Cat Scratch Disease in kidney transplant receptors: is it a rare or underdiagnosed pathology?

Cat Scratch Disease (CSD) is an infectious disorder which appears after cat scratching particularly in children and adolescents. Bartonella henselae is the etiologic agent more frequently involved. There are only a few recent reports demonstrating the disease after transplantation, although the illness is not infrequent in immunologically competent people. Indeed CSD in transplant receptors has only been recently emphasized in the literature and it was concluded that fever and lymphadenopathy in patients who had been exposed to cats should prompt clinicians to maintain a suspicion for the infection. In this report CSD infecting a renal transplanted adolescent complaining of headache, blurred vision and fever, presenting a cat scratching lesion in the right arm, with a bilateral painful cervical lymphadenopathy was related. He also presented indirect immunofluorescency identifying that the two subtype's titles of Bartonella-henselae and quintana- were elevated. Treatment with doxicicline e rifampicin was introduced and the patient became asymptomatic in about 3 weeks.

猫抓病（Cat Scratch Disease, CSD）是一种在猫抓伤后发病的感染性疾病，好发于儿童与青少年，其最常见的致病病原体为汉赛巴尔通体（Bartonella henselae）。尽管免疫功能正常人群中该病并不罕见，但目前仅有少数近期报道提及移植术后并发猫抓病的病例。事实上，移植受者罹患猫抓病的相关临床认知直至近年才在文献中得到重视，现有研究结论指出：若曾接触猫的患者出现发热与淋巴结病时，临床医师应保持对该感染的警惕性。本次病例报告中，一名肾移植术后青少年出现头痛、视物模糊伴发热，右侧手臂存在猫抓伤皮损，同时伴双侧痛性颈部淋巴结病，被确诊为猫抓病。经间接免疫荧光试验检测，患者血清中汉赛巴尔通体与五日热巴尔通体（Bartonella quintana）的两种亚型抗体滴度均升高。予多西环素（doxycycline）联合利福平（rifampicin）治疗后，患者约3周后症状完全消失，转为无症状状态。