The infections generated by Bartonella henselae cause in patients with a strong immune system a benign pathology known as “cat’s claw disease”, a lymphadenitis with self-limiting evolution, which spontaneously remits within 2-4 months. In people with immunodeficiency Bartonella henselae can cause vasculo-proliferative diseases such as bacillary angiomatosis and granulomatous hepatitis.
The diagnosis of bartonellosis is established with the help of the information obtained after the clinical examination of the patient and the serological investigations for the detection of specific IgM and IgG antibodies. Currently, the etiological agent of cat’s claw disease can be detected through serological tests in approximately 80% of the pediatric population aged between 3 and 12 years.
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Bartonella henselae infection
Bartonella henselae is a Gram negative bacterium that is transmitted to humans by direct inoculation following a cat scratches or bites or through the contact of a pre-existing skin lesion with the saliva or contaminated secretions of the feline.
After inoculation, the pathogen reaches the level of blood circulation where it targets the CD4+ cells of the immune system that act as precursors of the endothelial cells found mainly in the blood vessels, but also in other organs of the body. The ability of Bartonella henselae to affect lymphocytes determines the appearance immunological imbalances with the increased risk of infection of the body with other bacterial pathogens and unfavorable evolution of symptoms. In the absence of treatment, the bacteria can disseminate systemically with the appearance of multiple organ failure and in severe cases death.
Symptoms associated with cat claw disease
From the point of view of the clinical picture, cat’s claw disease presents manifestations with self-limiting evolution that implies the existence of a primary skin lesion, accompanied by local lymphadenopathy (inflammation of the lymph nodes near the area of inoculation of the pathogen), febrile syndrome and altered general condition determined by chills, headaches, myalgias, arthralgias or digestive complaints.
The incubation period following the inoculation of the pathogen can be between 2 days and 8 weeksthe lesions encountered in this pathology being initially intensely pruritic maculo-papular type (causes itching on the skin) which evolves with the appearance of vesicles, pustules and then crusts that detach spontaneously.
Lymphadenopathy associated with Bartonella henselae infection appears approximately 1 to 3 weeks after inoculation of the bacterium and accompanies the previously mentioned skin manifestations, being located more frequently at the axillary and epitrochlear level – 46% of cases, cervical and submandibular in 26% of cases. The femoral, inguinal, preauricular and clavicular ganglion groups can also be affected with the appearance of lymphadenopathy secondary to Bartonella henselae infection.
The evolution of bartonellosis is self-limited and spontaneously remits after a period of evolution that can be between 2 and a maximum of 4 months in the case of immunocompetent people, following the acute infectious episode, specific antibodies against Bartonella henselae of IgM and IgG type being detected in the patient’s serum. The chronic forms of evolution of the infections caused by Bartonella henselae are also rarely encountered they can extend for 2 years from the moment of inoculation of the pathogen.
The atypical forms of Bartonella henselae infection are found especially in the case of people with HIV infection and include ocular, hepatic, splenic, cerebral, bone or cardiovascular manifestations:
Parinaud’s oculoglandular syndrome evolves with preauricular lymphadenopathy and granulomatous conjunctivitis secondary to Bartonella henselae infection.
Neuroretinita it involves the temporary unilateral loss of vision (at the level of one eye) and requires a recovery period that can be between 1 and 3 months.
Acute encephalopathy represents a condition of the central nervous system caused by infection with Bartonella henselae which frequently presents an unfavorable evolution with the appearance of lethargy and finally the comatose state.
Endocarditis – Bartonella henselae it can cause cardiac damage in chronic drinkers and in people with pre-existing valvular damage.
Bacillary angiomatosis – systemic damage caused by Bartonella henselaecharacterized by integumentary, mucous membrane, hepatic and splenic tissue lesions that favor the formation of abscesses at the level of these organs.
Osteolytic lesions (loss of bone matrix).
Erythema nodosa, vasculitis – vascular lesions determined by Bartonella henselae appear as a result of the proliferation of the vascular endothelium and the accumulation of bacillary and polymorphonuclear neutrophilic microcolonies inside the blood vessels.
When we go to the doctor
Persistent adenopathies that are accompanied by febrile syndrome, headache, myalgia, bone pain and a feeling of permanent fatigue require a thorough medical examination of the patient and specialized investigations to establish the cause and administer specific treatment.
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Medical tests for the diagnosis of cat claw disease
The laboratory diagnosis for cat scratch disease is established by means of serological tests in order to determine specific antibodies of the IgM and IgG type in the patient’s serum, the isolation of the pathogen through special cultures in the microbiology department, histopathological examination and molecular biology techniques represented by PCR.
The direct methods used to establish the infection determined by Bartonella henselae they are represented by the isolation of the pathogen in culture, the detection of specific antigens, the detection of bacterial DNA by means of PCR and the visualization of the bacillus by means of special stainings. Indirect methods of bartonellosis detection assume the titration of specific anti-antibodies Bartonella henselae in the patient’s serum.
Treatment of Bartonella henselae infection
In the case of immunocompromised patients, bartonellosis presents a high risk of unfavorable evolution and requires the institution of antibiotic treatment in accordance with the indications of the infectious disease doctor.
Depending on the particularities and evolution of each individual case, the doctor can recommend to the patient a combination of antibiotics consisting of fluoroquinolones, macrolides and trimethoprim-sulfamethoxazole.
Complications of B. henselae infection
The main complications that can appear in the evolution of bartonellosis can be:
Tip neurologic
Encephalopathy Transverse myelitis Neuroretinal radiculitis Cerebellar ataxia, bone-osteomyelitis
Tip ocular-neuroretinita (inflammation of the optic nerve) unilateral bacterial
Tip cardiac – endocarditis.
In immunocompromised patients, bacillary angiomatosis can determine multiorgan damage with unfavorable evolution for the patient.
The main method of preventing bartonellosis is represented by avoiding contact with foreign cats or those that show aggressive behavior. Feline owners are advised to discourage the aggressive behavior of the felines they own and to avoid direct contact of the skin lesions with the animal’s saliva.
Regular external deworming of household pets prevents the transmission of infection with Bartonella henselae from one cat to another through fleas and reduces the risk of transmission of the pathogen from an infected animal to humans (Bartonella henselae it is not transmitted to humans by flea bites).
In the presence of a scratch or cat bite, it is recommended to wash the lesion with warm water and soap and carefully monitor the evolution of the person in question, especially if it associates immune deficiency secondary to HIV infection or immunosuppressive, radiotherapy or chemotherapy treatments.
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2023-08-09 22:04:58
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