Cat-Scratch Disease with Encephalopathy

Abstract

A case of encephalopathy complicating cat-scratch disease has been described. Neurologic signs manifested by convulstions and stupor appeared ten days after epitrochlear lymphadenopathy. The clinical course gradually improved over the next few days and recovery was complete. The spinal fluid was normal. The skin test with CSD antigen was positive. In all cases of encephalopathy developing within six weeks following the appearance of unexplained lymphadenopathy, the diagnosis of cat-scratch disease should be entertained. The importance of the cat-scratch disease antigen in diagnosis is emphasized.

Human bartonellosis: seroepidemiological and clinical features with an emphasis on data from Brazil - A review

“…Bartonella infections that deserve detailed discussion based on their increasing number of reports include blood culture negative infective endocarditis and fever of unknown origin. In addition, for several decades atypical manifestations of CSD such as meningoencephalitis, retinitis, dissemination with hepatosplenic abscesses and osteomyelitis have been reported, and it is likely that many such manifestations still go unrecognized (Stevens 1952, Adams & Hindman 1954, Selby & Walker 1979, Miller & Bell 1980, Johnson et al 1985, Wear et al 1985, Katner et al 1986, Greenbaum et al 1986, Lewis & Tucker 1986, Margileth et al 1987, Chrousous et al 1990, Apalsch et al 1993, Golden 1993, Tappero et al 1993, Bernini et al 1994, Waldwogel et al 1994, Hadley et al 1995, Whitman & Krafte-Jacobs 1995, Riviello & Ruoff 1998, Walter & Eppes 1998, Arisoy et al 1999, Hulzebos et al 1999, Robson et al 1999, Azevedo et al 2000, Krause et al 2000, Hmaimess et al 2004, Baylor et al 2007, Stockmeyer et al 2007). The onset of signs and symptoms of bartonellosis generally occur about one to two weeks after exposure, but this delay can range from 1-4 weeks, depending on the syndrome presented, and may last several months (Carithers 1985).…”

“…They are, in order of frequency: seizures with encephalopathy, status epilepticus and coma, neuroretinitis, aseptic meningitis, transverse myelitis, radiculitis, cerebral arteritis, acute hemiplegia, and dementia (Stevens 1952, Selby & Walker 1979, Miller & Bell 1980, Carithers 1985, Lewis & Tucker 1986, Baker et al 1995, Hadley et al 1995, Hamilton et al 1995, Noah et al 1995, Schwartzman et al 1995, Riviello & Ruoff 1998, Walter & Eppes 1998, Hmaimess et al 2004, Rocha et al 2004, Stockmeyer et al 2007, Baylor et al 2007). Overall neurological complications account for 1-2% of cases of CSD (Carithers 1985, Carithers & Margileth 1991, Noah et al 1995.…”

Acute hemiplegia associated with cat-scratch disease

“…Although the benefits of antimicrobial therapy are not completely proved, it is recommended to use Azithromycin [1,4]. There is no objective evidence of benefit using steroids [6,7].…”

“…Convulsions are relatively common (46%). In addition, other neurological manifestations that may accompany encephalopathy are neuroretinitis, Parinaud's oculoglandular syndrome, myelopathy, radiculopathy, facial nerve paresis, cerebral arteritis, and chronic inflammatory demyelinating polyneuropathy [6][7][8][9].…”