Hemagglutinating virus isolated from cat scratch disease

Cat scratch disease in Connecticut. Epidemiology, risk factors, and evaluation of a new diagnostic test

BACKGROUND

Although cat scratch disease is commonly diagnosed in patients who have unexplained regional lymphadenopathy after encounters with cats, its epidemiology and the risk factors for disease are not clearly defined, and there is no generally accepted diagnostic test.

METHODS

We conducted a physician survey to identify cases of cat scratch disease occurring over a 13-month period in cat owners in Connecticut. We interviewed both the patients (or their parents) and controls matched for age who owned cats. Serum from the patients was tested for antibodies to Rochalimaea henselae with a new, indirect fluorescent-antibody test.

RESULTS

We identified 60 patients with cat scratch disease and 56 age-matched subjects. Patients were more likely than controls to have at least one pet kitten 12 months old or younger (odds ratio, 15), to have been scratched or bitten by a kitten (odds ratio, 27), and to have had at least one kitten with fleas (odds ratio, 29). A conditional logistic-regression analysis found that in kitten-owning households, patients were more likely than controls to have been scratched or bitten by a cat or kitten (odds ratio, 12.4; 95 percent confidence interval, 1.0 to 150). Of 45 patients, 38 had serum samples with titers of 1:64 or higher for antibody to R. henselae, as compared with 4 of 112 samples from controls (P < 0.001). The positive predictive value of the serologic test was 91 percent. Of 48 serum samples from patients' cats, 39 were positive for antibodies to R. henselae, as compared with positive samples from 11 of 29 control cats (P < 0.001).

CONCLUSIONS

Cat scratch disease is strongly associated with owning a kitten, and fleas may be involved in its transmission. The serologic test for rochalimaea may be useful diagnostically, and our results suggest an etiologic role for this genus.

Use of silver staining (dieterlé's stain) in the diagnosis of cat scratch disease

Lymph node involvement in cat scratch disease is characterized by a granulomatous lymphadenitis with micro-abscesses. Recently, it has been shown that the possible aetiological agent is a micro-organism which stains with some silver stains. In this study 60 lymph nodes were studied from 60 patients, using a modified Dieterlé's stain. In 40 cases (66%) rod-shaped bacilli with rounded extremities were observed. They were negative both with the Gram and Ziehl-Neelsen stains. Since such micro-organisms were demonstrated in the majority of the nodes examined, it can be concluded that silver stains are appropriate for the diagnosis of this condition.

Continuing search for the etiology of cat scratch disease

Fifty cat scratch disease patients were tested for antibodies against candidate etiological agents, with inconclusive results. Future research should emphasize new viral isolation methods to discover the elusive agent.

Successful partial excision of an intramural fibroma of the left ventricle

A report of the only surviving adult to undergo partial excision of an intramural cardiac left ventricular fibroma is presented. Good results were obtained by relieving outflow tract obstruction through partial excision of the tumor from the septum and left ventricle. The need for conservative surgical treatment of patients with this rare, benign tumor is emphasized.

Intramural fibroma of the left ventricle

A case of left ventricular fibroma in a symptomless 17-year-old girl is described. The tumour was extensive and after its removal inadequate left ventricular function resulted in death at operation. The role of surgical treatment is discussed.

Cardiac fibroma

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Intramural ventricular cardiac fibroma. Successful removal in two cases and review of the literature

Two cases in which large intramural ventricular cardiac fibromas were successfully removed from children are reported. In one the fibroma was principally septal, and in the other it lay in the free wall of the left ventricle. These are the second and third such operations reported. A review of these two cases plus 34 other reported cases of cardiac fibroma indicates that a primary mural tumor of the heart should be suspected in patients, particularly children, with unexplained cardiac failure, unexplained cardiac dysrhythmia, intracardiac calcifications, irregular shadows on roentgenograms, or unexplained newly developing cardiac symptoms and murmurs. Angiocardiography is the best way of confirming the diagnosis. In view of the potential hazard of these tumors, their surgical removal should be undertaken, and this experience indicates that even very large and extensive intramural ventricular tumors may be removed successfully.

Fibroma of the right ventricle producing severe tricuspid stenosis

A case of fibroma of the right ventricle in a child of 16 months is reported. The clinical and hemodynamic findings were those of severe tricuspid stenosis. Angiocardiography proved the obstruction to be due to a cardiac neoplasm, localized within the right ventricle. An attempt at surgical removal failed because the tumor, almost completely filling the cavity of the right ventricle, was too extensive and could not be distinctly delineated from the healthy myocardium.

Cat scratch disease. A report of seven cases and comments on the salient features

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