Institut de bactériologie, Faculté de médecine et Hôpitaux universitaires de Strasbourg, 3, rue Koeberlé, 67000 Strasbourg
- Key words: Bartonella henselae – Cat scratch disease – Bacillary angiomatosis – Ctenocephalides felis – Afipia felis – Endocarditis – Opportunistic infection.
- Page(s) : 681-92
- Published in: 1998
The recent discovery of the bacterium Bartonella henselae was mainly due to the development of molecular biology techniques adapted to microbial diagnosis and to the description of new human diseases linked to Aids. About 10% of pet cats and 33% of stray cats harbour that bacterium in their blood. In immunocompetent patients, that bacterium is responsible for human cat scratch disease, characterized essentially by a localized lymph nodes enlargement in the vicinity of the entry site of the bacteria. This disease occurs more likely in pet cats less than 1-year-old and infested with fleas. The bacterium is transmitted to humans by scratches or bites ; the role of fleas is possible, but is not yet documented. In 5 to 13% of cases, the cat scratch disease appears as more severe, including health impairment, hepatitis, Parinaud’s oculo-glandular syndrome, neurological complications or stellate retinitis. In immunocompromised patients, B. henselae is responsible for various clinical presentations : bacillary angiomatosis, bacillary peliosis, recurrent or persistant bacteremia or endocarditis. Diagnosis of infections due to B. henselae can be performed by serological specific testing with sensitivity and specificity values ranging from 75 to 100%. Cultivation of the bacterium is fastidious, particularly in cases of cat scratch disease. The most efficient diagnostic test is the in vitro DNA amplification which has the drawback to require a lymph node sample. Antibiotics are usually inefficient for the treatment of cat scratch disease. By contrast, in immunocompromised patients, these infections are successfully treated for a more or less long time by macrolides or tetracyclines or rifampin.