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Cat scratches. Indications for consultation with other specialists

Cat scratch disease has several synonymous names, among which the most famous is felinosis. No matter how much we love pets, most often it is cats who bring us this infectious disease - for this reason the name has taken root. Although dogs, monkeys, etc. can be carriers of the infection.

It is important to understand that cats and other pets do not react in any way to the presence of the causative agent of felinosis. They do not develop any pathology. But they are carriers of the pathogen.

It is a mistake to think that cat scratches and bites are not dangerous to humans.

For reference. Statistics show that people under the age of 21 are at risk, and almost 90% of them have been bitten or scratched by kittens. The peak incidence rate is believed to occur between September and March.

Cat scratch disease, also called felinosis, is an acute zoonotic infectious pathology, characterized by transmissible contact routes of infection and characterized by damage to the lymphatic system and the appearance of specific skin lesions at the site of bacterial penetration (primary affect) in the form of suppurating papules.

For reference. In some cases, patients develop conjunctivitis, angiomatosis (proliferation of blood vessels) and liver tissue damage.

ICD 10 classifies cat scratch disease as A28.1.

Cat scratch disease - causative agent

For reference. Mostly children and adolescents suffer from felinosis. After suffering from the disease, stable lifelong immunity is formed. Repeated cases of the disease are extremely rare.

Felinosis - cat scratch disease: causes

Cats are the reservoir of Bartonella felinosis. Humans become infected when a cat infected with Bartonella bites, scratches, or licks damaged skin. Infection is also possible when Bartonella gets on the eye conjunctiva.

In isolated cases, a person may become infected after a cat flea bite.

Attention. A person infected with cat scratch disease is not contagious.

Cats are infected by flea bites. In the future, Bartonella can remain in the cat’s body for more than 12 months without causing illness and occurring in the form of asymptomatic bacteremia.

How does cat scratch disease develop?

Cat scratch disease begins with lymphogenous and hematogenous spread of Bartonella from the entrance gate (bites, scratches). At the same time, Bartonella actively penetrates erythrocyte cells, as well as vascular endothelial cells.

In patients with various immunodeficiency conditions, this process may be accompanied by the development of bacillary angiomatoses (proliferation of vascular tissue, especially small capillaries).

The occurrence of bacillary angiomatosis can be accompanied by significant damage to erythrocyte cells and bone marrow.

In places of massive penetration of the pathogen, the process of active proliferation of endothelial cells begins and inflammation develops, involving adjacent tissues in the pathological process.

For reference. Subsequently, some of the cells of the affected endothelium undergo necrosis, leading to the development of lymphadenopathy (damage to the lymph nodes) typical of cat scratch disease. Neutrophilic and eosinophilic cells accumulate around areas with inflammatory infiltrates.

Felinosis bacteria can infect:

vascular endothelium,
erythrocyte cells,
skin,
Bone marrow,
The lymph nodes,
liver,
endocardium

In some cases, the disease is accompanied by the occurrence of severe endocarditis with the occurrence of multiple bacterial vegetations and perforations on the valve leaflets.

In patients with bacillary angiomatosis, there is a massive proliferation of affected vascular endothelial cells with the appearance of single or multiple hematomas protruding above the skin (hematomas can be on a short stalk).

These formations are painless, however, if they are damaged, bleeding occurs. In some cases, papules and hematomas may become necrotic.

For reference. The size of these tumors can vary. In severe cases, the size of hemangiomas can reach 1-2 centimeters.

Felinosis - classification

The disease can pass:

atypical
typically.

In typical cases, benign lymphoreticulosis develops. Atypical forms of cat scratch disease include bacillary angiomatosis and ocular variants of felinosis.

Cat scratch disease - symptoms

The incubation period for felinosis ranges from three to twenty days (usually seven to fourteen days).

For reference. When typical forms of cat scratch disease occur, a primary affect is formed - a small papule at the site of already healed wounds (scratches or bites). The size of the papule can vary from two to five millimeters. They are painful, protrude above the skin and are surrounded by a halo of hyperemia.

Subsequently, the papules transform into vesicles or pustules, and then into ulcers covered with crusts. It should be noted that in some cases, the primary affect does not form during felinosis (in approximately 30% of patients). Also, it is not always detected during examination, since by the time you see a doctor, the crust has already fallen off and the ulcer has completely healed.

In most cases, the primary affect of cat scratch disease is located on the hands or forearms. In rare cases, on the skin of the face, legs, torso, etc.

The general condition of patients at this stage of felinosis is not impaired. Within 14-20 days, damage to the lymphatic system occurs, occurring as regional lymphadenitis. Most often, felinosis is accompanied by damage to the elbow and axillary lymph nodes, less often - to the parotid, cervical and inguinal.

For reference. The affected lymph nodes can increase to five centimeters in diameter. On palpation, they are mobile, dense, low-painful, and not fused to the skin. The inflammatory process can involve one or several regional lymph nodes.

Hepatosplenomegaly may also be present. Enlarged lymph nodes can last from several months to a year.

In half of the patients, enlarged lymph nodes are accompanied by weakness, fever and symptoms of general intoxication. The duration of the febrile period can be from one to three weeks.

Suppuration of the lymph nodes can occur approximately a month after the appearance of primary affects, however, with a mild course of the disease, felinosis can be accompanied only by regional lymphadenitis (without further suppuration of the lymph nodes).

The affected lymph nodes are enlarged, painful and adherent to the skin. Redness and tension of the skin over them are noted. When palpating the lymph node, fluctuation is noted.

For reference. Subsequently, a fistula forms, from which purulent contents can be released for several months.

In severe forms of the disease, approximately five percent of patients experience damage to the central nervous system, manifested by serous meningitis, polyneuritis, myelitis, paraplegia, and polyneuritis.

Also, with cat scratch disease, the development of thrombocytopenic purpura, myocarditis, pneumonia, endocarditis, osteomyelitis, and splenic abscesses is possible.

Symptoms of the ocular forms of cat scratch disease are:

unilateral conjunctivitis (the other eye is rarely affected);
pronounced swelling of the eyelid;
the appearance of ulcerating yellowish nodules on the upper eyelid;
the appearance of purulent discharge from the eye;
damage to the parotid lymph node, with its subsequent suppuration and the formation of a fistulous tract;
enlargement of the submandibular lymph nodes.

The duration of the disease can range from 1 to 8-10 weeks.

Development of hepatitis in cat scratch disease

In isolated cases, in persons with various immunodeficiencies, the formation of bacillary purpuric hepatitis is possible. This form of felinosis is accompanied by severe damage to the liver parenchyma.

Against the background of damage to the hepatic vessels, cystic formations filled with bloody contents form, compressing the hepatic parenchyma.

For reference. Against the backdrop of severe blood stagnation, liver dysfunction occurs. Vomiting, nausea, diarrhea, chills, fever, anemia, thrombocytopenia, bleeding, bloating, hepatomegaly, etc. are noted.

Diagnosis of cat scratch disease

When diagnosing felinosis, specific symptoms and medical history are taken into account.
(contact with a cat). A tank can be used to confirm the diagnosis. blood test and histological diagnosis of biopsy of lymph nodes, hemangiomas or papules.

Differential diagnosis of the disease is carried out with:

Kaposi's sarcoma,
tuberculosis of the lymph nodes,
cutaneous bubonic forms of tularemia,
bacterial lymphadenitis.

For reference. If necessary, consultation with narrow specialists (dermatovenereologists, surgeons, ophthalmologists, cardiologists) is recommended.

Cat scratch disease - treatment for children and adults

For mild cases of felinosis, treatment is carried out at home. Hospitalization is indicated for patients with severely complicated bacillary angiomatosis and purpuric hepatitis.

For reference. The length of sick leave depends on the severity of the patient’s condition and the presence of complications.

Treatment of felinosis is carried out with antibacterial drugs:

ciprofloxacin – 500 mg x 2 times a day orally,
azithromycin,
doxycycline – 100 mg x 2 times a day orally,
roxithromycin,
norfloxacin.

The duration of antibacterial therapy is from two to three weeks.

If bone tissue is damaged, combined antibacterial therapy (fluoroquinolone antibiotic and rifampicin) is prescribed.

Attention! Suppurating lymph nodes are not opened (to avoid the formation of fistulas), but punctured to remove purulent contents.

Usually, if treated correctly, the disease goes away completely within two to four months. If a relapse occurs, this means undertreatment of the primary disease. The course of treatment is repeated again and long-term prophylaxis with antibiotics is prescribed.

Felinosis: prevention

No specific prevention of cat scratch disease has been developed. To prevent infection, it is recommended to limit contact with stray animals, not let domestic cats go outside, and trim their claws regularly.

Attention. Bites and scratches should be treated with iodine or brilliant green.

Good day, dear readers. In this article we will talk about the manifestation of such an ailment as cat scratch disease. When getting a pet, parents don’t even think about the danger it can pose for the child. You will learn how felinosis infection occurs, how this disease is diagnosed and what means are applicable to treat it.

What is this

Felinosis is an infectious disease with an acute course.

For a long time, experts could not identify the causative agent of this disease. The disease was described as benign lymphadenopathy only in 1932 (Debra and Foshay). After 18 years, Mollare isolated what he thought was the pathogen, deciding that it was chlamydia. It was only more than 30 years later that it was established that cat scratch disease develops as a result of damage to the body by the gram-negative bacteria Bartonella henselae. And today, the DNA of this microorganism is isolated in 96 out of 100 patients.

This disease is more common in areas with temperate climates. An increase in infection cases is observed between September and March.

You need to know that 90% of all patients are mainly children and boys under 20 years of age. Boys are more likely to become infected. What is important is that entire families are not infected; as a rule, only one child is exposed to the disease.

The name of this disease takes its roots from the Latin name for cats - felis. The name of the pathogen is given in honor of the specialist who discovered the pathogen and revealed its properties - Diana Hensel (Bartonella henselae).

We have had a cat for four years now. My son often torments him, and Murchik defends himself as best he can. Therefore, scratches often appeared on my child’s body before. Now he has wiser and does not offend his pet. One day, after inflicting further “wounds,” my son’s temperature rose, but there were no additional symptoms. I took him to see a pediatrician, who immediately suggested cat scratch disease. However, I was confused by this assumption, because this was not the first time that a cat had scratched a child; such manifestations had never been observed before. The diagnosis was not confirmed, it was a coincidence. As it turned out, Nikita developed a sore throat.

Atypical forms of the disease

Under the influence of certain factors, non-standard manifestations of cat scratch disease may occur:

Neuroretinitis. There is swelling of the optic disc in only one eye, and visual acuity is impaired.
The ocular form develops when microorganisms enter the mucous membrane of the eye. Ulcerative granulomatous conjunctivitis may be observed.
The neurological form is manifested by the development of radiculitis, polyneuritis, neuropathy or radiculitis, and in rare cases, meningitis or encephalitis.
Bacillary angiomatosis. The presence of nodes up to 3 cm in size is typical.
Damage to the liver and spleen, possibly increasing these organs in size.
In fairly rare cases, the following atypical manifestations of the disease may occur:

erythema nodosum;
endocarditis;
osteomyelitis;
pleurisy.

Causes

The causative agent of the disease is Bartonella henselae. This bacillus is characterized by polymorphism. The microorganism grows quite slowly on a nutrient medium. Two genotypes of this bacterium have been isolated. However, when infected, there are no significant differences in the course of the disease. The infectious agent is not resistant to heat, but can easily withstand low temperatures.

The carrier of the infection is cats, which can carry these microorganisms within them for many years, and they themselves will not suffer. There is an assumption that Bartonella may be part of the microflora of the oral cavity of cats.

Infection occurs when an animal scratches or bites a person and damages the skin.

Factors aggravating the course of the disease:

diabetes;
HIV infection;
recent use of cytostatics;
congenital defect of immunity at the cellular level;
conditions with a lack of glucocorticoids (autoimmune hepatitis, psoriasis, autoimmune pathologies similar to rheumatoid arthritis);
recent serious illness or surgery.

In the presence of the above factors, the disease can have a very severe and protracted course. Moreover, the manifestations of this pathology may be so atypical that specialists may not immediately determine the diagnosis.

Methods and routes of transmission

As a rule, carriers of Bartonella are domestic cats and wild animals. This infection is spread by fleas, in whose intestines these microorganisms can exist for up to 9 days. According to statistics, Bartonella was detected in the blood of almost 50% of tested cats. The animal itself feels fine. The release of microorganisms occurs in urine or saliva, since cats lick themselves, the saliva quickly moves to their paws.

Infection can occur when:

cat bite;
salivary secretions getting into the eye or damaged area of skin;
in case of a scratch;
when pricked on a cactus thorn or, for example, a fish hook, if the animal’s saliva has previously come into contact with it;
if a child has a violation of the integrity of the skin and water or food consumed by an infected cat gets into this place.

What is important to know is that cats under one year of age are the most contagious.

The affected areas are the following parts of the baby’s body:

head;
face;
hands;
in rare cases, eyes;
legs.

You need to know that a child cannot become infected from another infected child. If a toddler has previously had phylenosis, then he acquires lifelong immunity, therefore, re-infection is impossible.

Symptoms

You need to know that the disease may not immediately manifest itself; the incubation period lasts from 3 to 10 days, and in rare cases up to 6 weeks.

If your baby has cat scratch disease, the symptoms of this disease will manifest differently, depending on what stage of development of the disease occurs.

The initial stage is characterized by the appearance of red papules at the site of a scratch or cat saliva left behind. As a rule, the baby does not feel any changes in the body.
The next stage in the development of the disease, which is called the height of the disease, is characterized by the presence of the following signs:

papules give way to festering ulcers, which subsequently become covered with crusts. Over time, they fall off and scars form in their place;
regional, in most cases cervical and axillary, is observed; upon palpation there is pain in the lymph nodes and their hardening;
headache;
general weakness;
lack of appetite;
hyperthermia;
possible enlargement of the spleen or liver, the occurrence of an allergic rash;
A clinical blood test shows an increase in the level of eosinophils and ESR.

The recovery period is characterized by a decrease in symptoms. Inflamed lymph nodes may return to normal, but serious suppuration with the need for surgical intervention cannot be ruled out.

It is important to know that with the atypical form, other signs of pathology may be observed, the main ones being:

neuroretinitis
hepatic purpura;
polyneuritis;
pleurisy.

I present to your attention cat scratch disease, photo:

Long scratches on hand

Scratched leg

Diagnostic methods

Diagnosis of this condition includes:

examination by specialists to establish a presumptive diagnosis;
blood test for possible pathogens;
histology of the rash, pustule, papules or lymph node with previous biopsy;
clinical blood test.

This study must be carried out because felinosis in its manifestations is often similar to lymphogranulomatosis, tuberculosis of the lymph nodes, bacterial lymphadenitis, and cutaneous bubonic tularemia.

Complications

Due to the fact that Bartonella spreads through the blood throughout the body, it can affect all kinds of organs, causing pathological processes:

arthritis;
myocarditis;
atypical pneumonia;
spleen abscess;
pleurisy;
osteomyelitis.

In addition, this bacterium can cause disturbances in the process of hematopoiesis, as a result of which blood cell counts will decrease and the following pathological conditions will arise:

eosinophilia;
thrombocytopenic purpura;
leukoclastic vasculitis;
hemolytic anemia.

Treatment

This disease is a self-replicating infection, which means it can go away without proper drug treatment. However, doctors prescribe therapy to reduce the severity of the course and the possibility of consequences. So, if your baby is diagnosed with cat scratch disease, treatment may include the following medications:

treating the wound with an antiseptic;
antihistamines, such as Cetrin, Claritin or Zyrtec;
non-steroidal anti-inflammatory drugs, for example, Diclofenac or Ibuprofen;
an antibacterial agent, for example Azithromycin or Ciprofloxacin.

If the condition is aggravated by the development of an abscess in the area of the lymph nodes, surgical intervention will be required.

Now you know what felinosis is, routes of infection and characteristic symptoms. Parents should understand that a cat can not only injure a child with scratches or vinegar, but also introduce an infection into his body. You must understand that the best means of prevention is the complete absence of a pet or making sure that the cat does not injure the child. In addition, the cat can be taken to a veterinarian and treated if necessary.

Cat scratch disease- an infectious disease that occurs after a cat bite and scratch and proceeds with the formation of a primary affect in the form of a suppurating papule with the subsequent development of regional lymphadenitis. ( Synonyms: Mollaret's granuloma, felinosis, cat scratch fever, benign lymphoreticulosis).

The occurrence of cat scratch disease

The causative agent of cat scratch disease- Rochalimaea henselae. Polymorphic non-motile gram-negative bacterium; is morphologically similar to representatives of the genus Rickettsia and exhibits similar properties to Afipia felis. A motile, non-fermenting, gram-negative rod-shaped bacterium. It is fastidious for in vitro cultivation, preferably grown on HeLa cells.

Reservoir and source of infection count various mammals (cats, dogs, monkeys, etc.). The disease is registered everywhere. In regions with a temperate climate, an increase in incidence is noted from September to March. Considering the nature of the infection, the main contingent is persons under 21 years of age; 90% have a history of bites or scratches caused by kittens. Studies conducted on animals have shown that the microorganism does not cause the development of any pathology in them and they do not respond with the development of hypersensitivity reactions when the pathogen antigen is administered intradermally. Incidence - 10:100,000 population (25,000 cases annually).

Course of cat scratch disease

Risk factors for developing the disease:

Disorders of cellular immune responses

HIV infection, especially when the CD4+ lymphocyte count is below 100 in 1 μl

Long-term use of GC, azathioprine, cyclophosphamide, cyclosporine, alcohol abuse.

Penetration of the pathogen through damaged skin or, less commonly, through the mucous membrane of the eye subsequently leads to the development of an inflammatory reaction in the form of a primary affect. Then, through the lymphatic ducts, the microbe enters the regional lymph nodes, which is accompanied by the occurrence of lymphadenitis. Morphological changes in the lymph nodes are characterized by reticulocellular hyperplasia, the formation of granulomas, and later microabscesses. The disease is usually accompanied by hematogenous dissemination with the involvement of other lymph nodes, liver, central nervous system, and myocardium in the pathological process. A severe and prolonged, and often atypical course of the disease is observed in patients with HIV infection.

Symptoms of cat scratch disease

Incubation period lasts from 3 to 20 days (usually 7-14 days). According to clinical manifestations, typical forms (about 90%) can be distinguished, manifested in the appearance of primary affect and regional lymphadenitis, and atypical forms, which include:

a) eye shapes;

b) damage to the central nervous system;

c) damage to other organs;

d) cat scratch disease in HIV-infected people.

The disease can occur in both acute and chronic forms. It also differs in the severity of the disease.

Typical disease begins, as a rule, gradually with the appearance of primary affect. In place of a scratch or cat bite that has already healed by that time, a small papule appears with a rim of skin hyperemia, then it turns into a vesicle or pustule, and then into a small ulcer. Sometimes the abscess dries out without forming an ulcer. Primary affect is often localized on the hands, less often on the face, neck, and lower extremities. The general condition remains satisfactory. 15-30 days after infection, regional lymphadenitis is observed - the most constant and characteristic symptom of the disease. Sometimes this is almost the only symptom. An increase in body temperature (from 38.3 to 41°C) is observed only in 30% of patients. Fever is accompanied by other signs of general intoxication (general weakness, headache, anorexia, etc.). The average duration of fever is about a week, although in some patients it can last up to a month or more. Weakness and other signs of intoxication last on average 1-2 weeks.

The elbow, axillary, and cervical lymph nodes are most often affected. Some patients (about 5%) develop generalized lymphadenopathy. The sizes of enlarged lymph nodes usually range from 3 to 5 cm, although in some patients they reach 8-10, are painful on palpation, and are not fused with the surrounding tissues. In half of the patients, the affected lymph nodes suppurate with the formation of thick yellowish-greenish pus, which cannot be isolated when cultured on ordinary nutrient media. The duration of adenopathy ranges from 2 weeks to one year (on average about 3 months). Many patients experience an enlargement of the liver and spleen, which persists for about 2 weeks. In some patients (5%), exanthema appears (rubella-like, papular, erythema nodosum type), which disappears after 1-2 weeks. The typical clinical form accounts for about 90% of all cases of the disease.

Eye shapes diseases are observed in 4-7% of patients. In their manifestations, these forms resemble Parinaud's oculoglandular syndrome (Parinaud's conjunctivitis). It probably develops as a result of saliva from an infected cat coming into contact with the conjunctiva. As a rule, one eye is affected. The conjunctiva is sharply hyperemic and edematous; against this background, one or more nodules appear that can ulcerate. The lymph node located in front of the earlobe significantly enlarges (reaching a size of 5 cm or more), the lymph node often suppurates, the duration of lymphadenopathy reaches 3-4 months. After suppuration and formation of fistulas, cicatricial changes in the skin remain. Sometimes not only the parotid but also the submandibular lymph nodes become enlarged. The acute period of the disease is characterized by severe fever and signs of general intoxication. Inflammatory changes in the conjunctiva persist for 1-2 weeks, and the total duration of the oculoglandular form of cat scratch disease ranges from 1 to 28 weeks.

Nervous system changes observed in 1-3% of patients. They manifest themselves in the form of encephalopathy, meningitis, radiculitis, polyneuritis, myelitis with paraplegia. Neurological symptoms are accompanied by high fever. They appear 1-6 weeks after the onset of lymphadenopathy. Neurological examination reveals diffuse and focal changes. There may be a short-term disturbance of consciousness. Cases of coma have been described. Thus, lesions of the nervous system develop against the background of classic clinical manifestations of cat scratch disease (in severe cases of this disease). They can also be considered complications of this disease.

Other complications may also occur: thrombocytopenic purpura, primary atypical pneumonia, splenic abscess, myocarditis.

In persons with immunodeficiencies the disease becomes generalized. HIV-infected people are characterized by a gradual onset, increased fatigue, general malaise, weight loss, recurrent fever, headaches; local lesions are rarely observed. Neurological manifestations are possible: impaired cognitive functions and behavior. They can be mistaken for mental disorders caused by HIV. Disseminated skin lesions resembling Kaposi's sarcoma are typical in patients with AIDS; damage to bones and various organs is noted. Patients with impaired immune status are characterized by the development of bacterial angiomatosis and peliosis, accompanied by excessive proliferation of the capillary network. More often, lesions are observed in regional lymph nodes, internal organs (including the heart, such as endocarditis; liver, spleen) and skin (on the latter in the form of nodules and/or papules of a flesh-colored or bluish-violet color; the nodules can ulcerate with the discharge of serous or bloody discharge and crusting).

Course and prognosis. In typical cases, the disease is self-limiting after 2–4 months. With proper treatment, complete recovery occurs. If the process recurs, a second course of antibiotics is prescribed.

Diagnosis of cat scratch disease

Diagnosis of the classic forms of cat scratch disease is not very difficult. Contact with a cat is important (in 95% of patients), the presence of primary affect and the appearance of regional lymphadenitis (usually after 2 weeks) in the absence of reaction of other lymph nodes. The diagnosis can be supported by a microbiological study of blood with plating on blood agar, a histological study of a biopsy of a papule or lymph node with staining of sections using silver and a microscopic search for accumulations of bacteria, as well as a molecular genetic study of the DNA of the pathogen from a patient’s biopsy.

Differentiated from the cutaneous bubonic form of tularemia, tuberculosis of the lymph nodes, lymphogranulomatosis, bacterial lymphadenitis.

In some patients, eosinophilia and increased ESR are noted in the hemogram. Skin test with a specific antigen (positive in 90% of patients 3–4 weeks after the onset of the disease).

Treatment of cat scratch disease

The disease ends in spontaneous recovery. In case of suppuration of the lymph node - puncture with suction of pus. The use of a new antibiotic, ketolide, from the group of macrolides, is promising.

Drugs of choice:

In uncomplicated cases - erythromycin 500 mg 4 times / day or doxycycline 100 mg 2 times / day orally, or ciprofloxacin 500 mg 2 times / day orally for 10-14 days with a normal state of the immune system or 8-12 weeks with immunodeficiency (rifampicin can be additionally prescribed)

For endocarditis, lesions of internal organs or bones - erythromycin 500 mg 4 times / day or doxycycline 100 mg 2 times / day parenterally for 2-4 weeks and then orally for 8-12 weeks

Alternative drugs - tetracyclines, azithromycin, clarithromycin, chloramphenicol, ofloxacin, ciprofloxacin.

Preventing cat scratch disease

Specific prevention has not been developed. Cat scratches and bites should be disinfected.

A cat is not only a source of natural relief from bad mood and tenderness without the use of any pills or herbs. Despite their tameness, cats remain relatives of wild predators and are capable of transmitting felinosis - cat scratch disease, through scratching or biting, especially at a young age. This disease has a long course and is accompanied by an inflammatory process, and sometimes leads to suppuration of the lymph nodes close to the scratch site. If at the time of infection the human immune system is in a depressed state (drug exposure, disease), complications may arise from the spleen, brain, and liver. If the body functions normally, the disease passes unnoticed, without complications.

The causative agent of the disease

Felinosis can be caused by a rather unusual bacterium - Bartonella henselae. The pathogen is an intermediate form between a virus and a bacterium: in shape it is a formation similar to a bacterium with the presence of a flagellum; it can be destroyed with the help of antibiotics. However, like a virus, a pathogen develops and lives inside a cell, and is grown not on nutrient media, but directly on living cells.

Bartonella's relatives, Rickettsia, are the cause of many diseases, including typhus, a pathology that develops on the head of people with lice.

The name of the pathology – felinosis – is derived from the word “Felis”, which means “cat” in Latin. The name of the causative agent of the disease - Bartonella henselae - is given in honor of the microbiologist who discovered this pathogen and described its properties (Diana Hensel).

How and from whom can you get infected?

The vast majority of Bartonella exist in the bodies of wild and domestic cats. The spread of the pathogen between individuals occurs with the help of cat fleas, in the intestines of which the microorganism can remain for up to 9 days. These insects do not pose a danger to humans.

According to statistics, almost 50% of cats have the causative agent of this pathology in their blood, while the animals show no symptoms of the disease, even with a long-term course of the disease. There is an opinion that this bacterium is normal for the mouth of cats. The bacterium is released in saliva and urine, from where it penetrates the cats' paws.

Thus, you can become infected:

at the moment of an animal bite;

when human skin is damaged by a cat's claw;

if animal saliva comes into contact with damaged skin or eyes;

through food and water consumed by the cat, provided that the food came into contact with mucous membranes or injured skin;

when pricked by a fishing hook, a plant thorn, or a splinter that has previously been exposed to the animal’s saliva.

In terms of contagiousness, the most dangerous are kittens that have not passed the age mark of one year. Adult cats are slightly less dangerous. But it is important to note that rodents, monkeys, and dogs can also serve as sources of infection. In some cases, a prick from a bird's feather or a hedgehog's needle is enough to become infected.

Usually affected:

skin of legs;

less often - eyes.

Infection does not occur from person to person. It should also be noted that, having once suffered felinosis, the disease does not develop again. 5% of the population is immune to felinosis (about 25% of this number are owners of domestic cats).

Some statistics

Most often, infection in temperate climates occurs in September-March (about 2/3 of all cases). This can be explained by the fact that in the cold season, human contact with domestic cats is closer. In the tropics, seasonality of the disease is not observed.

Approximately 90% of cases are children and adolescents under 20 years of age. In terms of gender, males are more often affected by the disease. Family outbreaks of the disease are rare: usually only one child gets sick, even if all the children have played with the kitten.

Factors that increase the chances of a more severe course of felinosis

A severe, and in some cases even an atypical form of felinosis develops in people who have been in contact with Bartonella in the following cases:

there is a congenital defect in the cellular immune system;

against the background of recent surgery or serious illness;

in cases where a person needs to take glucocorticoids (for the treatment of psoriasis, autoimmune hepatitis, autoimmune diseases such as rheumatoid arthritis);

after treatment with cytostatic drugs (azathioprine, cyclosporine, cyclophosphamide);

in HIV-infected people;

in patients with diabetes mellitus;

in people who abuse alcohol.

In the case of HIV infection, felinosis can have a long and severe course, and in some cases it manifests itself so atypically that even doctors cannot suspect such a diagnosis.

Symptoms of pathology

The bite site or scratch heals slowly in the first 3-10 days, but does not cause concern on the part of the person: the wound may be a little raw or painful, as usual with skin injuries. This is the incubation period, during which time the pathogen overcomes the barriers of tissue integument and actively reproduces. This period can be extended up to 3 weeks, in which case by the time the first symptoms of felinosis appear, there is no longer any skin damage.

After some time, which is required for the microbe to penetrate and accumulate (on average 7-14 days, sometimes 3 days-3 weeks), a crust remains at the site of the scratch, or a skin rash appears. Outwardly, it looks like several nodules, the sizes of which vary from a millet grain to a pea. The tumors do not hurt or itch.

After 2-3 days, the stage of the height of the disease begins: the nodules begin to fester and open, after which crusts appear in their place, which may itch slightly (especially when the scratched child is a pronounced allergy sufferer). Within 1-3 weeks, the crusts dry out and fall off, after which the bite site becomes invisible: there is no darker area of skin or scars. This outcome means that Bartonella has multiplied in sufficient quantities and overcomes local immunity in a certain area of the skin, after which it penetrates the lymphatic channel.

After 10-14 days (sometimes longer) from the moment the nodules form, the bacterium is caught by regional lymph nodes, which act as a kind of filter and try not to let the pathogen pass further.

In the case of a scratch or bite below the elbow, only one or several groups of regional lymph nodes enlarge: cervical, axillary, elbow. The order of manifestation of lymphadenitis may appear in an ascending manner, but the axillary lymph nodes may first enlarge, while the ulnar lymph nodes remain normal. Also, enlargement of the lymph nodes will occur from the axillary fossa, in the case where the shoulder or forearm was damaged by teeth or claws.

If the scratch/bite is on the leg, inflammation of the lymph nodes will occur in the groin and femoral area. In the case of a scratch on the face, the first reaction may manifest itself in the submandibular, anterior or posterior auricular groups, followed by an enlargement of one or a group of cervical lymph nodes.

Signs that make it clear that the lymph nodes have been affected by felinosis:

lymph nodes are dense;

they begin to gradually increase and reach 5-10 cm in diameter;

soreness when palpated;

the skin over the lymph nodes becomes red and hot to the touch;

lymph nodes are mobile and when displaced do not pull the skin along with them;

in the case of an enlarged group of lymph nodes, when palpated, they are not welded together (they can be “rolled” independently of each other).

Enlarged lymph nodes are accompanied by a general deterioration of the condition. The following symptoms occur:

increase in body temperature to 39ºС and above;

weakness;

malaise;

headache;

heartbeat;

loss of appetite;

sweating;

bad dream.

Not everyone’s temperature can rise to high levels; there are cases when, with felinosis, there is no temperature reaction. The increase in temperature lasts from 1 week to a month, while other symptoms disappear within two weeks. Lymph nodes remain enlarged for up to 3 months. In 50% of cases they fester and can subsequently open on their own. In such cases, thick, yellow-green pus is released onto the surface, which, when taken for bacteriological culture, does not show signs of a bacterial infection (the fact is that Bartonella does not grow on nutrient media, as stated above).

During this period, a reddish rash may appear on the skin of the body or limbs, which occupies larger or smaller areas of the skin. The rash disappears within a few days and does not cause pain or itching.

During the period of lymph node enlargement, the following may also be observed:

Pain and discomfort in the right hypochondrium - the liver becomes enlarged, which also acts as a filter against bacteria that have entered the circulatory system.

A feeling of discomfort or “pins and needles” in the left hypochondrium: manifestations of an enlarged spleen, which can also be damaged with felinosis. Enlargement of the spleen and liver is clearly diagnosed during an ultrasound scan of the abdominal cavity, although this does not manifest itself symptomatically.

Signs of heart damage are the development of arrhythmias and the appearance of pain in the heart.

The lymph nodes, which are located remotely from the scratch/bite site, begin to enlarge.

The above-described symptoms of cat scratch disease develop in people with insufficiently active immunity, as a result of which pathogens penetrate into the blood. Also, in “immunocompromised” people (chronic alcoholism, HIV, congenital immunodeficiency, diabetes mellitus, consequences of taking drugs that suppress the immune system), felinosis can be completely apathetic. In such cases, the infection remains in the body until the end of life and causes a chronic course of the disease.

In most cases, the disease goes away 1-2 months after the first lymph node enlarges: the temperature stabilizes, the headache goes away, appetite and sleep are restored, the lymph nodes begin to gradually shrink and become like small “balls” that are not fused to each other or to the skin. Quite rarely, with moderately weak immunity, felinosis can last for 1-2 years, with periods of onset and subsidence of symptoms.

Atypical forms of the disease

This term is used for:

Diseases that occur in response to a microbe entering not the skin, but other places (for example, the conjunctiva of the eyes).

Bartonella organ damage is typical only for people with “compromised” immunity.

Atypical forms are not one of the complications of the disease, but a severe atypical form of infection.

Eye damage

When cat saliva gets on the conjunctiva of the eye, the following may occur:

Conjunctivitis Parilo. In this case, only one eye is affected. It becomes swollen, red, and difficult to open. At the same time, there is no pain, just like any discharge. During an examination by an ophthalmologist, small ulcers and nodules on the conjunctiva are visualized.

Simultaneously with the development of eye damage, inflammation of the parotid lymph nodes occurs on the side on which the infection occurred. The anterior auricular node is always affected: it grows up to 5 cm and can fester, after which it opens and leaves behind a scar. The submandibular and cervical lymph nodes may also enlarge. At the same time, it is worth noting the deterioration of the general condition: sleep deteriorates, body temperature rises, palpitations and weakness appear.

Neuroretinitis. Vision in one eye is affected. The state of health remains unchanged. Changes that are characteristic of felinosis are detected during examination by an ophthalmologist.

Damage to the nervous system

When Bartonella penetrates into the blood, two to three weeks after inflammation of the regional lymph nodes, symptoms of damage to the nervous system may appear. They consist of a decrease in sensitivity exclusively in the area of the hands and feet, sometimes there is further progression, which manifests itself in the form of loss of motor function of one or more limbs, loss of coordination, and trembling.

Felinosis can also cause paralysis of the facial nerve, impaired consciousness, inappropriate behavior, and seizures.

Atypical forms of immunodeficiency

In people with significantly reduced functions of the immune system, felinosis occurs as peliosis hepatitis or bacillary angiomatosis.

Bacillary angiomatosis

This is the name of a pathology in which, in response to the presence of bacteria from the genus Bartonella in the body, blood vessels begin to grow (most often characteristic of people with HIV infection).

Here, after damage by a cat’s teeth or claws, an incubation period lasts for weeks or months, and the wound heals accordingly during this time. Cutaneous manifestations of pathology are characterized by the fact that they appear in any place, regardless of the location of the initial damage by the cat. Damage also occurs to the mucous membranes of the larynx, genitals, and oral cavity.

The disease begins with the appearance not of small red nodules on the surface of the skin, but of purple or red spots that do not protrude above it. Nodules appear over time, already against the background of the presence of spots. In this case, the nodules are large, up to 3 cm in diameter, painful, and covered with inflamed red skin. The number of formations can vary from several to hundreds. Around each nodule there is a “collar” consisting of thin, eroded (oozing and reddish) epidermis.

The disease is accompanied by malaise and fever, and weight loss is also noted. Pathology can also affect other organs: bone marrow, muscles, central nervous system, heart, spleen, liver.

The course of bacillary angiomatosis can occur in different ways: it can resolve on its own, or, in the presence of severe damage to internal organs, it can lead to death.

Peliosis hepatitis

In this case, cavities appear in the liver that fill with blood, as a result of which the liver tissue takes on the appearance of a sponge. Symptoms of liver damage due to felinosis:

areas of hemorrhage appear on the skin, which are associated with damage to the blood coagulation system;

bleeding gums increases;

the skin becomes pale yellow;

the abdomen is felt bloated, which indicates the accumulation of gases in the abdominal cavity;

chills occur periodically;

prolonged fever.

Complications

After Bartonella spreads through the blood to various internal organs, the following may develop:

atypical pneumonia;

osteomyelitis;

spleen abscess;

myocarditis;

The bacterium can also cause the development of serious blood complications, which include a decrease in the quantitative composition of various blood cells:

leukocytes (leukoclastic vasculitis);

eosinophilic leukocytes (eosinophilia);

red blood cells (hemolytic anemia);

platelets (thrombocytopenic purpura).

Diagnostics

The diagnosis and subsequent treatment of felinosis is carried out by an infectious disease specialist. This specialist is able to distinguish wound suppuration from cat scratch disease only by appearance. If, after being scratched by a cat, there is swelling and suppuration of the injury site, most likely the wound is infected with common pathogenic microflora: staphylococci, streptococci, Proteus, and in some cases fungal flora.

Such suppuration occurs on the second day after traumatic contact with a cat; the site of injury becomes painful, red, and a light liquid begins to ooze, which is subsequently replaced by pus. With felinosis, the scratch heals, and only against the background of the crust does the formation of nodules begin at the site of the bite/scratch, which do not itch, do not hurt, and do not fester.

“Bloating” of the hand after a scratch or bite is most likely a manifestation of phlegmon (purulent melting of tissue), or even worse, an anaerobic infection such as gas gangrene. In such cases, immediate surgical care with hospitalization in a hospital is required.

If a person begins to complain of enlarged lymph nodes, consultation with an infectious disease specialist will be required. It is better that this is not a doctor from a clinical hospital, but a doctor from the emergency department of an infectious diseases hospital. Here there is a lower probability of infecting other patients, since such manifestations in the absence of nodules on the skin must be differentiated from infectious mononucleosis, lymphogranulomatosis, HIV infection, as well as from such dangerous diseases as tularemia and plague.

Having suspected felinosis, after studying the anamnesis (manifestation of nodules, contact with a cat), the doctor of the infectious diseases department can confirm the preliminary diagnosis with the help of studies. To do this, you need to collect material from nodules or tissue, or from a lymph node, or from an abscess, by puncturing the pathological element and collecting the contents for the following types of laboratory tests:

PCR, or polymerase chain reaction method: this is how particles of Bartonella henselae can be recognized and detected. The analysis is performed in paid laboratories.

Histological: under a microscope, characteristic changes in tissues, as well as bacteria, are visible.

Serological tests also help in terms of diagnosis - determining the presence of antibodies to the Bartonella bacterium. For these purposes, either RSC or ELISA reactions are used.

At 3-4 weeks of illness, you can perform a skin allergy test by injecting a solution containing Bartonella particles under the skin: in the vast majority of patients with felinosis (90%), localized swelling and redness will appear on the skin as a response. This study is not applicable to children.

A complete blood count can also help determine infection. Among the main indicators: accelerated ESR, increased number of eosinophils, which do not directly indicate pathology, but confirm the presence of infection. Using liver tests, you can find out whether liver dysfunction is present and at what stage it is. An abdominal ultrasound can reveal an enlarged spleen or liver, on the basis of which the patient’s regimen can be adjusted. Semi-bed rest is required when the spleen is enlarged, since with high activity it can be damaged.

Treatment of the disease

Felinosis is treated according to the following algorithm: medications for systemic use, compresses are prescribed, and in some cases it is necessary to resort to surgical treatment.

A typical pathology, uncomplicated by damage to the nervous system, spleen, liver, heart, can be treated at home. Other forms of the disease require hospitalization in the infectious diseases department.

Drug treatment

Prescribed:

Anti-inflammatory and painkillers: mefenamic acid, Diclofenac, Ibuprofen.

Antibiotics: Clarithromycin, Gentamicin, Ofloxacin, Tetracycline, Erythromycin, Doxycycline. They are used in the form of tablets, in case of eye damage - in the form of eye drops.

Antihistamines: Erius, Zodak, L-cet, Cetrin.

In case of severe disease, glucocorticoids can be used: Prednisolone, Dexamethasone.

Compresses

It is recommended to apply compresses to the area of inflammation of the lymph nodes. To do this, take one part dimethyl sulfoxide to four parts water, moisten gauze with this mixture and apply it to the lymph node area, place polyethylene on top and then secure the compress with a bandage and insulate it with a warm cloth.

Physiotherapeutic methods

The area of inflamed regional lymph nodes is affected by diathermy and UHF.

Surgery

If the affected lymph nodes are painful and tense, their contents are punctured for drainage. Thus, the pressure in the capsule of the node drops, and the pain process, accordingly, is stopped.

Cat scratch disease in children

Felinosis in children in most cases occurs in a typical form: the place where the cat damaged the skin disappears, and in its place nodules appear, which subsequently suppurate and open. After this stage, one or a group of neighboring lymph nodes increases in size. The disease lasts about a month and can go away on its own without treatment.

The development of an atypical form of pathology can be observed in HIV-infected children or children after organ transplantation or chemotherapy. In such cases, it is impossible to predict which organ or system will be affected. The symptoms of felinosis in children are no different from the symptoms presented above in adults.

Diagnostics for children is also standard; punctate PCR is the main method for determining the presence of pathology.

Treatment is carried out using the drug “Sumamed” (dose – 10 mg/kg per day). Starting from 8 years of age, Tetracycline or Doxycycline can be used for treatment. Drugs such as Ofloxacin or Ciprofloxacin are allowed from 16-18 years of age.

Disease prognosis

In most cases, the disease goes away on its own with the complete disappearance of all symptoms. With timely assistance, even severe forms of the disease can be treated. The prognosis of the disease is questionable when the nervous system is damaged, since Bartonella can cause irreversible changes in the brain.

Disease prevention

What to do if you are scratched by a cat:

wash the scratch area with laundry soap and running water;

treat the wound with 3% hydrogen peroxide;

cauterize with brilliant green or alcohol.

Taking antibiotics is ineffective. It is also useless to treat cats (as potential sources of disease spread).

Cat scratch fever (felinosis, benign lymphoreticulosis, Mollare granuloma) is a serious infectious disease. Appears as a result of cat bites or scratches. The disease is characterized by inflammation of regional lymph nodes - papules initially suppurate, sometimes conjunctivitis, angiomatosis occurs, and the liver is affected. Fever and general poisoning of the body are noted.

The source of its occurrence is a mobile rod-shaped bacterium. Its habitat is the oral cavity of mammals. Mostly cats, dogs, monkeys. The disease most often affects children and young people under the age of 20. The infection enters the body through licking, scratching, or biting through damaged skin. Often through scratches. That is why felinosis is called cat scratch disease. However, it is worth remembering that you can become infected from any mammal infected with this disease when a viral bacterium enters the human body.

What it is?

Cat scratch disease (felinosis) is an acute infectious disease that belongs to the group of bartonellosis, which has a clear relationship with scratches or bites of cats, manifested by the appearance of a primary focus (affect) or local lesion, as well as inflammation of the lymph nodes on the affected side, and rarely the appearance of a general intoxication of the body and damage to internal organs. The disease is considered mild and self-limiting.

Causes and risk factors

The causative agent of cat scratch disease is Rochalimaea henselae. Polymorphic non-motile gram-negative bacterium; is morphologically similar to representatives of the genus Rickettsia and exhibits similar properties to Afipia felis. A motile, non-fermenting, gram-negative rod-shaped bacterium. It is fastidious for in vitro cultivation, preferably grown on HeLa cells.

Risk factors for developing the disease:

Disorders of cellular immune responses
HIV infection, especially when the CD4+ lymphocyte count is below 100 in 1 μl
Long-term use of GC, azathioprine, cyclophosphamide, cyclosporine, alcohol abuse.

Various mammals (cats, dogs, monkeys, etc.) are considered the reservoir and source of infection. The disease is registered everywhere. In regions with a temperate climate, an increase in incidence is noted from September to March. Considering the nature of the infection, the main contingent is persons under 21 years of age; 90% have a history of bites or scratches caused by kittens. Studies conducted on animals have shown that the microorganism does not cause the development of any pathology in them and they do not respond with the development of hypersensitivity reactions when the pathogen antigen is administered intradermally. Incidence: 10:100,000 population (25,000 cases annually).

How does cat scratch disease manifest itself - symptoms and first signs

A scratch or site of a cat bite heals slowly for the first 3-10 days, without causing any concern on the part of the person: it may hurt a little or irritate, like a regular skin injury. This is the incubation period; At this time, the pathogen overcomes the barriers of the integumentary tissue and multiplies. This period can extend up to 3 weeks, then at the time the first symptoms of felinosis appear, skin trauma no longer exists.

After the time it takes for the microbe to penetrate and accumulate (3 days to 3 weeks, on average 7-14 days), a rash appears in the place where there was a scratch or where a crust remains. It looks like several nodules the size of a millet grain to a pea, which do not itch or hurt.
After 2-3 days, the period of the height of the disease begins: such nodules fester and open up on their own, after which they become covered with a crust and may begin to itch slightly (especially if a child with allergies has been scratched). Within 1-3 weeks, the crusts dry and fall off, after which the bite site ceases to be noticeable: there are no scars or darker areas of skin left. This means that Bartonella has multiplied in sufficient quantities, overcome the local immunity of the skin area and entered the lymphatic system.
After 10-14 days (less often - longer) from the moment the first nodules appear, the microbe is caught by regional lymph nodes - local filters that try to prevent it from passing further.

If the arm below the elbow was bitten, one or more groups of lymph nodes enlarge: elbow, axillary, cervical. The order in which lymphadenitis appears may be exactly this, but the axillary nodes may immediately enlarge, while the ulnar nodes remain unchanged. Also, starting from the axillary fossa, the lymph nodes will enlarge if the forearm or shoulder is damaged by claws or teeth.

If the bite/scratch is on the leg, the lymph nodes in the femoral and groin area become inflamed. When the face is scratched, the submandibular, anterior or posterior ear groups may be the first to react; after which one or more lymph nodes from the cervical group enlarge.

Signs that indicate that the lymph nodes are damaged due to felinosis:

lymph nodes gradually increase, reaching from 5 to 10 cm in diameter;
the skin over them is not red or hot to the touch;
lymph nodes can be moved - they do not pull the skin along with them;
they are dense;
it hurts to feel them;
when enlarging the entire group of nodes, probing them, you can “roll” them independently of each other: they are not soldered together.

Enlarged lymph nodes are accompanied by a deterioration in the person’s general condition. The following symptoms appear:

fever, sometimes up to 39°C or higher;
weakness;
poor sleep;
sweating;
headache;
malaise;
loss of appetite;
heartbeat.

Not everyone’s temperature rises to such high numbers: in some cases, it may be completely absent. The increase in temperature lasts from a week to a month, other symptoms gradually disappear within 2 weeks. Lymph nodes remain enlarged for up to three months. In half of the cases, they suppurate and can spontaneously open: then thick yellow-green pus is released to the surface, which, when taken for bacteriological examination, does not show signs of bacterial infection (as you remember, Bartonella does not grow on nutrient media).

During the same period, a reddish rash may appear on the skin of a person’s body or limbs, occupying larger or smaller areas of the skin. It does not itch or hurt and disappears after a few days.

During the period of lymph node enlargement, the following may also be observed:

a feeling of “needles” or discomfort in the left hypochondrium: this may indicate an enlarged spleen, which can also be affected by felinosis. Enlargement of the liver and spleen can also be detected on an ultrasound scan of the abdominal cavity, without being accompanied by any symptoms;
discomfort and pain in the right hypochondrium - this is an enlargement of the liver, which is also a filter on the way of Bartonella, which by this time has entered the blood;
heart pain, arrhythmias. These are signs of heart damage;
enlargement of lymph nodes located far from the site of infection.

The above symptoms of cat scratch disease occur in people whose immunity is not active enough and allows the infection to enter the blood. In those people who are called “immunocompromised” (who have received drugs that suppress the immune system, suffer from diabetes mellitus, congenital immunodeficiency, HIV, chronic alcoholism), felinosis proceeds completely atypically. In them, the infection can remain in the body forever, causing chronic disease.

Usually the disease ends a month or a little less after the first lymph node enlarges: the temperature drops, the headache goes away, sleep and appetite are restored, the lymph nodes gradually decrease in size and become dense little “balls” that are not fused to each other and the skin. Very rarely, with moderately weak immunity, felinosis can last 1-2 years, when its symptoms either subside or reappear.

Atypical form

When infectious agents come into contact with the mucous membrane of the eye, there is a high risk of developing conjunctivitis. Symptoms in case of contact with skin:

fever;
the appearance of ulcers;
suppuration of injuries;
After healing, scars form.

This form of felinosis occurs in 10% of cases. It is usually diagnosed in children, as well as the elderly (people whose body reactivity is reduced). The duration of the disease is from 6 to 8 weeks.

Diagnostics

Diagnosis of the classic form of this disease is not difficult. The main significance is the presence of direct contact with the cat, the presence of primary affect, the development of regional lymphadenitis, with no reaction of other lymph nodes.

To confirm the diagnosis, a microbiological blood test and a histological study of a biopsy of a lymph node or papule with staining of the sections are performed.

Differential diagnosis is carried out with the following diseases: progressive focal leukoencephalopathy, cryptococcal meningitis, cerebral toxoplasmosis, acute hepatitis, infectious mononucleosis, influenza, histoplasmosis, coccidioidosis, cryptococcosis, lymph node cancer, lymphoma, streptococcal and staphylococcal infections, borreliosis, babeshiosis, rickettsiosis, myco bacteriosis, erysipeloid , tularemia, pasteurellosis, bubonic plague, sporotrichosis.

Complications

If, when the first symptoms of felinosis appear, you do not consult a doctor and do not fully treat the pathology, then dangerous complications may develop. As conjunctivitis progresses, vision loss may occur. Damage to the central nervous system is possible. This leads to the progression of meningitis, inflammation of the brain and spinal cord.

Treatment for cat scratch disease

Therapy in its typical form is carried out on an outpatient basis. The infection is classified as self-limiting (it can go away without treatment), but medication can help the body cope with the pathogen faster and mitigate the symptoms of the disease.

Drug treatment:

Non-steroidal anti-inflammatory drugs to relieve the inflammatory reaction (ibuprofen, indomethacin, diclofenac and their modern analogues).
Antihistamines (Claritin, Zyrtec, Cetrin, Erius and others).
Etiotropic therapy includes the prescription of antibacterial drugs: azithromycin, doxycycline and its derivatives, erythromycin and its derivatives, and the effectiveness of ciprofloxacin, rifampicin, bactrim, and gentamicin in felinosis has also been established. It is believed that such therapy should be prescribed only for severe forms of infection with the development of atypical forms, as well as when felinosis occurs in immunocompromised individuals (HIV infection, chronic diseases, recipients of organ and tissue transplants, and others).

If abscesses occur in the area of the lymph nodes, surgical assistance is required (opening, removal of pus), which affects the duration of healing and sclerosis.