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[Three children with systemic cat scratch disease].

I Murano1, H Yoshii, H Kurashige

  • 1Department of Pediatrics, Yamaguchi Prefecture Central Hospital.

Kansenshogaku Zasshi. the Journal of the Japanese Association for Infectious Diseases
|May 1, 1999
PubMed
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Cat scratch disease, caused by Bartonella henselae, can present without swollen lymph nodes, manifesting as prolonged fever and liver/spleen lesions. This highlights its potential as a cause of fever of unknown origin, especially in Japan.

Area of Science:

  • Infectious Diseases
  • Pediatrics
  • Hepatology

Background:

  • Cat scratch disease (CSD) is typically associated with regional lymphadenopathy.
  • Bartonella henselae is the primary causative agent of CSD.

Observation:

  • Three pediatric patients presented with atypical CSD, exhibiting prolonged fever and back pain without lymphadenopathy.
  • Two patients developed hepatosplenic granulomas, including hypoechoic lesions in the liver and spleen.
  • One patient required a partial left hepatic lobectomy for a significant hepatic lesion.

Findings:

  • All patients demonstrated elevated antibodies to Bartonella henselae.
  • Bartonella henselae DNA was confirmed via polymerase chain reaction in tissue from the patient who underwent surgery.

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  • These findings indicate systemic Bartonella henselae infection.

    • Implications:

    • Cat scratch disease should be considered in the differential diagnosis of fever of unknown origin, particularly when lymphadenopathy is absent.
    • The prevalence of Bartonella henselae infections may be underestimated in Japan.
    • Early recognition and diagnosis are crucial for appropriate management of atypical CSD presentations.