Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)
EFFECTIVE MARCH 1, 2008 THIS DISEASE IS NO LONGER REPORTABLE IN THE STATE OF WISCONSIN. THE GUIDELINES BELOW SHOULD BE FOLLOWED FOR CASES DIAGNOSED PRIOR TO MARCH 1, 2008 I. IDENTIFICATION
A. CLINICAL DESCRIPTION: Cat-scratch disease (CSD) is a bacterial zoonotic disease caused by the bacterium Bartonella henselae. In well-described cases, a blister or papule may be noted at the site where the bacterium was inoculated (typically, the site of a bite, scratches, or lick from a cat), followed several days later by subsequent regional lymphadenopathy. Low-grade fever and discomfort at the lymph node site are common. Affected lymph nodes may become purulent and spontaneously erupt.
Although CSD is usually self-limited, more serious manifestations can occur weeks or months after initial onset. These include granulomatous lesions of the liver or spleen, encephalopathy (including seizures, coma, and combative behavior), neuroretinitis, endocarditis, and osteomyelitis.
In persons with impaired immune responses, such as HIV-positive patients and persons on immune suppressive drug therapy, signs may be significantly modified and may persist indefinitely depending on the extent of immune suppression. Persistent bacteremia and significant recurrent fever are likely. In persons with CD4 T-lymphocyte counts below 100, lymph node swelling may not be apparent; however, angiomatous lesions involving the skin, viscera or other tissues (bacillary angiomatosis) may develop. Untreated Bartonella infections in immune impaired persons may be life-threatening.
B. REPORTING CRITERIA: Laboratory confirmation of Bartonella infection (see below) in a person with clinically compatible signs and symptoms.
C. LABORATORY CRITERIA FOR CONFIRMATION:
1. Single positive IgG antibody titer by IFA to B. henselae antigen (or surrogate B. quintana antigen). Significant cutoff values established by individual laboratories (e.g., >1/128 at CDC or the Mayo Clinic; >1:512 at the Wisconsin State Laboratory of Hygiene) OR
2. A fourfold change in IgG antibody titer to B. henselae antigen in acute and convalescent serum samples, OR
3. Isolation of B. henselae from a clinical specimen, OR
4. Positive PCR assay for Bartonella performed on patient tissue by the CDC
Comments : CSD patient sera will cross-react strongly with Bartonella quintana (the agent of trench fever) antigen. However, case histories should readily sort out the nature of the infectious agent; CSD is usually cat-associated, whereas trench fever is not. Bartonella quintana infections are transmitted by human body lice and typically produce recurrent febrile episodes. Lymphadenopathy is not typically associated with B. quintana infection. Both B. henselae and B. quintana can cause similar syndromes in immune-impaired persons.
D. WISCONSIN CASE DEFINITION:
1. A person with lymphadenopathy or with a clinical diagnosis of bacillary angiomatosis/peliosis and a single high IgG antibody titer to B. henselae antigen, OR
2. A person with a fourfold change in IgG antibody titer to B. henselae antigen in acute and convalescent serum samples, OR
3. A person from whom B. henselae is isolated from a clinical specimen, OR
4. A person with a positive PCR assay for Bartonella performed by the CDC
II. ACTIONS REQUIRED/ PREVENTION MEASURES
A. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.
B. EPIDEMIOLOGY REPORTS REQUESTED:
C. PUBLIC HEALTH INTERVENTIONS:
1. Patient education as needed regarding the risks of infection from cat scratches/bites, especially from kittens and especially from flea-infested cats. Risks are highest for children and immune compromised adults.
2. If a homeless person is seropositive for B. quintana/henselae and has a febrile illness, consider the possibility of trench fever and assess patient for body lice infestation.
III. CONTACTS FOR CONSULTATIONA. BCDP / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 267-7321.
B. DPH REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.
C. WSLH/
1. Bacterial Serology: (608) 262-3217.
2. Culture: (608) 263-3421.IV. RELATED REFERENCES
1. Heymann DL., ed. CAT-SCRATCH DISEASE. In: Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2000:90-92.
2. Pickering LK, ed. Cat-Scratch Disease (Bartonella henselae). In: Red Book: 2003 Report of the Committee on Infectious Diseases. 26 th ed. Elk Grove Village , IL : American Academy of Pediatrics, 2003:232-234.
V. DISEASE TRENDS
Cat scratch disease was not officially reportable until April, 2000. Thus, no trend data are available.