Mr. Vimal Pathak

M.Pharm 2^nd Sem

GIP (Geeta University, Naultha Panipat )

Introduction:

A cat’s bite or scratch can transmit the infectious disease known as cat-scratch disease (CSD). When someone bites or scratches someone with cat scratch illness, a non-painful bump or blister appears where the cell damage occurred, and there may be some swelling on the lymph nodes. People experience headaches, exhaustion, and an increase in body temperature as a result. After infection, these symptoms appear 2–14 days later.

The causative organism of (CSD) is Bartonella henseale (Bacteria) which spread through the cat’s saliva. The older cat’s less prone to spread (i.e., Bartonella henseale) rather than young cat’s which is more prone to this. Generally, diagnosis is done on the basis of symptoms shown in the people and blood test is taken as a confirmation of this diseases. The infected persons need a supportive care from there family, relatives and friends as a primary care. The by the physician infected persons is diagnosed and some antibiotics is given which are used to developed immunity in severe disease. The person gets recover within 3-4 months but some persons may require one year to recover because each individual body can response to the medicine in different ways. The estimate says, that about 1 in 10,000 person is affected and children are more prone to CSD.

Cat -Scratch diseases caused by bite of cat or scratch as shown in Figure.1

Etiology:

The etiologic agent of Cat-scratch disease is B. Henselae, is a fastidious intracellular gram- negative bacteria rod. This infection affects the lymph nodes at the site where young cat bite or scratch. When a cat-scratch disease is in spreading stage there were number of clinical reviews data published but the main causative microorganism was not named over a decade. Dr. Douglas, a pathologist who identified that cat-scratch disease patient’s lymph node noticed a novel bacterium Initially, after studies over decade they founded that a species Bartonella and chlamydia exhibit cross-reactivity. Then, using an electron microscope, a staining method called Starry, Warthin stain was utilized to find black dots in specimens of afflicted lymph nodes that were caused by bacteria.

Epidemiology:

The catch-scratch disease spread worldwide but this disease is un-reportable in human beings that why this case report of this disease was not proper available. The CSD spread around the world depend upon demography, continued season & variety of cats. In humid climate, CSD is most likely to spread in the fall and winter, which may be ideal for adult cat breeding and the delivery of kittens. To know about current instances of CSD, Truven Health Market Scan Commercial Claims and Encounters conducted an analysis of the database. They check the case control study from 2005-2013. This study consists of all data about Health Insurance claim by the employees, their spouse & their dependents. All of the participants are 65 years of age or older. The duration of analysis phase was about 9 years. The factors which are taken such as region, age, sex these were taken as a reference to measure the person/ year spread rate to overcome from this disease. About 13,273 objects were diagnosed from CSD, & both in and OPD cases were go through. The study tell about the occurrence rate about 4.5/100,000 OPD specimen of Cat-Scratch Disease and for in patient it was about 0.19/100,000 population which was mush less than out patients. Low incidence was founded in mountain region because fleas were not been in this area. The age group of about 5-9 years these was more prone to CSD, then in female and in male is very less. If we saw a trend now start that mostly cats were owned by women over men which leads to the more spreading pattern among the women. The CSD increases with increases of cat’s residing in home.

Pathophysiology:

According to the clinical research observation, lymphadenopathy has developed at the place where the bite or scrape was injected. This could result in a reaction of the vascular-proliferative in the host and a relatively weak immune response. The Cat-scratch disease infection causes the lymph node to expand and become sensitive throughout the period of 1-2 weeks. Chronic lymphadenopathy also develops as a result of CSD. In addition, cat scratch illness can cause abnormalities in the functioning of the liver, spleen, central nervous system (CNS), and eyes. This condition can become extremely severe and even fatal.

Histopathology

The lymph node undergone histological examination its shows granulomas with micro abscesses. Comparable histological changes in the local lymph nodes at the lesion’s centre and the injection site.

History

The symptoms resembling with Cat Scratch disease was first detailed reviewed by Henri Parinaud in 1869, and Robert Debre initially described the clinical condition in 1950.

In 1953, A bacillus that is gram-negative and called Afipia felis in 1991 by using staining. Warthin- Starry silver and the bacillus was cultivated successfully. So, they were started believing that CSD was caused by bacteria i.e., Afipia felis, but this was disapproved while performing a study of immune system in 1990s. The two main rod-shaped Gram-negative causative organism was founded which was B. henselae and B. Clarridgeiae,

Self-limited lymphadenopathy and a high fever are present in 85–90% of youngsters. A variety of difficulties can arise in people with disseminated sickness, especially in the elderly, very young, and hosts with weakened immune systems like HIV patients or transplant recipients. In rarer cases, neurologic and ocular involvement may occur.
The initial inoculation lesion, that is a vesicle, nodule, or erythematous papule, which is the first cutaneous symptom. Although it might linger for months, this lesion typically lasts 1 to 3 weeks. An inflammatory mucosa that recovers without leaving scars and is undetectable, like the conjunctiva, could be the main location of the vaccination.Participation of the lymphatic system manifests as regional tender lymphadenopathy, which can be a single node or several nodes with a diameter is about in range of one to five cm. Overlying erythema is present. Suppuration mainly causes in 10%. The injection location has enlarged lymph nodes. Typical sites include the axillary, cervical, supraclavicular, submandibular, and epitrochlear.

The duration of the lymphadenopathy could be one to four months. Visceral organ involvement, which shows up as fever, weight loss, and abdominal pain, might damage the liver, spleen, or both. Dementia are the symptoms in elderly persons are among the neurologic side effects of cat scratching. Aseptic meningitis or encephalitis are the disease which generally causes in children. It has been reports of status epilepticus, though. Cat scratch illness has been linked to a wide range of musculoskeletal problems, such as arthralgias, myalgias etc.

Sign and Symptoms:

The symptoms arise from CSD commonly affects lymph node, the lymph become swollen near one side of the neck is typically where the inoculating cut or bite occurs. This condition showed within 1-3 weeks following vaccination and this is referred as Lymphadenopathy. The symptoms shown in the neck, jaw, axilla or arms, neck also showed Some systemic symptoms occur such as loss of appetite, aches and malaise. Some sign also being observed such as chills, joint pains, backache, headache, arthritis and this sign may take about 7-14weeks and 2-3 months, for appearance of that sign showed. In rare situation, CSD is a reason for serious disease such as seizure, encephalopathy or endocarditis. The most common manifestation in the eyes of Cat Scratch Disease is Parinaud’s oculo-glandular syndrome. The person who has low level of frequency are more sensitive to CSD causing bacteria.

Transmission:

In 1950, Robert Debre recognized that Pussy are the prime source of Catch-scratch Disease. The babies of cat (kitten) mostly carry more numbers of bacterial cells in the primordial, and they seem to be carrier of CSD bacteria than young cats. Vector transmitter of B. Henseale among cat’s was fleas. When a combine study done on the basis of PCR and clinical study, then it was obtained that Bartonella are also contained by Spider.

Histology:

On histological study of lymph node, it shows granulomatous inflammation due to CSD. The lesions on the upper layer of skin are observed under microscope, this provide demonstration about cell necrosis which are surrounded by Histocytes. Additionally observed are sinuses packed with Mono- cytosis B cells, often devoid of intrafollicular and perifollicular epithelioid cells, and palisading histiocytes (suppurative granulomas). Even though this pattern is widespread, it only happens in a tiny portion of situations.

Diagnosis:

For determination of CSD, there are two methods are used:

• The Warthin- Starry stain gives the existence of B. Henseale, but this method provides little bit difficulty in interpreting and difficulty to isolate and hardly it will take 3-6 week for incubate.
• The PCR polymeric chain reaction is best method for identification of and the sensitivity is about 45-78 % and a linearity of 100 %.

Treatment:

Healthy individuals who eat a balanced diet are less likely to contract the CSD bacterium, while occasionally 5–7% of healthy individuals do. It will contaminate our spleen, eye, liver or CNS

The recommended medication for CSD is azithromycin, which is also recommended for pregnant women in order to lessen the consequences of Tetracycline on foetal abnormalities.
However, because Doxycycline can permeate both the ocular layer and the brain system, it was mainly chosen for the cure of B. Henseale’s optic neuritis.

Prognosis:

With symptomatic treatment, such as painkiller, NSAIDS, and heating pad, 90 to 95% of children will recover from CSD on their own. Contingent the structure in question, person with promulgate disease may experience morbidities and recovery times ranging from days to year.

Pearls and additional concerns:

Particularly in infants CSD is as frequent cause of swollen glands. The diagnosis will be aided by a high awareness of the condition, a comprehensive history and a physical examination. The course could be lengthy. When evaluating and treating the affected person the patients age and coexisting conditions taken into account. To prevent the sickness, persons surround cats must be supervised and fleas must be adequately controlled.

Prevention:

To prevent Cat-scratch disease (CSD) need to follow affective control measure of fleas. Recently, the pussycat which are living in outside or polluted environment are most contender to be exposed by fleas. So, put your cats inside and prevent them from infestation.

Without exposure of inside-outside cats there be a negligible chance of infestation. B. henseale containing cat are asymptomatic. So, thoroughly washing your arms before handling the cat or cat species. This would be a great way of prevention from CSD and the possibility of spreading was reduced.

Evaluation:

Given the accurate history and examination results, CSD disease is believe to be the disease. Cat exposure is typically required for diagnosis. The IFA diagnosis may be supported by no antibody detective test, but they do not rule out the diagnosis. Although it is not usually recommended, the Biopsy of lymph node should be taken into consideration if that treatment is not obvious. Because of the potential for fistulas, excision of the afflicted lymphatic system has historically been avoided. To extract tissue, ultrasound may help with needle aspiration.

Conclusion:

Avoid letting animals lick wounds and cleanse any wounds, including cat scratches, right away with warm, soapy water. Fourth, our veterinary expert (EBB) advises testing and treating all affected pets when humans are infected, especially those who are at risk for a serious infection.

Person has impaired immune systems CSD may be incapacitating.
About 90–95% of children affected from Cat scratch disease recover on their own, and the condition is treated symptomatically with warm compresses, painkillers, and antipyretics.

Recovery from a disseminated infection may take some days, months or sometimes annually, and the acuteness of consequences varies according to the organ systems that are impacted.