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Zsófia Váradi
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Pyelon plastic surgery in 2013 (pyeloureteral stenosis l.u.)
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Colelithiasis
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City Hospital, Keszthely:
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Painful swelling in the left elbow
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Palpable solid mass
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X-ray: normal
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City Hospital, Tatabánya, Dept. Of Pediatrics
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Palpable mass in the left axillary region, erythema on the upper arm
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CRP 28 mg/l, other parameters: normal
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Soft tissue US: lymphadenopathy
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Serology tests (EBV, CMV, Bartonella)
Therapy: iv. amoxicillin-clavulanic acid, SMX/TMP orally
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Control soft tissue US: axillar lymphadenopathy without signs of suppuration
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Surgical exploration of the solid mass in the elbow: macroscopically desintegrated lymph
node, small amount of pus (histology, microbiological analysis in progress)
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Axillar lymphadenopathy l.s., inhomogeneous structure,
hypervascularisation, without signs of suppuration
Serology: Bartonella henselae IgM and IgG positivity
Histology: absceding granulomatous lymphadenitis without signs of
malignancy
Diagnosis: cat-scratch disease
Bartonella henselae (Gram negative bacillus)
Zoonosis – natural reservoir: cat (kitten!), dog
Transmission:
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Traumatic contact with the infected animal: cat scratch or
bite
By vectors: flea bite
Self-limited regional lymphadenopathy (85-90%)
in young immunocompetent individuals
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Disseminated disease: rare
Immunocompromised patients: bacillaris angiomatosis,
splenitis, peliosis hepatis
Localized cutaneous and lymph node
disorder near the site of organism
inoculation
Primary inoculation lesion
Regional lymphadenopathy
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Liver, spleen – FUO!
eye
Nervous system
musculoskeletal
Emerg Infect Dis. Sep 2006; 12(9): 1338–1344.
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analysis of 786 lymph node specimens from patients with suspected
CSD
2001. january – 2005. august
Culture, PCR, serology(DIF), histology
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50% infectious agents
 31% B. henselae (245 cases)
 7% Mycobacterial infection (mostly M. tuberculosis)
 In 10 cases B. henselae+mycobacteriosis together
 In 3 cases B. henselae+malignancy (lymphomas)
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7% malignancy (47/181):
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6 squamosous cell carcinoma, 1 acute leukemia, 36 lymphoma, 4 Kaposi-sarcoma
Clinical history, symptoms
 Serology (most cost-effective): IFA, EIA
 PCR (high specificity)
 CT/MR, UH, echocardiography
 Histology
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Warthin-Starry stain
Necrotizing granuloma
Not recommended for most patients with mild-tomoderate disease!
Azithromycin (drug of choice?)
 TMP-SMZ
 Doxycycline
 Ciprofloxacin
 Rifampin
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