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Published byJulius Bishop Modified over 9 years ago
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Zsófia Váradi
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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)
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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
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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
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Localized cutaneous and lymph node disorder near the site of organism inoculation Primary inoculation lesionRegional lymphadenopathy
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Liver, spleen – FUO! eye Nervous system musculoskeletal
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Emerg Infect Dis. Sep 2006; 12(9): 1338–1344. analysis of 786 lymph node specimens from patients with suspected CSD 2001. january – 2005. 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
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Clinical history, symptoms Serology (most cost-effective): IFA, EIA PCR (high specificity) CT/MR, UH, echocardiography Histology Warthin-Starry stain Necrotizing granuloma
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Not recommended for most patients with mild-to- moderate disease! Azithromycin (drug of choice?) TMP-SMZ Doxycycline Ciprofloxacin Rifampin
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