What is Benign Lymphoreticulosis in Children?
Benign lymphoreticulosis is a common infectious disease that is caused by Bartonella Hensel, a gram-negative bacillus from the family Bartoneliaceae – B. henselae. Also, the disease is called felinosis or cat scratch disease.
The causative agent enters the child’s body through scratches or bites of a cat. The disease is accompanied by symptoms of moderate intoxication, regional lymphadenitis. Often, in the place of a cat’s scratch, primary affect can be observed. This place turns red and swells a lot.
Epidemiology
The infection is “stored” in the organisms of birds and rodents. Cats are passive carriers of the pathogen – Hensel’s Bartonella. Only in extremely rare cases do they have the disease manifested in an obliterated or asymptomatic form.
A child may become infected with benign lymphoreticulosis if the skin or mucous membrane is damaged by feathers, bones, etc. It is not known for sure whether the infection is transmitted to children from a sick person. Cases of the disease are recorded year-round, the largest rise – in the cold season (autumn and winter). It is believed that this is due to the fact that rodents migrate to the houses and dachas of humans, where cats attack them. Mostly children with lymphoreticulosis are affected; susceptibility is not exactly known. The disease is fixed in the form of sporadic disparate cases. There are cases when whole families fall ill.
Causes of Benign Lymphoreticulosis in Children
The causative agent of benign lymphoreticulosis refers to chlamydia. Their infectious particles are round in shape, the size is from 250 to 300 nm. Infectious particles are found in macrophages and cells of the reticuloendothelium, have a similar development cycle, group antigen and the same chemical composition with the causative agent of such a disease as ornithrosis and other diseases of the Chlomydozoaceae group.
Pathogenesis during Benign Lymphoreticulosis in Children
The causative agent enters the body of the child through damage to the skin and mucous membranes. In more rare cases, the conjunctiva, tonsils, gastrointestinal tract or respiratory tract serves as the entrance gate.
In the place through which the infection entered, the so-called primary affect appears. It is a dense papule that can turn into an ulcer and crust. Further, the causative agent of the disease through the lymphatic vessels enters the regional lymph nodes. There it actively multiplies, releases a toxin, which leads to adenitis. If the process is not stopped, a breakthrough of the lymphatic barrier and hematogenous dissemination of infection with damage to the spleen, liver, central nervous system and other organs can occur.
Pathomorphology
The biggest changes occur in the regional lymph nodes as close to the primary affect. The process can undergo both a single lymph node and a whole group. At the same time, the nodes are enlarged, moderately compacted and soldered together. If they are cut, it can be observed that inside they are dark red in color, homogeneous or with areas of necrosis and melting depending on the stage at which the pathological process is located.
In the early stages of the disease, reticular cell hyperplasia predominates with a gradual transformation into a granuloma consisting solely of epithelial cells. The central part of the granuloma undergoes necrosis, and a microabscess forms. Further, microabscesses can merge, the entire lymph node is involved in the process, as well as the surrounding fiber – an inflammatory conglomerate is formed with a tendency to melt.
Histological examination reveals clusters of giant multinuclear cells of the Berezovsky-Sternberg type in the foci of inflammation. Morphological changes in the disease with benign lymphoreticulosis are not specific, similar to those in brucellosis, tularemia, lymphogranulomatosis, tuberculosis.
This disease sometimes proceeds in a severe generalized form (affecting the entire body), then the granulomatous process “acts” in the brain (causing encephalitis), in the lungs (causing pneumonia), in the liver (causing hepatitis), in the bones (causing osteomyelitis), mesentery (causing adenitis), etc.
Symptoms of Benign Lymphoreticulosis in Children
An incubation period lasts from 10 to 1 month – the period from infection to the onset of the first symptoms. In some cases, 2 months. The disease has an acute onset, the temperature “jumps” to 38-39 ° C. A sick child feels a slight malaise. The regional lymph node or group of nodes increases.
More than others, axillary and cervical lymph nodes are affected, in more rare cases, inguinal, femoral, submandibular. Sometimes adenitis is localized unusually – in front of the auricle, in the subclavian or supraclavicular region, etc.
Lymph nodes increase, reaching 10 cm in diameter. Sometimes they reach 15 cm. Lymph nodes in lesions are inactive, dense, sensitive or painful on palpation. Sometimes they fester. Thus, the most important and characteristic sign of benign lymphoreticulosis is an increase in regional lymph nodes.
Often the disease begins with regional lymphadenitis, intoxication manifests itself at a later date or does not occur at all. And then the only sign of the disease is adenitis. But most sick children at the peak of the disease have the following symptoms:
- headaches and muscle aches
- fever
- loss of appetite.
Symptoms rarely appear:
- scarlet-like, measles-like, erythematous or large-skin rashes on the skin;
- intestinal dysfunction.
A red papule, sore, pustule, crust, or infiltrated, hyperemic, and painful scratch from a cat’s claw appears at the site of infection. Long before regional lymphadenitis, the primary affect appears as described above. Therefore, at the time of the onset of symptoms on the skin, you can almost not notice the changes, or they can be mild.
Felinosis of a typical form passes according to the “scenario” described above. Atypical form: glandular-ocular, abdominal, anginal, cerebral, pulmonary, etc. Symptoms correspond to the lesion (mesademitis, encephalitis, tonsillitis, pneumonia, conjunctivitis with regional lymphadenitis). Subclinical and erased forms of benign lymphoreticulosis are considered atypical.
Changes in peripheral blood correspond to the stage of the disease. In the beginning, moderate leukocytosis (an increase in the number of white blood cells in the blood) with lymphocytosis and monocytosis is observed. ESR is within normal limits. When suppuration of the lymph nodes begins, leukocytosis ranges from 15 thousand to 25 thousand. Eosinophilia, neutrophilia with a shift to the left, and an increased ESR are also observed.
Diagnosis of Benign Lymphoreticulosis in Children
Felinosis (cat scratch disease) can be diagnosed if primary affect is found at the site of cat scratches or bites, regional lymphadenitis with a tendency to suppuration and prolonged torpid (fast) flow, according to mild symptoms of intoxication and changes in the peripheral blood.
The diagnosis is distinguished from bacterial lymphadenitis, lymphogranulomatosis, lymph node tuberculosis, and tularemia.
Treatment of Benign Lymphoreticulosis in Children
Treatment is mainly aimed at eliminating the symptoms. If there is suppuration, doctors advise to make a puncture of the lymph node or incision. Drugs are used for antibacterial therapy (azithromycin, erythromycin, clindamycin) in doses corresponding to age. The course is from 5 to 7 days. But the effectiveness of this type of therapy is rather low.
They have a physiotherapeutic effect on the area of the affected lymph nodes (UHF, diathermy). In severe cases, corticosteroid drugs are used, the course of treatment is short (from 5 to 7 days). The forecast is favorable.
Prevention of Benign Lymphoreticulosis in Children
It is recommended in order to prevent benign lymphoreticulosis in children to avoid scratching and biting a cat. There are no specific preventive measures.