Newswise — A new study shows the association between the feline transmitted disorder and head and neck masses. Surgical intervention is rarely needed, but an antibiotic regimen should be established
According to one medical society, the best way to avoid cat-scratch disease (CSD), also known as cat scratch fever and benign lymphoreticulosis, is to stay away from cats. That is not really practical considering the millions of cats in the United States. Historically, the disease, which is carried in cat saliva and therefore transmitted by either a cat scratch or bite, has been considered a child's disease. However, a recent study has found a correlation between the disease and complications of the head and neck.
Research completed in 1992 demonstrated that B. henselae is the principal causative infectious agent of CSD. This small, fastidious, gram negative rod shaped bacterium gathers to form small white colonies with the cat acting as reservoir and carrier. Kittens are more likely to transmit the disease than adult cats, and the cat flea is the second known carrier of the disease.
The weaker the recipient's immune system the higher the possibility for a number of disorders to occur including bacillary angiomatosis, bacillary peliosis and (systemic) bacteriemia frequently develops. Neuroretinitis, endocarditis, aseptic meningitis and osteomyelitis also have been described in immunocompetent subjects as well.
In relation to the head and neck, an infection with B. henselae that typically leads to cat-scratch disease usually results in an attack on the area's lymph nodes. Another consequence to the head and neck is Parinaud's oculoglandular syndrome, which is a combination of conjunctivitis and ispilateral (same side) preauricular lymphadenopathy.
The association between head and neck disorders and catch scratch disease will be presented by Dr. Gerd J. Ridder from the University Clinic, Freiberg, Germany, will present his findings at the American Academy of Otolaryngology—Head and Neck Surgery Foundation (http://www.entnet.org) Annual Meeting and OTO EXPO, September 21-24, 2003, at the Orange County Convention Center, Orlando, FL.
Methodology: Between January 1997 and May 2003, a total of 721 patients with primarily unclear masses in the head and neck were prospectively included in this study. The mean age in this group of patients was 32 years, ranging from 3 to 89 years. There were 50 female and 49 male patients. CSD was diagnosed when at least two of the following three criteria were fullfilled:
1) presence of clinical symptoms typical for CSD2) serologic detection of antibodies against B. henselae3) detection of Bartonella henselae DNA in pus or extirpated lymph nodes.
The most frequent clinical symptom was acute cervico-facial lymphadenopathy, followed by chronic and abscessing lymphadenopathies. In 20 cases, there was an intraparotideal lymphadenopathy, a finding that may easily be mistaken for a tumor of the parotis.
Results: CSD was diagnosed in 99 (13.7%) of the patients. Toxoplasmosis represented the most frequent primary infection. Secondary or reactive lymph node infections were diagnosed in 92 of the patients. In 63 cases a malignant tumor was found and in 90 subjects a benign tumor was found. In 261 of the patients, the cause of the cervico-facial lymphadenopathy could not be determined.
Conclusions: Cat scratch disease may be the source of unknown masses in the head and neck region. In patients diagnosed with this CSD, a surgical intervention is usually only necessary when there is a large abscessing lymph node. The author support antibiotic treatment in patients with suppurating lymph nodes, painful lymphadenitis or systemic manifestations of CSD. The antibiotics used most frequently are azithromycin and erythromycin. Ciprofloxacin may be used as an alternative.
It is important to mention that to date there is no standardized antibiotic treatment regimen for patients with CSD. So far there has only been one prospecitve randomised double-blind placebo-controlled study showing oral azithromycin to be a useful drug for treatment of CSD.
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