Syndrome of Rochalimaea henselae Adenitis Suggesting Cat Scratch Disease
- Matthew J. Dolan, MD;
- Michael T. Wong, MD;
- Russell L. Regnery, PhD;
- James H. Jorgensen, PhD;
- Maria Garcia, MA;
- John Peters, PhD; and
- Dennis Drehner, DO
- From Wilford Hall USAF Medical Center, Lackland AFB, Texas; the Centers for Disease Control, Atlanta, Georgia; the University of Texas Health Science Center, San Antonio, Texas. Requests for Reprints: Matthew J. Dolan, MD, Department of Infectious Diseases, Wilford Hall USAF Medical Center, Lackland AFB, TX 78236. Acknowledgments: The authors thank Dr. Theodore E. Woodward and Dr. Gregory P. Melcher for review of the manuscript.
Abstract
Objective: To describe a clinical syndrome of cat scratch disease caused by Rochalimaea henselae, including methods for isolation of the organism from tissue and for identification.
Design: Case series.
Setting: U.S. Air Force referral hospital infectious diseases clinic.
Patients: Two previously healthy patients.
Main Measurements and Results: Two immunocompetent patients who had handled cats developed unilateral upper-extremity adenitis associated with a distal papular lesion and fever. The adenitis and distal lesions persisted and progressively worsened. Cultures of the involved lymph nodes from both patients grew R. henselae, a recently described organism associated with bacillary angiomatosis and peliosis hepatis in human immunodeficiency virus-infected patients and with bacteremia in immunocompromised and immunocompetent hosts. The organism was characterized as oxidase negative and X-factor dependent and had a characteristic pattern in analysis of whole-cell fatty acids differing from Afipia felis, a bacterium that has been associated with cat scratch disease. The identity of the isolate was confirmed by analysis of whole-cell fatty acids using gas chromatography and by amplification of the citrate synthetase gene sequence and analysis of the polymerase chain reaction-amplified product. The organisms were broadly susceptible to a variety of antimicrobials by broth microdilution; however in vitro resistance to first-generation cephalosporins correlated with clinical failure of therapy.
Conclusion: Rochalimaea henselae can be a cause of cat scratch disease in immunocompetent patients.
- Copyright ©2004 by the American College of Physicians
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