9 and 10 The diagnosis of human cases of tularemia is usually confirmed by the demonstration of an antibody response to F. tularensis, which occurs about 2 weeks

after the onset of the disease. 11 The detection of serum antibodies is most frequently achieved by agglutination or an ELISA. 11 Commercially available antigens can also be used with standard tube agglutination tests. A fourfold increase during illness or a single titer Erastin of 1:160 or greater is considered diagnostic. 12 In first case, axillary LAP biopsy was reported as suppurative granulomatous lymphadenitis. He was referred to our clinic with presumptive diagnosis of TB. All other granulomatous inflammation reasons, primarily TB, had been excluded with clinical, laboratory and radiological findings. Because of history click here of thorn prick, Francisella tularensis agglutination test was performed. CSD only occurs in humans, especially those who are scratched or bitten by kittens and then

develop regional lymphadenitis proximal to the site of injury. Primary involvement is that of the lymph nodes, which first show lymphoid hyperplasia. Later, scattered granulomas with central areas of necrosis coalesce to form abscesses. Bartonella henselae is the responsible Gram negative bacillus. 13 The clinical diagnosis of CSD is based on the detection of an enlarged lymph node and possibly a skin lesion at the contact site. Clinicians should investigate the patient’s contact history with cats, dogs, rodents, fleas, ticks, or other blood sucking arthropods. Pathology suggestive for B. henselae infection includes granuloma formation, with microabscesses and follicular hyperplasia. 14 and 15 The laboratory diagnostic approaches include culture, histological, serological,and molecular methods. 16 The culturing of Bartonella is still a complicated process. 17 A more practical means of laboratory diagnosis is serology for B. henselae antibodies, Disadvantages to serologic diagnosis include variable sensitivity and specificity, inability to distinguish Low-density-lipoprotein receptor kinase between

active versus prior infection, and lack of Bartonella species-specific antibody response, resulting in cross-reactivity. 14 and 15 The majority of CSD cases resolve spontaneously and do not require antibiotic treatment. In complicated CSD, treatment with trimethoprim-sulphamethoxazole, ciprofloxacin or azithromycin is recommended, with gentamicin being reserved for the severely ill patient. 18 In our case axillary LAP biopsy reported as micro abscess and necrotizing granulomatous lymphadenitis. All other granulomatous inflammation reasons, primarily TB, had been excluded with clinical, laboratory and radiological findings. With detailed anamnesis, it was learned that he had a history of cat bite 1 month ago. We saw skin lesion at the contact site. So he was diagnosed as CSD depending on clinical and histological findings. During 3 months follow-up LAP did not recur.