Felinosis is a cat scratch disease . This infectious disease, which may be acute or chronic in nature, is the focus of the article. An ailment develops after scratching or biting an infected animal, most often a cat. This pathology is also known to science under other names - benign lymphoreticulosis or granuloma Mollare (in honor of the scientist P. Mollare, who first described the symptoms of the disease from cat scratches in the last century).
Initially, researchers believed that the disease has a viral etiology, but in 1963, Russian infectious disease scientists - G.P. Chervonskaya, I.I. Terskikh and A.Yu. Bekleshov - identified the pathogen, which turned out to be a microbe from the rickettsia group.
Pathogenesis and description of the disease
The causative agent of Mollare granuloma, or cat scratch disease, is the bacterium Rochalimaea henselae. This microorganism is widely represented in the environment. Infections are ubiquitous and seasonal - about 70% of cases of the disease are diagnosed in the autumn-winter period. It is difficult to determine the risk group for this pathology, since people of all ages can suffer from it. But the most susceptible to felinosis are children, adolescents and young people under the age of 20.
The main carriers of the infection are mammals, especially domestic cats. The bacterium lives on the body of the animal constantly, without causing it the most allergic reactions or any violations. But when a pathogenic bacterium enters the human body, it displays its entire dangerous essence, negatively affecting our state of health.
Natural gates for a microbe are considered to be skin on the arms and legs, head, face and neck. The bacterium can also penetrate through the conjunctiva. By the way, the infection is not transmitted from an infected person to a healthy one. Carriers Rochalimaea henselae are animals only.
Felinosis is called a cat scratch disease because infection occurs due to wounds and abrasions on the skin resulting from contact with the animal. The bacterium that appears on the skin does not threaten a person with normal immunity. However, penetrating deep into the smallest damage on the epidermis, against the background of a weakening of the protective functions of the body, the microbe can be activated:
- First, the pathogenic bacterium begins to release toxic substances at the site of the scratch, which causes the development of inflammation.
- Next, the process of cell destruction and the penetration of the pathogen into the lymphatic channel takes place.
- With the flow of lymph, the infection gets to nearby lymph nodes, provoking their inflammation.
- After the bacteria enter the bloodstream and spreads throughout the body, settling in the tissues of the internal organs.
Felinosis is called a cat scratch disease because infection occurs due to wounds and abrasions on the skin resulting from contact with the animal. The mechanism of the development of the disease is called dissemination of the infection, which leads to pathological changes in the target organs. These include the lymph nodes, spleen, liver, heart, and all those to which the harmful microflora has spread.
What contributes to the occurrence of felinosis
A favorable condition for the manifestation of the disease from cat scratches is the weakening of the body's immune defense. The cause of this condition may be:
- metabolic disorders;
- failure in the system of cellular immunity;
- AIDS (acquired immunodeficiency syndrome);
- long-term use of potent drugs (hormonal drugs and cytostatics possess immunosuppressive properties);
- bad habits, and in particular alcohol abuse.
After recovery, the patient has a strong immunity. The symptoms of the disease from feline scratches (felinosis) of a person with a positive HIV status are especially difficult to tolerate. In them, the infection proceeds atypically, characterized by a long recurrent course.
How does the disease manifest itself
In a predominant number of cases, benign lymphoreticulosis develops according to the standard scenario. The same as in the photo, the symptoms of the disease from cat scratches can appear after 3-5 days or 2-3 weeks after infection. A long incubation period contributes to the latent spread of infection, so it is very rare to start treatment immediately after infection.
At first, the disease develops gradually and does not cause concern. At the site of the scratch, which served as the pathway for the bacteria, a papule (a specific tubercle) appears. The abrasion itself heals in a few days. After some time, the papule turns into an abscess, which after breaks through and forms a small erosion on the skin. In this case, the general well-being of the infected person at this stage does not deteriorate at all, the patient does not feel any changes, signs of inflammation in the body.
From the moment of infection, after 2-3 weeks, the most characteristic manifestation for the disease from cat scratches occurs - lymphadenitis. The inflammatory process in the lymph nodes located as close as possible to the site of infection is accompanied by an increase in body temperature to 38-41 ° C. Fever usually lasts from 1 to 4 weeks, sometimes longer, but in half the cases, the body temperature can be subfebrile (not exceed 38 ° C).
Key features
As the disease progresses, in addition to fever, patients experience other symptoms of the disease from cat scratches. In children, the manifestations are more pronounced than in adults, however, in general, the clinical picture is the same for everyone, regardless of age:
- general weakness;
- malaise;
- lethargy;
- sleep disturbances;
- loss of appetite;
- increased sweating;
- cardiopalmus;
- dyspnea;
- aching headache.
Symptoms of the disease last no longer than 2-3 weeks. Swollen lymph nodes are a common symptom of this disease.
With felinosis, axillary, elbow and cervical lymph nodes can increase in size up to 5 cm, and in severe cases even reach 8 cm in diameter. When probing, they do not cause pain, since they are not connected either with each other or with neighboring tissues. In the absence of treatment, the affected lymph nodes suppurate, then their remote groups are involved in the pathological process, which leads to the development of generalized adenopathy. The cyclic duration of this disease is three months, but it can last much longer.
Ocular Granuloma Mollare
Judging by the photo, the disease from cat scratches can affect the conjunctiva of the eye. Such a course of pathology occurs in approximately one in twenty patients with benign lymphoreticulosis. As a result of the saliva of an infected animal entering the conjunctiva, only one eye is usually involved in the pathological process. The affected visual organ suddenly swells, turns red. On the conjunctiva, peculiar nodules arise, and ulcers can form in their place.
In parallel with the suppuration of the eye, the anterior apex lymph node enlarges. Gradually, it reaches five centimeters in diameter. If the lymph node begins to fester, a fistula forms, since the infiltrate needs to go out in some way. After treating the disease from cat scratches, a scar will resemble a manifestation of an ailment.
In many cases, lymphadenopathy affects both the posterior and submandibular lymph nodes. Often this process is accompanied by a significant increase in body temperature and other symptoms of the disease from cat scratches. Diagnosis of felinosis is usually not difficult, since obvious signs of intoxication of the body can also testify in its favor.
The duration of the course of the ocular form of benign lymphoreticulosis varies within 1-2 weeks, but often the disease acquires a protracted nature and passes only after a few months. It is worth noting that the external manifestations of the disease (inflammation of the conjunctiva) disappear after 10-14 days.
Complicated course of felinosis
If the Moller granuloma acquires a chronic course, a number of complications are possible. In severe cases, with felinosis, the central nervous system is often affected. About a month and a half after the enlargement of the lymph nodes, neurological symptoms occur, characteristic of meningitis, encephalopathy, myelitis and other diseases. A complication can be either a short-term aggravation of a patient’s condition or lead to a coma and death.
In HIV-infected patients, subcutaneous hemorrhages, which develop as a result of bacterial vascular damage, are noted simultaneously with the described complaints. This manifestation indicates the spread of infection throughout the body through the hematogenous route.
Other complications of felinosis (cat scratch disease) are:
- myocarditis;
- abscess of the spleen;
- pneumonia.
Diagnostics
Most often, the diagnosis of "benign lymphoreticulosis" is not in doubt among experienced professionals. During the examination of the patient, collecting complaints and making an anamnesis, a qualified doctor will surely see a connection between the person’s contact with the animal and the characteristic symptoms in the form of inflammation of the lymph nodes. However, the specialist’s assumption of felinosis is not a diagnosis yet.
Confirm or deny the suspicion of a doctor can only positive results of a microbiological blood test or histological analysis of biomaterial, the sampling of which is carried out during a biopsy. The nature of the papule or pustule on the skin is determined in the laboratory. Sometimes the tissue of the affected lymph node is taken as a sample. Increasingly, the diagnosis of cat scratch disease involves the use of a modern method - a molecular genetic study of bacterial DNA.
Patients will also have to pass a detailed blood test, the results of which will be another confirmation of felinosis in the presence of elevated eosinophils and erythrocyte sedimentation rate.
For the treatment of benign lymphoreticulosis, differentiation with diseases such as:
- lymph node tuberculosis;
- tularemia of the skin-bubonic form;
- lymphogranulomatosis.
Antibiotic infection treatment
Most often, this disease is cured on its own, i.e. immunity must cope with it, but sometimes the patient can not do without medical intervention.
The main role in therapy belongs to the etiotropic treatment - the use of antibacterial drugs in order to suppress the activity of the microbial pathogen and eliminate the pathogenic microflora. Before treating the disease from cat scratches, it is necessary to determine the degree of sensitivity of the bacteria Rochalimaea henselae to antibiotics of various groups. To fight the infection, the following antibacterial agents are used:
- "Erythromycin";
- "Ciprofloxacin";
- Clarithromycin;
- "Azithromycin";
- "Doxycycline";
- Ofloxacin.
In the atypical course of felinosis, a topical antibiotic is used (in the form of eye drops for conjunctival damage).
Other drugs
In the case of obvious inflammation and enlarged lymph nodes, anti-inflammatory therapy is carried out using NSAIDs based on diclofenac, nimesulide and other active substances. Patients are advised to do compresses with Dimexidum twice a day. The solution is prepared in a ratio of 1: 4 (for 1 tbsp. L. Of medicine - 4 tbsp. L. Of water). A gauze dressing is moistened in it and applied to the affected lymph node. To eliminate painful sensations, lowering body temperature, Ibuprofen, Paracetamol, Analgin, Papaverine are used.
If the lymph node begins to fester, carry out its puncture. However, only medical staff in the clinic should do this under sterile conditions. The lymph node is punctured with a special needle, and the purulent masses that are its contents are aspirated, after which the cavity is washed with an antiseptic solution.
The prognosis of felinosis
In the predominant number of cases, the prognosis is favorable: the disease passes quickly, as the body heals spontaneously. However, letting the disease drift in case of dissemination of the infection is by no means possible. The prognosis will depend on the severity of the pathology, the timeliness of the provision of medical care to the patient. It’s almost impossible to say something concrete about the patient’s recovery, if the infection has affected the central nervous system. The causative agent is capable of causing irreversible changes in brain tissue.
Preventive measures
Today, unfortunately, there is no specific prevention of felinosis. It is possible to prevent the disease from cat scratches only if you immediately treat the damaged area on the skin with hydrogen peroxide, alcohol or another antiseptic.
When the characteristic symptoms of the disease appear, it is necessary to immediately consult a doctor. If, after contact with the animal, enlarged lymph nodes are observed, body temperature is increased and signs of intoxication are present, it is worth going to an appointment with an infectious disease specialist or therapist, and consult a neurologist, cardiologist or ophthalmologist.