Recent advances in diagnosis and treatment of cat scratch disease

The cause of cat scratch disease (CSD), first described in France in 1950 and in the United States in 1951, was unknown until 1983 when the bacterium in lymph nodes was detected using a Warthin-Starry silver stain. Afipia felis has been an infrequent cause of CSD since1988, when this gram-negative bacterium was first isolated from 10 patients with CSD. In 1992 Bartonella organisms were isolated from immunocompetent and immunocompromised patients. An indirect fluorescent antibody test to detect bartonella-specific serum immunoglobulins was developed in 1992. Since then multiple studies have shown that three Bartonella species may produce either CSD in humans, usually Bartonella henselae or Bartonella clarridgeiae, or bacteremia in healthy cats. Also, these two bacteria and Bartonella quintana cause bacillary angiomatosis, bacillary peliosis, or relapsing bacteremia in humans. Cats are healthy carriers of Bartonella organisms and may be bacteremic for months to years. Cat-to-cat transmission of Bartonella organisms involves the cat flea in absence of direct contact transmission. CSD is the most common cause of regional lymphadenitis in children and adolescents. Present knowledge on the etiology, clinical features, epidemiology, pathogenesis, diagnosis, and management of CSD are presented. Also, brief comments about the etiology, clinical presentation, and treatment of bacillary angiomatosis and bacillary peliosis are provided.