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Cat Scratch Disease: 9 Years of Experience at a Pediatric Center
Omayma Amin1, Christina A Rostad1, Mark Gonzalez2
1Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Insights
Cat scratch disease (CSD) in children often presents with swollen lymph nodes in late summer, typically after cat exposure. Atypical CSD cases without lymphadenopathy are also common, highlighting the need for broader diagnostic considerations.
Area of Science:
- Pediatric Infectious Diseases
- Veterinary Epidemiology
- Bartonella henselae Infections
Background:
- Cat scratch disease (CSD) understanding in children is limited.
- Epidemiology, risk factors, and clinical features require further elucidation.
- Improved knowledge can optimize pediatric patient care.
Purpose of the Study:
- To analyze the epidemiology and clinical features of CSD in children.
- To investigate the prevalence of Bartonella infection in companion animals.
- To correlate animal and human disease patterns.
Main Methods:
- Retrospective analysis of pediatric CSD cases (2010-2018) with Bartonella henselae testing.
- Review of veterinary diagnostic data for Bartonella in companion animals (2018-2020).
- Correlation of clinical presentations with diagnostic results and exposure history.
Main Results:
- 304 pediatric CSD cases identified, peaking in August and September.
- Median age 8.1 years, 92.4% with reported cat exposure.
- Lymphadenopathy present in 78.8%, but atypical presentations (20.7%) and splenic/hepatic microabscesses (38.1%) were noted.
- Bartonella seroprevalence in canines was 8.2% across Georgia.
Conclusions:
- CSD in school-aged children typically presents with subacute regional lymphadenopathy in late summer, linked to cat exposure.
- Atypical clinical manifestations of CSD are frequently observed.
- Understanding these features aids in diagnosing CSD in pediatric populations.
Background:
A more complete understanding of the epidemiology, risk factors, and clinical features of cat scratch disease (CSD) in children could help guide patient care.
Methods:
We conducted a retrospective analysis of children presenting to a tertiary pediatric hospital system in Atlanta, Georgia between January 1, 2010 and December 31, 2018 who had serology, polymerase chain reaction, and/or cytopathological results consistent with a Bartonella henselae infection. We also retrospectively reviewed veterinary diagnostic results performed at the University of Georgia from 2018 to 2020 to ascertain the burden of bartonellosis in companion animals within the state.
Results:
We identified 304 children with CSD over 9 years with the largest proportion of diagnoses made during August (41 of 304, 13.5%) and September (47 of 304, 15.5%). The median age of child cases was 8.1 years (interquartile range [IQR], 5.4-12.1); 156 (51.3%) were female; 242 of 262 (92.4%) reported feline exposure; and 55 of 250 (22%) reported canine exposure of those with exposure histories documented in the medical record. Although lymphadenopathy was present on physical examination in the majority of cases (78.8%), atypical presentations lacking lymphadenopathy were also common (63 of 304, 20.7%). Among children with radiographic imaging, 20 of 55 (36.4%) had splenomegaly and 21 of 55 (38.1%) had splenic and/or hepatic microabscesses. Among veterinary data, Bartonella seroprevalence was 12 of 146 (8.2%), all among canines, with a geographic distribution that spanned the state of Georgia.
Conclusions:
Distinguishing clinical features of CSD included subacute regional lymphadenopathy in school-aged children in the late summer, almost all of whom had cat exposure. Atypical clinical manifestations of CSD were also commonly identified.
