Zsófia Váradi

 Pyelon plastic surgery in 2013 (pyeloureteral stenosis l.u.)  Colelithiasis  City Hospital, Keszthely:  Painful swelling in the left elbow Palpable solid mass X-ray: normal  ↓  City Hospital, Tatabánya, Dept. Of Pediatrics  Palpable mass in the left axillary region, erythema on the upper arm  CRP 28 mg/l, other parameters: normal  Soft tissue US: lymphadenopathy  Serology tests (EBV, CMV, Bartonella) Therapy: iv. amoxicillin-clavulanic acid, SMX/TMP orally  Control soft tissue US: axillar lymphadenopathy without signs of suppuration  Surgical exploration of the solid mass in the elbow: macroscopically desintegrated lymph node, small amount of pus (histology, microbiological analysis in progress)

 Axillar lymphadenopathy l.s., inhomogeneous structure, hypervascularisation, without signs of suppuration Serology: Bartonella henselae IgM and IgG positivity Histology: absceding granulomatous lymphadenitis without signs of malignancy Diagnosis: cat-scratch disease

 Bartonella henselae (Gram negative bacillus)  Zoonosis – natural reservoir: cat (kitten!), dog  Transmission:  Traumatic contact with the infected animal: cat scratch or bite  By vectors: flea bite  Self-limited regional lymphadenopathy (85-90%) in young immunocompetent individuals  Disseminated disease: rare  Immunocompromised patients: bacillaris angiomatosis, splenitis, peliosis hepatis

Localized cutaneous and lymph node disorder near the site of organism inoculation Primary inoculation lesionRegional lymphadenopathy

 Liver, spleen – FUO!  eye  Nervous system  musculoskeletal

Emerg Infect Dis. Sep 2006; 12(9): 1338–1344.  analysis of 786 lymph node specimens from patients with suspected CSD  january – august  Culture, PCR, serology(DIF), histology  50% infectious agents 31% B. henselae (245 cases) 7% Mycobacterial infection (mostly M. tuberculosis) In 10 cases B. henselae+mycobacteriosis together In 3 cases B. henselae+malignancy (lymphomas)  7% malignancy (47/181): 6 squamosous cell carcinoma, 1 acute leukemia, 36 lymphoma, 4 Kaposi-sarcoma

 Clinical history, symptoms  Serology (most cost-effective): IFA, EIA  PCR (high specificity)  CT/MR, UH, echocardiography  Histology Warthin-Starry stain Necrotizing granuloma

Not recommended for most patients with mild-to- moderate disease!  Azithromycin (drug of choice?)  TMP-SMZ  Doxycycline  Ciprofloxacin  Rifampin