Shoham N, Miron D, Raz R, Garzozi H J
Dept. of Ophthalmology, HaEmek Medical Center, Afula.
Harefuah. 2000 Jun 15;138(12):1034-6, 1086.
Cat-scratch disease is manifested by subacute, regional lymphadenitis and occurs mainly in children. The causative agent is a pleomorphic, gram-negative bacillus, Bartonella henselae carried by asymptomatic cats. Parinaud oculoglandular syndrome is the most common ocular manifestation of this disease. It is characterized by unilateral conjunctivitis with polypoid granuloma, usually of the palpebral conjunctiva, and preauricular lymphadenopathy. The diagnosis is supported by a history of exposure to cats and is confirmed by positive serologic tests or positive PCR assay. The occurrence of more than 1 case of Parinaud syndrome in a family is rare. We describe 2 sisters with Parinaud oculoglandular syndrome, proven by serologic tests. They reported that they used to cuddle with their cats, among them a kitten. Because of the refractory conjunctivitis and signs of imminent periorbital cellulitis, they were treated with oral tetracycline with apparently good responses. We recommend asking about contacts with cats in any atypical conjunctivitis accompanied by regional lymphadenopathy, especially in young patients. Systemic antibiotics should be given when there is any suspicion of significant ocular involvement, if the patient is immunosuppressed, or if there are systemic manifestations of cat-scratch disease.
猫抓病表现为亚急性局部淋巴结炎,主要发生于儿童。病原体是一种多形性革兰氏阴性杆菌——汉赛巴尔通体,由无症状的猫携带。帕里诺眼腺综合征是该病最常见的眼部表现。其特征为单侧结膜炎伴息肉样肉芽肿,通常位于睑结膜,以及耳前淋巴结病。接触猫的病史有助于诊断,血清学检测阳性或聚合酶链反应(PCR)检测阳性可确诊。一个家庭中出现1例以上帕里诺综合征的情况较为罕见。我们描述了2例经血清学检测证实患有帕里诺眼腺综合征的姐妹。她们报告称过去常与猫,包括一只小猫一起亲昵。由于结膜炎难治且有眼眶蜂窝织炎即将发生的迹象,她们接受了口服四环素治疗,反应明显良好。我们建议,对于任何伴有局部淋巴结病的非典型结膜炎患者,尤其是年轻患者,询问其与猫的接触史。如果怀疑有明显的眼部受累、患者免疫功能低下或有猫抓病的全身表现,应给予全身抗生素治疗。