784 Cat-Scratch Disease – Clinical Report

Murinello N, Martins S
Introduction: Cats are domestic animals very common in Portuguese houses, however they are reservoirs of infectious agents and potential sources of infection to humans. The Cat- Scratch disease is a zoonosis caused mainly by Bartonella henselae transmitted to humans by inoculation into wounds caused by scratches and cat bites, previously infected by cat fleas.
Clinical report: We report a case of Cat-Scratch disease of an immunocompetent 44-year-old woman, married, with two sons, unemployed (Graffar Class IV), with smoking habits and previous history of intravenous drug use. The patient attended the health centre complaining of painful swelling in her right arm, lasting two weeks that didn’t relieved with non-steroid anti-inflammatory drugs. Additionally, the patient complained of anorexia, asthenia, rigors and fever. She presented a crust in a finger of the right hand, epitrochlear lymphadenopathy and other smaller regional lymphadenopathies. Her symptoms started three days after she was scratched by her kitten. The patient’s laboratory evaluation, tuberculin reaction and chest X-ray were normal. A presumptive diagnosis of cat-scratch disease was made based on the epidemiology and the clinical presentation. Due to the painful lymphadenopathy, she was treated empirically with azithromycin for five days with fast resolution of most of the symptoms. The diagnosis of B. henselae infection was confirmed by serology and PCR on lymph node biopsy. For the epidemiological study of the origin of the infection, it was additionally performed an investigational study of the patient’s kitten and their ectoparasite.
Conclusion: Among healthy individuals the Cat-Scratch has a benign course, being possible to diagnosis and to treat it in primary care. However, to better understand the epidemiology and clinical spectrum of bartonelloses in our country, future studies need to be performed in patients and animal reservoirs to identify circulating Bartonella species.
784 Cat-scratch disease – clinical report