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BENIGN INOCULATION RETICULOSIS [lat. felinus cat's + osis); synonym: the high-quality

lymphoreticulosis, a disease of cat's scratches] — an infectious disease, the activator a cut gets into a human body through the injured skin as a result of scratch or a sting of a cat; the disease is characterized by temperature increase, regional lymphadenitis and is frequent formation of primary affect in the place of implementation of an infection. In a crust, time synonyms F. are used by many as the main names of a disease.

It is described in 1950 Mr. of Mollare and Reyl - whether (P. Mollaret, J. Reilly), and also R. Debra. In the USSR the disease is for the first time described in 1955 by M. F. Maretska.

E t and about l about and I. Activator F. treats a sort of chlamydias (see), has the kokkovidny form, the sizes apprx. 250 — 350 nanometers, is an intracellular parasite. Consider that a natural tank of a contagium — rodents and birds.

E and and d e m and about l about and I. Infection of the person results from a scratching, is more rare — a sting of a cat, edges usually is a passive carrier of the activator. However at cats the disease proceeding asymptomatically can also develop. Cases of infection of the person at injury of skin by feathers and bones of ititsa are described, by needles of a hedgehog, etc. From the sick person healthy the activator is not transferred. Children are ill preferential. The disease has sporadic character, in rare instances 2 — 3 family members at the same time can get sick.

Pathogeny. In the place of penetration of the activator (is more often on skin of distal departments of extremities, occasionally in a conjunctiva } in several days after infection there is primary affect (see Affect primary) in the form of a dense papule, edge sometimes ulcerates and becomes covered by a crust. It is primary center of reproduction of the activator. Local manifestations quite often remain unnoticed. On limf, to ways the activator gets into a regional limf, a node — the secondary center of reproduction of the activator, there is lymphadenitis (see). In case of overcoming limf, a barrier there is hematogenous dissimination of the activator that can lead to defeat of nek-ry bodies.

Pathological and N and - t about m and I. The pathoanatomical picture depends on duration of a disease and reactivity of an organism. Microscopically in a zone of primary affect inflammatory infiltrate from the lymphocytes and leukocytes sometimes located perivaskulyarno is found. The leading sign is defeat limf, nodes (one or group). Limf, nodes are increased, condensed, soldered among themselves. Later in them the centers of abscessing accurately are defined. Safety of very tectonics limf, a node or insignificant disturbances of its structure is characteristic of early changes (a bed week from the beginning of a disease). In cortical and a deep cortex increase in number and the size of lymphoid follicles, considerable expansion of their light centers is noted. In pe-rifollikulyarny zones and brain sine proliferation of histiocytes is noted. Separate plasmocytes, eosinophils, macrophages are visible. Process can be stabilized or passes into the following granulematozny phase (2 — 4 weeks from the beginning of a disease), edges is characterized by formation in cortical, okolokorkovy and marrow, and sometimes and in the capsule limf, a node of the roundish or oval granulomas consisting of epithelial cells. More often on the periphery of a granuloma single multinucleate colossal cells of the nixa type L not and or cells of foreign bodys are found (see. Colossal cells). Colossal cells can remind also Hodzhkin's cells or cells of Berezovs of whom — Shternberg (see the Lymphogranulomatosis). Occasionally colossal cells are located out of granulomas and even outside the capsule limf, a node. Strom Limf, a node the long time remains intact. Late Changes, or a phase of abscessing (up to 3 months from the beginning of a disease), are characterized by emergence in the center of granulomas of neutrophilic leukocytes and adjournment of fibrin. At increase of quantity of leukocytes microabscesses with the central area of a necrosis surrounded with shaft from the epithelial cells which are located in the form of a paling form. The centers of abscessing, merging among themselves, form gyrose narrow cavities — star-shaped abscesses. In a further nekrotizirovan-ny of a granuloma the organizations are exposed. Changes in limf, nodes at F. are not patognomonich-yaymn and at early stages can remind a pakhovy lymphogranulomatosis, a tularemia, a toxoplasmosis, pasteurellosis, malignant lymphoma (in particular, a histiocytosis).

Single observations of osteolytic defeat at F are known. long tubular bones (e.g., a metaepiphysis of a femur), representing granulematozny inflammatory infiltrate from lymphocytes and segmentoyaderny leukocytes. The meningitis described at this disease, encephalitis, pneumonia quickly regress and morphologically are not studied.

And m of m at N and t e t. The postponed disease leaves durable immunity.

To l and N and h e with to and I cards and - N and. An incubation interval — on average 2 — 3 weeks. The disease begins with temperature increase to 38 — 39 °, sticks to edge of several days to 2 weeks. Head and muscular pains, sometimes dysfunctions of intestines, an enanthesis are noted. At the same time there is the most characteristic and constant symptom F. — regional lymphadenitis (elbow, axillary, pakhovy, is more rare submaxillary, parotid, etc.). Multiple «floor-by-floor» defeat limf, nodes is occasionally observed (e.g., elbow, then axillary lymphadenitis). Struck lymf. nodes moderately (sometimes considerably) are increased, plotnovata, are slow-moving, painful at a palpation. In half of cases there is their suppuration, fluctuation appears. At spontaneous opening or a puncture suppurated limf, a node dense yellowish pus is emitted. In several weeks there occurs slow healing, a ?k-swarm can drag on up to 3 months and more. A recurrence is possible.

Cases of an asymptomatic course of a disease, and also a form of a disease, are noted by the shown quinsy, an abdominal syndrome, atypical pneumonia, defeat of a nervous system (encephalitis, a myelitis, neuritis), to-rye differ in a high-quality current.

The diagnosis is established on the basis of the anamnesis (contact with a cat, cat's scratches) and a wedge, symptoms (emergence of an inflammatory small knot in the field of infection atriums, existence of regional lymphadenitis). In blood in the heat of a disease the moderate leukocytosis with shift to the left, an eosinophilia and the accelerated ROE is noted. Confirm the diagnosis a positive intracutaneous test with group ornitozny antigen, and also reaction of binding complement with ornitozny antigen; the last, however, appears rather late and in low credits (see the Ornithosis).

The differential diagnosis is carried out with lymphadenitis of other etiology (see Lymphadenitis), a tularemia (see), a brucellosis (see), tuberculosis limf, glands, a lymphogranulomatosis (see), an inguinal lymphogranulomatosis (see the Lymphogranulomatosis pakhovy), an infectious mononucleosis (see the Mononucleosis infectious), cells to an eye (see); at the same time major importance has epidemiol. anamnesis and serol. methods of a research.

Symptomatic treatment. N of an azn cha yut physiotherapeutic procedures (UVCh-therapy, a diathermy) on area struck limf, a node. At suppuration limf, a node make its puncture with extraction of pus. At a severe disease apply corticosteroids. Data on efficiency of antibiotics (tetracycline) are contradictory.

Forecast, as a rule, favorable.

P r about f and l and to t and to and; it is necessary to avoid scratches and stings of cats.

Bibliography: Gelenko A. M. A morph

logical changes in lymph nodes at a high-quality lymphoreticulosis (a disease of «cat's scratches»), Arkh. patol., t. 43, No. 11, page 78, 1981;

Maretskaya M. F. Features of a current of a high-quality lymphoreticulosis (disease of cat's scratch), Klin, medical, t. 36, No. 12, page 104, 1958; Tala of N-t about in V. A. Histologic differential diagnosis of a high-quality reticulosis and tubercular lymphadenitis, Probl. tube., No. 9, page 54, 1979;

Terski of the X I. I., etc. Activator of a high-quality lymphoreticulosis, Vopr. virusol., No. 4, page 481, 1977; With and-r i t h e r s H. A. Oculoglandular disease of parinaud, A manifestation of cat-scratch disease, Amer. J. Dis. Child., v. 132, p. 1 195, 1978; D e b r e R. e. a. La ma-iadie des griffes de chat, Sem. Hop. Paris, t. 26, p. 1895, 1950; L u d d y R. E. a. o. Cat-scratch disease simulating malignant iimphoma, Cancer, v. 50, p. 584, 1982; W i n s h i p T. Pathologic changes in so-called cat-scratch fever; review of findings in lymph nodes of 29 patients and cutaneous lesions of 2 patients, Amer. J., din. Path., v. 23, p. 1012, 1953.

S. D. Nosov; G. A. Frank (stalemate. An.).,