CAT SCRATCH Dz (CSD)—CAT SCRATCH FEVER, CAT FEVER, BENIGN INOCULATION LYMPHORETICULOSIS
RELATIVELY COMMON CAUSE OF PED CHRONIC CERVICAL LAD
PROBABLY DESCRIBED FIRST IN 1889 BY HENRI PARINAUD—PARINAUD SYNDROME IS AN ATYPICAL PRESENTATION OF CSDz
>90% Hx FELINE CONTACT(KITTENS>CATS), >50% Hx OF INOCULATION SITE—-USUALLY DISTAL (BITE OR PAPULE)
POSSIBLE TO BE CARRIED BY OTHER ANIMALS (DOGS, RABBITS, MONKEYS, FISH BONES, PORCUPINE QUILLS)
INNOCULATION—ERYTHEMATOUS RXN(MAY TAKE DAYS TO DEV.) NON-PRUTITIC/PAPULAR—-RESOLUTION WITHOUT SCARRING—2-4 WEEKS—REGIONAL LAD (OFTEN UNILAT–PRE-AURICULAR/SUBMANDIBULAR)/ LOW GRADE TEMP—-OTHERWISE ASYMPTOMATIC, CONJUNCTIVITIS, MALAISE, FATIGUE——2-3 MONTHS–SPONT RESOLUTION
SKIN OVERLYING THE LAD “PARCHMENT LIKE”
SYNDROME OF PARINAUD = UNILAT CONJUNCTIVITIS WITH LARGE PAINFUL PREAURICULAR CYSTS
Dx: Hx
ELISA OR PCR: BARTONELLA HENSLEAE (FORMERLY ROCHALIMEAE HENSLEAE) OR AFIPIA FELIS (ARMED FORCES INST OF PATH)-1991—–INTRACELLULAR M/O IN THE RICKETTSEA FAMILY
INDIRECT IMMUNOFLORESCENCE TEST AVAIL—MUST BE SENT TO OKLAHOMA CHILDRENS HOSPITAL
MILD EOSINOPHILIA
HIGH ESR
BIOPSY—-WARTHIN STARRY SILVER IMPREGNATION STAIN—-SHOWS SMALL PLEOMORPHIC G- COCCOBACILLUS
IN ANTIQUITY USED TO DO TRANSFER INOCULATION TEST (HANGER ROSE SKIN TEST) = MOLLARET-DEBRE TEST—-LIKE KVEIM-SITZBAUGH TEST
Rx: EXPECTANTLY—–TELL PTS IT HAS A VARIABLE COARSE—WOULD GIVE ZITHROMAX (PROBABLY SOME EFFICACY—NEW STUDY IT SEEMS TO REDUCE THE AMOUNT AND DURATION OF THE REGIONAL LAD)
40% MAY FORM SUPPURATIVE ADENOPATHY—-MAY DRAIN FOR SYMPTOMATIC RELIEF
MAY USE BROAD SPEC ABX TO PREVENT SUPERINFXN
MAY EXCISE OR I&D—-10% SINUS FORMATION
PROBABLY A GOOD IDEA TO COVER THE PTS WITH P.O. ABX—BUT THE ORGANISM IS INTRACELLULAR AN THUS PROTECTED EVEN THOUGH IT IS SENSITIVE