Three Cases of Cat Scratch Disease Diagnosed byIndirect Immunofluorescence Antibody Assay and/or Polymerase Chain Reaction of 16S rRNA gene of Bartonella henselae.

Abstract

ABSTRACT. Three suspected cases of cat scratch disease were diagnosed by indirect immunofluorescence antibody assay and/or polymerase chain reaction. Patient 1 was a 10-year-old female who presented swelling of the right axial lymph nodes with pain and fever. She kept a kitten, and many scratches were observed on her both legs and dorsum manus. Antibody titers against Bartonella (B.) henselae were 1:32 for IgM 3 weeks after the onset of the symptoms and 1:64 for IgG 8 weeks after the onset. The DNA for 16S rRNA type I of B. henselae was detected from the blood sample obtained 3 weeks after the onset of symptoms by polymerase chain reaction for the first time in Japan. Patient 2 was a 22-year-old female veterinary student with a cat scratch at the bottom of her neck by a male kitten. She developed a papule at the scratch, slight fever, and neck pain. Although both Bartonella-specific IgG and IgM antibodies were negative before the scratch, the IgG antibody titer rose to 1:512 14 weeks after the onset. B. henselae was isolated from the kitten and its DNA found to be for 16S rRNA type I by PCR. Patient 3 was a 23-year-old female veterinary student with a cat scratch on her left forearm. A small reddish papule developed on the scratch, and she experienced swelling of the left axial lymph node and pain. Both the IgG and IgM antibodies against B. henselae were negative before the cat scratch, and the IgG titer rose significantly to 1:128 and 1:1,024 in 2 and 5 weeks, respectively, after the onset of the symptoms. KEY WORDS: Bartonella henselae, cat scratch disease, PCR.

First Isolation of Bartonella henselae Type I from a Cat‐Scratch Disease Patient in Japan and Its Molecular Analysis

“…In Australia, seventeen B. henselae strains were isolated from the 83 PCR-positive human specimens (9). In our previous study, though genetical and/or serological diagnosis was successful in three suspected CSD patients, no Bartonella species was isolated from the patients (20). Thus, an isolation of B. henselae from CSD patients is seldom accomplished, because suitable materials are not available, the culture conditions are not appropriate or the organism shows fastidious, cytozoic and slowgrowth characteristics.…”

“…The antibody titer to B. henselae was examined by IFA test with strain B. henselae Houston-1. The IFA test procedure was as reported previously (20).…”

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Cat-scratch disease (CSD) is a worldwide zoonosis primarily caused by Bartonella henselae (5,11,20,24,33,34), but Bartonella clarridgeiae has also been linked to a few human cases of CSD (17,19). The organism also causes bacillary angiomatosis (15,31) and peliosis (32) in immunocompromised individuals and bacteremia in immunocompetent individuals.

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“…The isolation and establishment of Bartonella strains are extremely important for both etiological diagnosis and epidemiological and genetical analysis of the isolates. Though many clinical cases of CSD have been reported in Japan (20,24,33), there are to date no available reports of the isolation of B. henselae from human cases in Japan.B. henselae type II was detected in 18% of the isolates from CSD patients in the Netherlands (3), and 94% of cat isolates in Germany (27).…”

“…Most cases are diagnosed based on clinical manifestations, the history of contacts with cats, serology (14,20,24,26,28,33) or PCR-based methods for examining the biopsy specimens (2, 10, 28). However, the isolation of the organism from patients is relatively difficult and only a few cases of the organism isolation have been reported worldwide (7,9,18,25), because suitable material is not available, the culture conditions are not appropriate or the organism shows fastidious, cytozoic and slow-growth properties.…”