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The Etiology of Cat-Scratch Fever (Comments on Current Literature)Blattner RJ. J Pediatr 1960;56:839-41

Currently it is certain that the etiologic agent of cat scratch disease is the bacterium Bartonella, henselae. Cats, usu-ally kittens, are the reservoir forB henselae and frequently are bacteremic for a prolonged period (eg, longer than 1year) and are asymptomatic. The human inoculation event usually is a scratch, but exactly how the bacterium getsfrom the cats bloodstream to the claw is debated.

There were several mis-steps along the etiologic path that ended atB henselae. Blattner, in the June 1960 issue ofTheJournal,retells of prior mis-steps and adds a few more from experimentation and exuberance at the time. Before 1960,cat scratch disease was summarily ascribed to a .virus probably in the group of psittacosis-venereal lymphogran-uloma agents (neither of which, incidentally, is a virus). Blattner reviews new evidence showing that rabbits immu-

nized using material from lymph nodes of patients with cat scratch fever produced a hemagglutinating antibody.Researchers stated in 1960 that good evidence has been obtained that the hemagglutinin is a virus.and will bepublished. Agglutinating antibodies aside, an inciting virus was not to be found.

Years passed without an etiologic agent, without a confirmatory blood test, and with doctors (including this writer)

actually injecting intradermally into suspect patients an antigen from a local stash crudely prepared by the Freimethod from lymph node aspiration of purulent material from a typical case. Skin reaction confirmed the diagnosis.By 1975, even before discovery of HIV or blood transmission of hepatitis viruses, this did not seem safe. The discoveryof a purported etiologic agent from Armed Forces Institute of Pathology material and named after the Institute asa new genus and species, Afipia felis, was the next mis-step. Then the causative bacillus was thought to belong to

the genus Rochalimaea before the dust finally settled on B henselae. There followed quickly identification of anever-expanding spectrum of disease and identification ofB henselaeas a major cause of certain clinical constellationssuch as fever of unknown origin, acute encephalopathy, and granulomatous infection in flat bones and in bonemarrow of long bones. There is still room for discovery in diagnostic tests, treatment, and prevention.

Sarah S. Long, MDSection of Infectious Diseases

St Christophers Hospital for ChildrenPhiladelphia, Pennsylvania

10.1016/j.jpeds.2009.12.050

June 2010 ORIGINAL ARTICLES

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