 52 | issue = 1 | pages = 1-16 | month =  | year = 2012 | doi =  | PMID = 22706525 }}</ref>
 
==Micrograph==
Features:<ref name=Ref_ILNP113>{{Ref ILNP|113}}</ref>
*Necrotizing granulomas with:
**Neutrophils present in microabscess (necrotic debris) - '''key feature'''.
***Microabscesses often described as "stellate" (star-shaped).
*+/-Multinucleated giant cells.
*Microorganism consistent with ''B. henselae''.
 
Notes:
*May involve capsule or perinodal tissue.
 
DDx of stellate abscess in lymph nodes - ''cat split'':<ref name=pmid>URL: [http://www.dermpathmd.com/mnemonics/mnemonics_dermatopathology.htm http://www.dermpathmd.com/mnemonics/mnemonics_dermatopathology.htm]. Accessed on: 23 September 2011.</ref>
*Cat-scratch disease.
*[[Sporotrichosis]].
*[[Lymphogranuloma venereum]].
*[[Tularemia]].
 
===Images===
www:
*[http://www.webpathology.com/image.asp?case=386&n=1 Cat-scratch disease (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=2&Case=386 Cat-scratch disease - high mag. (webpathology.com)]
<gallery>
Image:Cat_scratch_disease_-_very_low_mag.jpg | CSD - very low mag. - showing serpentine shaped microabscesses (WC)
Image:Cat_scratch_disease_-_low_mag.jpg | CSD - low mag. - showing serpentine shaped microabscesses (WC)
Image:Cat_scratch_disease_-b-_high_mag.jpg | CSD - high mag. - showing neutrophilic abscesses (WC)
</gallery>
 
==Stains==
*[[Warthin-Starry stain]] +ve -- bacilli.
*[[Gram stain]] -ve.
 
==IHC==
*B. henselae IHC stain +ve -- bacilli - '''diagnostic'''.
 
==See also==
*[[Lymph node pathology]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Lymph node pathology]]

Latest revision as of 01:56, 4 January 2014

Cat scratch disease
Diagnosis in short

Cat scratch disease. H&E stain.
LM necrotizing granulomas with neutrophils and star-shaped (stellate), +/-multinucleated giant cells, microorganisms consistent with B. henselae
LM DDx sporotrichosis, lymphogranuloma venereum, tularemia
Stains Warthin-Starry stain +ve
IHC B. henselae +ve
Site lymph node - see lymph node pathology
Clinical history contact with cats
Signs fever, lymphadenopathy
Prevalence rare
Prognosis benign
Clin. DDx other causes of lymphadenopathy, e.g. lymphoma

Cat scratch disease, also cat scratch fever, is an uncommon pathology of the lymph node.

General

  • Infection caused Bartonella henselae,[1] a gram-negative bacillus (0.3-1.0 x 0.6-3.0 micrometers) in chains, clumps, or singular.[2]
  • Treatment: antibiotics.

Clinical

Features:[3]

  • Usually unilateral lymphadenopathy.
    • May be disseminated in individuals with immune dysfunction.
  • Contact with cats.

Gross

  • Lymphadenopathy - usu. unlitateral.

Micrograph

Features:[3]

  • Necrotizing granulomas with:
    • Neutrophils present in microabscess (necrotic debris) - key feature.
      • Microabscesses often described as "stellate" (star-shaped).
  • +/-Multinucleated giant cells.
  • Microorganism consistent with B. henselae.

Notes:

  • May involve capsule or perinodal tissue.

DDx of stellate abscess in lymph nodes - cat split:[5]

Images

www:

  • CSD - very low mag. - showing serpentine shaped microabscesses (WC)

  • CSD - low mag. - showing serpentine shaped microabscesses (WC)

  • CSD - high mag. - showing neutrophilic abscesses (WC)

Stains

IHC

  • B. henselae IHC stain +ve -- bacilli - diagnostic.

See also

References

  1. ↑ Jerris, RC.; Regnery, RL. (1996). "Will the real agent of cat-scratch disease please stand up?". Annu Rev Microbiol 50: 707-25. doi:10.1146/annurev.micro.50.1.707. PMID 8905096.
  2. ↑ Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 110. ISBN 978-0781775960.
  3. ↑ 3.0 3.1 Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 113. ISBN 978-0781775960.
  4. ↑ Asano, S. (2012). "Granulomatous lymphadenitis.". J Clin Exp Hematop 52 (1): 1-16. PMID 22706525.
  5. ↑ URL: http://www.dermpathmd.com/mnemonics/mnemonics_dermatopathology.htm. Accessed on: 23 September 2011.
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