今日の臨床サポート

猫引っかき病

著者: 羽田野義郎 東京医科歯科大学医学部附属病院 感染制御部

監修: 大曲貴夫 国立国際医療研究センター

著者校正/監修レビュー済:2019/11/14
患者向け説明資料

概要・推奨   

  1. 免疫正常者、猫引っかき病の典型例では、アジスロマイシン5日間投与により早期にリンパ節腫脹を軽快させる(推奨度2)
  1. 猫引っかき病が疑われる場合、可能であればリンパ節生検を施行するべきである。悪性腫瘍や抗酸菌感染症の場合があり、約1/4で悪性腫瘍と診断されている(推奨度2)
  1. 5~14%で肝臓、脾臓、眼、中枢神経系などへの播種性病変を来す(推奨度1)
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧には
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧に
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧に
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲
  1. 日本人のBartonella henselae IgG 抗体陽性率は6.4%である(推奨度2)。
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
羽田野義郎 : 特に申告事項無し[2021年]
監修:大曲貴夫 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行った(変更なし)。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 主な原因微生物は主にBartonella henselaeであるが、それ以外のBartonella 属も報告されている[1]
  1. 全国的な猫引っかき病患者数に関する統計はないが、年間発生数は1万人以上と推定している国内の報告もある[2]
  1. 国内では猫引っかき病は秋から冬に関して多くなる傾向である。
  1. 猫との接触歴の聴取が重要となるが、ある文献では猫との接触は99.1%で確認された[3]
  1. 犬やネコノミからの感染例もあり得る[4]
  1. 自然軽快するリンパ節腫脹が特徴的な感染症であるが、5~10%で播種性病変の形成、脳炎、視神経網膜炎などを来すことがある。
  1. HIVなどの免疫不全者が感染した場合、細菌性血管腫を起こすことがある[1]
 
  1. 国内では、猫引っかき病は秋から冬にかけて多くなる傾向がある(推奨度2)
  1. 日本での血清学的(IFA)に診断した猫引っかき病130人の症例集積研究[2]
  1. 罹患時期は秋~冬にかけて多くなる傾向。5、6月は少なく、10~12月に多い。
  1. 局所的なリンパ節腫脹は84.6%で、頚部リンパ節:33%、腋窩リンパ節:27%、鼠径リンパ節:18%となっている。
  1. 平均発熱期間は9.8日であったが、14日以上が20.8%あった。
  1. 非定型、播種性のケースは全体の20.8%であり、その内訳は不明熱(37%)、視神経炎(22.2%)、脳症(14.8%)、肝脾の肉芽腫(11.1%)、パリノー眼肉芽症候群(7.4%)であった。
  1. 追記:日本からの症例集積研究。診断がつかないリンパ節腫脹や持続する発熱の場合、罹患時期を参考にすることがあるが、この研究は秋~冬に多いことを示しており、参考となる。
  1. 2000年のサーベイランスでは、国民の10%は猫を、23%は犬を飼っている。
  1. 報告数は1990年代後半から増加してきており、猫引っかき病はまれではない可能性を示唆している。
 
  1. 5~14で肝臓、脾臓、眼、中枢神経系などへの播種性病変を来す(推奨度1)
  1. 1,200人の猫引っかき病と診断された患者のうち、猫との接触は99.1%で確認された。
  1. 1,200人中60人(5%)で視神経症状、結節性紅斑、脳炎、骨病変などが出現した[3]
  1. 追記:猫引っかき病と診断したら、播種性疾患を示唆する症状がないかどうかを、1回は確認する。播種性病変を疑った場合は抗菌薬治療を開始する。
問診・診察のポイント  
  1. 全年齢層にみられるが、特に20歳以下の女性に多い。

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

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文献 

著者: Stephen A Klotz, Voichita Ianas, Sean P Elliott
雑誌名: Am Fam Physician. 2011 Jan 15;83(2):152-5.
Abstract/Text Cat-scratch disease is a common infection that usually presents as tender lymphadenopathy. It should be included in the differential diagnosis of fever of unknown origin and any lymphadenopathy syndrome. Asymptomatic, bacteremic cats with Bartonella henselae in their saliva serve as vectors by biting and clawing the skin. Cat fleas are responsible for horizontal transmission of the disease from cat to cat, and on occasion, arthropod vectors (fleas or ticks) may transmit the disease to humans. Cat-scratch disease is commonly diagnosed in children, but adults can present with it as well. The causative microorganism, B. henselae, is difficult to culture. Diagnosis is most often arrived at by obtaining a history of exposure to cats and a serologic test with high titers (greater than 1:256) of immunoglobulin G antibody to B. henselae. Most cases of cat-scratch disease are self-limited and do not require antibiotic treatment. If an antibiotic is chosen, azithromycin has been shown in one small study to speed recovery. Infrequently, cat-scratch disease may present in a more disseminated form with hepatosplenomegaly or meningoencephalitis, or with bacillary angiomatosis in patients with AIDS.

PMID 21243990  Am Fam Physician. 2011 Jan 15;83(2):152-5.
著者: Kyoko Murakami, Masato Tsukahara, Hidehiro Tsuneoka, Hidechika Iino, Chizuru Ishida, Kumiko Tsujino, Akiko Umeda, Tomoko Furuya, Shigeto Kawauchi, Kohsuke Sasaki
雑誌名: J Infect Chemother. 2002 Dec;8(4):349-52. doi: 10.1007/s10156-002-0194-6.
Abstract/Text To clarify the clinical manifestations of cat scratch disease (CSD), we evaluated a total of 130 seropositive patients with CSD. The patients' ages ranged from 1 to 68 years; 103 (79.2%) were under 18 years of age. CSD occurred predominantly in the fall and winter months. Regional lymphadenopathy was noted in 110 (84.6%) of the cases, and the most common sites were the neck (33%), axillary (27%), and inguinal (18%) regions. One hundred of the patients (77%) had general symptoms, such as fever, headache, and malaise. The clinical manifestations of CSD showed a wide spectrum from typical or classical CSD, with regional lymphadenopathy, to atypical or systemic CSD. Of the 130 cases, 103 (79.2%) were typical CSD and 27 (20.8%) were atypical CSD. Atypical cases of CSD were commonly reported as fever of unknown origin (37.0%), neuroretinitis (22.2%), encephalopathy (14.8%), hepatosplenic granuloma (11.1%), and Parinaud's oculoglandular syndrome (7.4%). Fever of unknown origin or prolonged fever lasting more than 14 days was evident in 27 (20.8%) of the 130 cases in this study. Eleven of the 27 cases lacked lymphadenopathy. Our findings suggest that CSD is not a rare disease in Japan. The indirect fluorescent antibody (IFA) test to detect Bartonella species may provide a prompt diagnosis of CSD and facilitate appropriate therapy.

PMID 12525897  J Infect Chemother. 2002 Dec;8(4):349-52. doi: 10.1007/・・・
著者: H A Carithers
雑誌名: Am J Dis Child. 1985 Nov;139(11):1124-33.
Abstract/Text This study by one individual of 1,200 patients with cat-scratch disease provides a heretofore unavailable realistic evaluation of a common infectious disease. All patients had lymphadenopathy, a prerequisite for diagnosis. Suppuration occurred in 11.8% of patients. Cat contact was established for 99.1%, and the cat was immature in the vast majority. An inoculation site, the most neglected feature in the study of the patients, was detected in 92.6%. The results of a skin test, considered as specific as the standard tuberculin test and to be safe but not standardized, was positive in 99%. The 12 patients with negative skin tests probably were tested too early in the course of the disease to have developed reactivity. Skin tests of 578 family members of patients, who served as controls, gave positive results in 18.5%. Of 60 patients with unusual manifestations, 48 had the oculoglandular syndrome of Parinaud. Other manifestations included erythema nodosum, encephalopathy, osteolytic lesions, thrombocytopenic purpura, and erythema marginatum. Most patients in this series had received antibiotics of many types during the course of the disease. None appeared beneficial. The disease is benign in character in a majority of patients. Surgical removal of involved lymph nodes or biopsy of lymph nodes or inoculation sites is not necessary for diagnosis or management. A survey of hospitals in the United States discharging more than 750 pediatric patients annually indicates that cat-scratch disease is a problem in all sections of the country.

PMID 4061408  Am J Dis Child. 1985 Nov;139(11):1124-33.
著者: K M Zangwill, D H Hamilton, B A Perkins, R L Regnery, B D Plikaytis, J L Hadler, M L Cartter, J D Wenger
雑誌名: N Engl J Med. 1993 Jul 1;329(1):8-13. doi: 10.1056/NEJM199307013290102.
Abstract/Text BACKGROUND: Although cat scratch disease is commonly diagnosed in patients who have unexplained regional lymphadenopathy after encounters with cats, its epidemiology and the risk factors for disease are not clearly defined, and there is no generally accepted diagnostic test.
METHODS: We conducted a physician survey to identify cases of cat scratch disease occurring over a 13-month period in cat owners in Connecticut. We interviewed both the patients (or their parents) and controls matched for age who owned cats. Serum from the patients was tested for antibodies to Rochalimaea henselae with a new, indirect fluorescent-antibody test.
RESULTS: We identified 60 patients with cat scratch disease and 56 age-matched subjects. Patients were more likely than controls to have at least one pet kitten 12 months old or younger (odds ratio, 15), to have been scratched or bitten by a kitten (odds ratio, 27), and to have had at least one kitten with fleas (odds ratio, 29). A conditional logistic-regression analysis found that in kitten-owning households, patients were more likely than controls to have been scratched or bitten by a cat or kitten (odds ratio, 12.4; 95 percent confidence interval, 1.0 to 150). Of 45 patients, 38 had serum samples with titers of 1:64 or higher for antibody to R. henselae, as compared with 4 of 112 samples from controls (P < 0.001). The positive predictive value of the serologic test was 91 percent. Of 48 serum samples from patients' cats, 39 were positive for antibodies to R. henselae, as compared with positive samples from 11 of 29 control cats (P < 0.001).
CONCLUSIONS: Cat scratch disease is strongly associated with owning a kitten, and fleas may be involved in its transmission. The serologic test for rochalimaea may be useful diagnostically, and our results suggest an etiologic role for this genus.

PMID 8505963  N Engl J Med. 1993 Jul 1;329(1):8-13. doi: 10.1056/NEJM・・・
著者: Hirotsugu Yamanouchi, Kinichi Izumikawa, Takashi Hisamatsu, Michiko Yoshinaga, Eisuke Sasaki, Koichi Izumikawa, Tomoichiro Hayakawa, Kohei Hara, Soich Maruyama, Hiroshi Ohtani, Isao Shimokawa
雑誌名: Kansenshogaku Zasshi. 2004 Mar;78(3):270-3.
Abstract/Text A 50-year-old male with left cervical lymphadenopathy visited our hospital. Infectious and lymphomatous diseases were suspected in the patient. Since the patient owned a dog, which often licked the patient's face, Bartonella infection was also suspected. Histopathological examination in the lymph node biopsy revealed the epithelioid granuloma, but B. henselae was not detected from the culture of the lymphnode. B. henselae DNA also was not detected from the lymph node. Since the antibody titer (lgG) to B. henselae showed 1:128 by immunofluorescent antibody technique (IFA), he was serdogicalg diagnosed as cat-scratch disease. 'Cat-scratch disease' is named after cat scratch, however we propose 'B. henselae infection' which is more appropriate since other animals could serve as a cause of infection.

PMID 15103910  Kansenshogaku Zasshi. 2004 Mar;78(3):270-3.
著者: R Zbinden, N Michael, M Sekulovski, A von Graevenitz, D Nadal
雑誌名: Eur J Clin Microbiol Infect Dis. 1997 Sep;16(9):648-52.
Abstract/Text Four commercial slides were compared with in-house slides for the detection of immunoglobulin G (IgG) against Bartonella henselae in 58 healthy persons from a rural region by an indirect immunofluorescence assay. MRL-BA slides (MRL Diagnostics, USA) and Virion slides (Virion, Switzerland) with agar-derived Bartonella henselae showed IgG titers of > or = 1:256 in 44.8% and 51.7%, respectively, whereas Bion slides (Bios, Germany), MRL-Vero slides (MRL Diagnostics), and in-house slides with cell-associated Bartonella henselae showed such titers in 3.4%, 5.1% and 3.4%, respectively. The MRL-Vero slides (Bartonella IgG substrate slides, MRL Diagnostics) were further evaluated with 26 patients with cat scratch disease, 20 patients with lymphadenopathy not due to cat scratch disease, 100 blood donors from an urban area, and 120 blood donors from a mixed urban/rural area. In our mixed urban/rural population the IgG titer of 1:256 had a sensitivity of 84.6% and a specificity of 93.4% for the serodiagnosis of cat scratch disease. Seroprevalence was higher in blood donors from the mixed area (50.8%) than from the urban area (37%). MRL-Vero slides were considered useful for the serodiagnosis of cat scratch disease by indirect immunofluorescence and have replaced our in-house system. However, patients with low IgG titers should be retested three to four weeks after initial sampling to demonstrate a possible rise of IgG titers in paired sera.

PMID 9352257  Eur J Clin Microbiol Infect Dis. 1997 Sep;16(9):648-52.・・・
著者: A Sander, M Posselt, K Oberle, W Bredt
雑誌名: Clin Diagn Lab Immunol. 1998 Jul;5(4):486-90.
Abstract/Text Serologic testing for the presence of antibodies to Bartonella henselae is a widely accepted diagnostic procedure for laboratory confirmation of the diagnosis of cat scratch disease (CSD). In this study a commercially available indirect immunofluorescence assay (IFA) based on B. henselae-infected human larynx carcinoma cells (test A) was evaluated. Sera from 42 patients with CSD (20 confirmed by PCR) and 270 sera from healthy controls (consisting of 63 cat owners, 65 individuals whose last close contact with cats was >6 months previously, and 142 persons who had never been exposed to cats) were investigated for antibodies to B. henselae. All patients with CSD had titers of immunoglobulin G (IgG) to B. henselae of 128 or higher (test A; sensitivity, 100%). Of the 270 controls 189 (70%) were seronegative (titer, <64), 38 (14.1%) had titers of 64, 30 (11.1%) had titers of 128, 9 (3.3%) had titers of 256, and 4 (1.5%) had high titers, 512 (test A; specificity, 70%). Of the cat owners and individuals who had never had close contact with cats, 71.4 and 71.12%, respectively, were seronegative, and titers of 64, 128, 256, and 512 were found in 14.3 and 16.2%, 1.6 and 10.5%, 9.5 and 0.7%, and 3.2 and 1.4%, respectively. The sera from the patients and from the first 100 healthy adults without a history of close contact with cats were additionally tested with a second commercially available IFA, based on Vero cells infected with B. henselae and Bartonella quintana (test B). The sensitivity and specificity of test B were 93 and 73%, respectively. For patients with CSD the cross-reactivity between B. henselae and B. quintana in this test was 95%. Both systems are highly sensitive but less specific for detection of IgG antibodies to B. henselae in samples from patients with clinically apparent CSD. For detection of IgM antibodies, test A seems to be more sensitive (88%) and more specific (95%) than test B (sensitivity and specificity of 64 and 86%, respectively). The data show that the seroprevalence of antibodies to B. henselae in German individuals is high (30%). Low antibody levels are not sufficient evidence of active or prior infection.

PMID 9665953  Clin Diagn Lab Immunol. 1998 Jul;5(4):486-90.
著者: Jean-Marc Rolain, Hubert Lepidi, Michel Zanaret, Jean-Michel Triglia, Gérard Michel, Pascal-Alexandre Thomas, Michèle Texereau, Andreas Stein, Anette Romaru, François Eb, Didier Raoult
雑誌名: Emerg Infect Dis. 2006 Sep;12(9):1338-44. doi: 10.3201/eid1209.060122.
Abstract/Text We report microbiologic analysis of 786 lymph node biopsy specimens from patients with suspected cat-scratch disease (CSD). The specimens were examined by standard, cell culture, and molecular methods. Infectious agents were found in samples from 391 (49.7%) of 786 patients. The most commonly identified infectious agent was Bartonella henselae (245 patients, 31.2%), the agent of CSD. Mycobacteriosis was diagnosed in 54 patients (6.9%) by culture and retrospectively confirmed by using a specific real-time PCR assay. Neoplasm was diagnosed in 181 specimens suitable for histologic analysis (26.0%) from 47 patients. Moreover, 13 patients with confirmed Bartonella infections had concurrent mycobacteriosis (10 cases) or neoplasm (3 cases). A diagnosis of CSD does not eliminate a diagnosis of mycobacteriosis or neoplasm. Histologic analysis of lymph node biopsy specimens should be routinely performed because some patients might have a concurrent malignant disease or mycobacteriosis.

PMID 17073081  Emerg Infect Dis. 2006 Sep;12(9):1338-44. doi: 10.3201/・・・
著者: M J Dalton, L E Robinson, J Cooper, R L Regnery, J G Olson, J E Childs
雑誌名: Arch Intern Med. 1995 Aug 7-21;155(15):1670-6.
Abstract/Text BACKGROUND: Bartonella henselae (formerly the genus Rochalimaea) has recently been isolated from patients with cat-scratch disease and their cats, and since September 1992 the Centers for Disease Control and Prevention has offered an indirect fluorescent antibody assay for Bartonella-specific antibody.
METHODS: Physicians submitted serum samples from patients suspected of having cat-scratch disease or other Bartonella-associated illness and completed a questionnaire that recorded clinical information. Indirect fluorescent antibody assay was performed with the use of antigen derived from three Bartonella species: B henselae, Bartonella quintana, and Bartonella elizabethae.
RESULTS: During 16 months, 3088 serum samples were received. The largest numbers of specimens and the highest percentages positive (titer, > or = 64) were observed in the fall and winter. Clinical histories of the first 600 patients for whom serum samples and completed information forms were received were examined in detail; seropositivity was significantly associated with cat contact, cat age of less than 1 year, cat scratch, presence of an inoculation papule, and regional adenopathy. Of 91 patients whose illness met a strict clinical definition of cat-scratch disease, 86 (95%) had titers of 64 or greater to either B henselae or B quintana. A fourfold rise or fall in titer was observed in 87 of 132 patients with paired serum samples.
CONCLUSIONS: The indirect fluorescent antibody assay for Bartonella-specific antibody is sensitive for the diagnosis of cat-scratch disease. Redefinition of cat-scratch disease on the basis of cause and use of this assay as a diagnostic criterion is recommended.

PMID 7542443  Arch Intern Med. 1995 Aug 7-21;155(15):1670-6.
著者: B La Scola, D Raoult
雑誌名: J Clin Microbiol. 1996 Sep;34(9):2270-4.
Abstract/Text The clinical manifestations of Q fever and bartonelloses can be confused, especially in cases of infectious endocarditis. Differential diagnosis of the diseases is important because the treatments required for Q fever and bartonelloses are different. Laboratory confirmation of a suspected case of either Q fever or bartonelloses is most commonly made by antibody estimation with an indirect immunofluorescence assay. With an indirect immunofluorescence assay, 258 serum samples from patients with Q fever were tested against Bartonella henselae and Bartonella quintana antigens, and 77 serum samples from patients with infection by Bartonella sp. were tested against Coxiella burnetii antigen. Cross-reactivity was observed: more than 50% of the chronic Q fever patients tested had antibodies which reacted against B. henselae antigen to a significant level. This cross-reaction was confirmed by a cross-adsorption study and protein immunoblotting. However, because the levels of specific antibody titers in cases of Bartonella endocarditis are typically extremely high, low-level cross-reaction between C. burnetii antibodies and B. henselae antigen in cases of Q fever endocarditis should not lead to misdiagnosis, provided serology testing for both agents is performed.

PMID 8862597  J Clin Microbiol. 1996 Sep;34(9):2270-4.
著者: M Maurin, F Eb, J Etienne, D Raoult
雑誌名: J Clin Microbiol. 1997 Sep;35(9):2283-7.
Abstract/Text Diagnosis of Chlamydia or Bartonella infections continues to rely mainly on serology. However, serological cross-reactions between members of these genera have recently been described. Sera from eight patients originally diagnosed as having Chlamydia pneumoniae endocarditis reacted with both Chlamydia sp. and Bartonella quintana antigens (microimmunofluorescence technique). Adsorption of sera with B. quintana or C. pneumoniae antigens removed anti-C. pneumoniae antibodies, whereas adsorption with C. pneumoniae antigens did not change antibody titers to B. quintana. Western blot analysis confirmed the presence of cross-reacting antigens and showed antibody patterns in all sera to be compatible with a Bartonella infection. These patients were therefore probably suffering from Bartonella-induced rather than Chlamydia-induced endocarditis. In contrast, sera from 10 patients presumed to be suffering from C. pneumoniae pneumonia did not display anti-B. quintana antibodies, although cross-reacting antigens were revealed by Western blotting. This work highlights the possibility that cases of infective Bartonella endocarditis are erroneously diagnosed as chlamydial infections.

PMID 9276403  J Clin Microbiol. 1997 Sep;35(9):2283-7.
著者: Marijn J Vermeulen, Bram M W Diederen, Harold Verbakel, Marcel F Peeters
雑誌名: J Med Microbiol. 2008 Aug;57(Pt 8):1049-50. doi: 10.1099/jmm.0.2008/001024-0.
Abstract/Text
PMID 18628513  J Med Microbiol. 2008 Aug;57(Pt 8):1049-50. doi: 10.109・・・
著者: Gerd Jürgen Ridder, Carsten Christof Boedeker, Katja Technau-Ihling, Roland Grunow, Anna Sander
雑誌名: Clin Infect Dis. 2002 Sep 15;35(6):643-9. doi: 10.1086/342058. Epub 2002 Aug 14.
Abstract/Text Bartonella henselae is the causative agent of cat-scratch disease (CSD), which usually manifests as acute regional lymphadenopathy. The causes of cervical lymphadenopathy, with special regard to CSD, were investigated in a study of 454 patients who presented with unclear masses in the head and neck from January 1997 through January 2001. Sixty-one patients (13.4%) experienced CSD; 54 (11.9%) had primary lymphadenopathy due to other infectious agents, and 41 (9.0%) had lymphadenopathy that occurred in association with primary infections of other organs. For 171 patients (37.7%), the cause of the cervical lymph node enlargement could not be found. B. henselae DNA was detected in extirpated lymph nodes only during the first 6 weeks of lymphadenopathy, which indicates that the results of polymerase chain reaction strongly depend on the duration of illness. CSD should be included in the differential diagnosis of adenopathy in the otorhinolaryngologic patient population, to avoid unnecessary treatment.

PMID 12203159  Clin Infect Dis. 2002 Sep 15;35(6):643-9. doi: 10.1086/・・・
著者: Brandy Fouch, Susan Coventry
雑誌名: Arch Pathol Lab Med. 2007 Oct;131(10):1591-4. doi: 10.1043/1543-2165(2007)131[1591:ACOFDB]2.0.CO;2.
Abstract/Text Cat-scratch disease resulting from Bartonella henselae infection is usually a benign, self-limited process in immunocompetent children. Even the rare cases associated with neurologic manifestations are not generally fatal. We report a case of a previously healthy 6-year-old boy with cat-scratch disease, systemic dissemination, and encephalitis that led to his death. Autopsy revealed perivascular lymphocytic infiltrates and microglial nodules in the brain. To our knowledge, this finding has not been previously reported in B. henselae infection, possibly because of the paucity of material available for complete neuropathologic evaluation. This case illustrates the extreme severity of the spectrum with which cat-scratch disease can present and provides evidence of brain histopathology that may be representative of the disease.

PMID 17922599  Arch Pathol Lab Med. 2007 Oct;131(10):1591-4. doi: 10.1・・・
著者: Sulene L Chi, Sandra Stinnett, Eric Eggenberger, Rod Foroozan, Karl Golnik, Michael S Lee, M Tariq Bhatti
雑誌名: Ophthalmology. 2012 Jan;119(1):183-7. doi: 10.1016/j.ophtha.2011.06.042. Epub 2011 Sep 28.
Abstract/Text OBJECTIVE: To describe the clinical manifestations and to identify risk factors associated with visual outcome in a large cohort of patients with cat scratch optic neuropathy (CSON).
DESIGN: Multicenter, retrospective chart review.
PARTICIPANTS: Fifty-three patients (62 eyes) with serologically positive CSON from 5 academic neuro-ophthalmology services evaluated over an 11-year period.
METHODS: Institutional review board/ethics committee approval was obtained. Data from medical record charts were collected to detail the clinical manifestations and to analyze visual outcome metrics. Generalized estimating equations and logistic regression analysis were used in the statistical analysis. Six patients (9 eyes) were excluded from visual outcome statistical analysis because of a lack of follow-up.
MAIN OUTCOME MEASURES: Demographic information, symptoms at presentation, clinical characteristics, length of follow-up, treatment used, and visual acuity (at presentation and final follow-up).
RESULTS: Mean patient age was 27.8 years (range, 8-65 years). Mean follow-up time was 170.8 days (range, 1-1482 days). Simultaneous bilateral involvement occurred in 9 (17%) of 53 patients. Visual acuity on presentation ranged from 20/20 to counting fingers (mean, 20/160). Sixty-eight percent of eyes retained a visual acuity of 20/40 or better at final follow-up (defined as favorable visual outcome). Sixty-seven percent of patients endorsed a history of cat or kitten scratch. Neuroretinitis (macular star) developed in 28 eyes (45%). Only 5 patients had significant visual complications (branch retinal artery occlusion, macular hole, and corneal decompensation). Neither patient age nor any other factor except good initial visual acuity and absence of systemic symptoms was associated with a favorable visual outcome. There was no association between visual acuity at final follow-up and systemic antibiotic or steroid use.
CONCLUSIONS: Patients with CSON have a good overall visual prognosis. Good visual acuity at presentation was associated with a favorable visual outcome. The absence of a macular star does not exclude the possibility of CSON.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
PMID 21959368  Ophthalmology. 2012 Jan;119(1):183-7. doi: 10.1016/j.op・・・
著者: E S Arisoy, A G Correa, M L Wagner, S L Kaplan
雑誌名: Clin Infect Dis. 1999 Apr;28(4):778-84. doi: 10.1086/515197.
Abstract/Text We reviewed 19 cases of hepatosplenic cat-scratch disease at Texas Children's Hospital (Houston). The range of the patients' ages was 2 years 4 months to 11 years 8 months. The chief complaint was fever for all patients. The duration of fever before diagnosis was 7 to 56 days (mean, 22 days). Abdominal pain was present in 13 patients (68%). Thirteen children were treated with rifampin alone, and three received rifampin therapy plus gentamicin or trimethoprim-sulfamethoxazole. Once rifampin therapy was initiated alone or in combination, improvement was noted within 1 to 5 days (mean, 2.6 days) for patients who had had prolonged fever the duration of which before rifampin therapy averaged 3 weeks. The most common dosage and duration for our patients were 20 mg/[kg x d] every 12 hours and 14 days, respectively. Rifampin should be considered in the initial antimicrobial treatment of hepatosplenic cat-scratch disease.

PMID 10825038  Clin Infect Dis. 1999 Apr;28(4):778-84. doi: 10.1086/51・・・
著者: J B Reed, D K Scales, M T Wong, C P Lattuada, M J Dolan, I R Schwab
雑誌名: Ophthalmology. 1998 Mar;105(3):459-66. doi: 10.1016/S0161-6420(98)93028-7.
Abstract/Text OBJECTIVE: This study aimed to report the long-term outcomes of patients treated with an antibiotic drug combination for Bartonella henselae neuroretinitis.
DESIGN: The study design was a retrospective case series.
PARTICIPANTS: Seven consecutive patients with neuroretinitis and cat scratch disease participated.
INTERVENTIONS: Patients underwent medical and ophthalmic evaluations. Blood cultures were obtained, and B. henselae antibody titers were measured. Tuberculosis, Lyme, toxoplasmosis, syphilis, and sarcoidosis were excluded. Patients received oral doxycycline 100 mg and rifampin 300 mg twice daily for 4 to 6 weeks and were observed for an average of 16 months (range, 10-24 months). Formal electrophysiologic testing was performed in three patients after resolution of neuroretinitis.
MAIN OUTCOME MEASURES: The changes in ocular inflammation and visual function associated with treatment were recorded. Follow-up examinations and electrophysiologic testing documented sequelae.
RESULTS: Patients presented following cat exposure with fever, malaise, and blurred vision. Decreased visual acuity (ranging from 20/40 to counting fingers) frequently was associated with dyschromatopsia and afferent pupillary defects. Ophthalmoscopic analysis showed signs of neuroretinitis, including nerve fiber layer hemorrhages, cotton-wool spots, multiple discrete lesions in the deep retina, and stellate macular exudates. B. henselae infection was confirmed with positive blood cultures or elevated immunofluorescent antibody titers or both. Therapy appeared to promote resolution of neuroretinitis, restoration of visual acuity, and clearance of bacteremia. After 1 to 2 years, two eyes had residual disc pallor, afferent pupillary defects, retinal pigmentary changes, and mildly decreased visual acuity. Electrophysiologic studies showed that when compared to the fellow eye, affected eyes had subnormal contrast sensitivity, abnormal color vision, and abnormal visually evoked potentials. Conversely, electroretinograms were normal in all subjects.
CONCLUSIONS: B. henselae is a cause of neuroretinitis in cat scratch disease. Compared to historic cases, doxycycline and rifampin appeared to shorten the course of disease and hasten visual recovery. Long-term prognosis is good, but some individuals may acquire a mild postinfectious optic neuropathy.

PMID 9499776  Ophthalmology. 1998 Mar;105(3):459-66. doi: 10.1016/S01・・・
著者: J M Rolain, P Brouqui, J E Koehler, C Maguina, M J Dolan, D Raoult
雑誌名: Antimicrob Agents Chemother. 2004 Jun;48(6):1921-33. doi: 10.1128/AAC.48.6.1921-1933.2004.
Abstract/Text
PMID 15155180  Antimicrob Agents Chemother. 2004 Jun;48(6):1921-33. do・・・
著者: J W Bass, B C Freitas, A D Freitas, C L Sisler, D S Chan, J M Vincent, D A Person, J R Claybaugh, R R Wittler, M E Weisse, R L Regnery, L N Slater
雑誌名: Pediatr Infect Dis J. 1998 Jun;17(6):447-52.
Abstract/Text OBJECTIVE: To determine the efficacy of azithromycin in the treatment of patients with typical cat-scratch disease.
DESIGN: Prospective, randomized, double blind, placebo-controlled clinical trial.
SETTING: Large military medical center and its referring clinics.
PATIENTS: Active duty military members and their dependents with laboratory-confirmed, clinically typical cat-scratch disease.
INTERVENTION: Study participants assigned by randomization to treatment with oral azithromycin or placebo for 5 days.
OUTCOME MEASURES: Lymph node volume was calculated using three dimensional ultrasonography at entry and at weekly intervals. The ultrasonographer was blinded to the treatment groups. Endpoint evaluations were predetermined as time in days to 80% resolution of the initial total lymph node volume.
RESULTS: Demographic and clinical data showed that the azithromycin and placebo treatment groups were comparable at entry although the placebo group tended to be older. Eighty percent decrease of initial lymph node volume was documented in 7 of 14 azithromycin-treated patients compared with 1 of 15 placebo-treated controls during the first 30 days of observation (P = 0.026). After 30 days there was no significant difference in rate or degree of resolution between the two groups.
CONCLUSIONS: Treatment of patients with typical cat-scratch disease with oral azithromycin for five days affords significant clinical benefit as measured by total decrease in lymph node volume within the first month of treatment.

PMID 9655532  Pediatr Infect Dis J. 1998 Jun;17(6):447-52.
著者: A M Margileth
雑誌名: Pediatr Infect Dis J. 1992 Jun;11(6):474-8.
Abstract/Text 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.

PMID 1608685  Pediatr Infect Dis J. 1992 Jun;11(6):474-8.

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