Careful examination; evidence of cutaneous inoculation in the form of a nonpruritic, slightly tender pustule or papule. Typical intraocular presentations include neuroretinitis with optic nerve edema, macular star formation, and discrete white retinal or choroidal lesions. Vascular leakage from the optic nerve head results in the macular star formation, which may persist for months despite resolution of the neuroretinitis. More sight-threatening presentation includes intermediate uveitis, retinal vasculitis, vascular occlusions artery and venous , and retinitis.
Less common posterior segment findings include granulomas, choroiditis, angiomatoisis lesions, and local serous retinal detachments. Unilateral conjunctiva injection, foreign body sensation, and epiphora. Malaise and headache in fewer than one third of patients. Typical history of prodromal symptoms, lymphadenopathy, and cat exposure helps strengthen the diagnosis, especially when presenting in young adults or children. It more commonly presents in the younger ages in the late summer and fall months.
Visual field testing sometimes shows cecocentral scotoma. Optical coherence tomography OCT can display the degree of subretinal fluid, retinal thickening, and exudates.
OCT angiography may be able to show neovascularization within an area of chorioretinitis. Although rarely required, in the presence of typical presentation and blood titers, lymph node biopsy or culture may be performed. A PCR assay on tissue or blood is also available. Abnormalities of bilirubin excretion and elevated hepatic transaminases are usually secondary to hepatic obstruction by granuloma, mass, or lymph node. In patients with neurologic manifestations, lumbar puncture usually reveals normal CSF, although there may be a mild pleocytosis and modest elevation in protein.
Etiologies that must be differentiated include other causes of optic nerve head swelling such as optic neuritis, and sarcoid papillitis. Also, infectious etiologies such as syphilitic perineuritis, and rarely toxoplasmosis can produce a similar clinical appearance. Pseudotumor cerebri can mimic the less frequent appearance of bilateral CSD. Lyme disease, Rocky Mountain Spotted Fever, toxoplasmosis, toxocariasis, histoplasmosis, and leptospirosis may also cause neuroretinitis.
CSD tends to be a self-limiting disease.
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Treatment is dependent on age, immune status, systemic manifestations, and ocular complications. Warm compresses to the affected nodes. In cases of encephalitis or coma, antibiotics and supportive care are indicated. Azithromycin has been observed to cause rapid resolution of lymphadenopathy. However, the distribution of azithromycin to the eye appears higher for conjunctival tissue but lower in intraocular fluids. Corticosteroids are also a consideration for both systemic and ocular therapy. Intravitreal anti-VEGF therapy has been used for the treatment of choroidal neovascularization as well as macular edema in the setting of CSD.
Mayo Clinic Q and A: What is cat scratch fever?
Visual improvement can vary based on the initial ophthalmic manifestation. In Habot-Wilner et al.
In this series more patients had retinal or choroidal lesions. Until it does, you can take an over-the-counter anti-inflammatory medicine like ibuprofen or naproxen sodium to ease swelling and pain. A hot compress can help, too. To relieve very tight, painful glands, your doctor may gently insert a needle into them and drain the fluid. This can prevent the infection from spreading to other places in your body, like your liver or bones.
You may need to take this medicine for several months. Skin Problems and Treatments Reference. Causes The problem is a type of bacteria called called Bartonella henselae. Children are more likely than adults to get CSD. Continued Diagnosis If you tell your doctor that you were scratched or bitten by a cat, he may be able to diagnose you by looking at your symptoms. Treatment For people in good health, CSD will likely go away without treatment. Prevention You can keep your family pet. A few simple steps can help you avoid getting CSD.
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A skin disorder characterized by red, elevated lesions surrounded by a scaly ring. This condition may become a more widespread disorder that involves internal organs. Parinaud's oculoglandular syndrome. A condition that involves a red, irritated and painful eye similar to conjunctivitis pink eye , fever, and swollen lymph nodes in front of the ear on the same side Can cat scratch disease be prevented? When should I call my healthcare provider? Key points about cat scratch fever Cat scratch disease is an infection caused by a bacterium in cat saliva. The disease causes redness and swelling at the site of a cat scratch or bite, and flu-like symptoms.
If you are scratched or bitten by a cat or kitten, it is important to promptly wash the area with soap and water. Cat scratch disease can be treated by antibiotics. Next steps Tips to help you get the most from a visit to your healthcare provider: Know the reason for your visit and what you want to happen.
- Cat Scratch Disease.
- Cat-Scratch Disease.
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Before your visit, write down questions you want answered. Bring someone with you to help you ask questions and remember what your provider tells you. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.