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Clinical Presentation of Cat Scratch Disease in Pediatric Patients-A Single-Center Study
Sevliya Öcal-Demir1, Kaan Kahraman2, Gülçin Bozbeyoğlu3
1Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, İstanbul, Türkiye.
Insights
Cat scratch disease (CSD), caused by Bartonella henselae, often presents as lymphadenopathy in children. Early suspicion and diagnosis using cat contact history, serology, and ultrasound are key for effective treatment with azithromycin.
Area of Science:
- Pediatrics
- Infectious Diseases
- Bacteriology
Background:
- Cat scratch disease (CSD) is an infectious illness primarily caused by Bartonella henselae.
- Typical presentation involves regional lymphadenopathy, but disseminated forms with fever of unknown origin (FUO) can occur.
Purpose of the Study:
- To evaluate pediatric cases of CSD to enhance disease awareness.
- To analyze clinical, laboratory, and radiological findings, treatments, and outcomes in children with CSD.
Main Methods:
- Retrospective analysis of 29 children diagnosed with CSD between 2019 and 2022.
- Evaluation of demographic data, clinical signs, laboratory results, imaging findings, and treatment responses.
Main Results:
- Most patients (93.1%) presented with lymphadenopathy, predominantly axillary.
- Disseminated disease manifestations included FUO, neuroretinitis, and encephalopathy.
- Ultrasound revealed characteristic lymph node changes; serology was positive in 24/27 patients. Azithromycin was effective, though sometimes requiring extended duration or combination therapy.
Conclusions:
- CSD should be suspected in pediatric regional lymphadenopathy unresponsive to antibiotics.
- Cat contact history, serology, and ultrasound are crucial diagnostic tools.
- Azithromycin is effective, but treatment may necessitate adjustments in duration or additional therapies.
Objective:
Cat scratch disease (CSD) is the infectious disease caused by Bartonella henselae. Its typical presentation is regional lymphadenopathy. Also it may present with symptoms related to involved organs or disseminated disease with fever of unknown origin (FUO). Here children with CSD are evaluated to increase awareness about disease.
Materials And Methods:
A total of 29 children diagnosed with CSD between 2019 and 2022 were involved in the study. Patients' demographic characteristics, clinical, laboratory and radiological findings, treatments, and outcomes were analyzed.
Results:
Seventeen of the patients were male, 12 were female, and their mean age was 116.5 ± 51 months. About 69.6% of them had a history of cat contact. Twenty-seven patient (93.1%) had lymphadenopathy, mostly axillary involved (61.5%). Other manifestations were disseminated disease presented with FUO, neuroretinitis, and encephalopathy. Twenty-seven patients (93.1%) had received antibiotics before admission without any improvement. Ultrasound showed that the affected lymph nodes were conglomerated, lobulated contoured, and cortical thickened, with one-third having cystic suppurative components. Serologic tests were positive in 24 of 27 patients. Twenty-one patients gave response to 5 days azithromycin treatment, in 8 patients this treatment extended to 10-14 days, rifampicin with/without doxycycline was given to 6 patients, and steroids were given to 3 patients.
Conclusion:
In case of regional lymphadenopathy, especially axillary, not responding to nonspecific antibiotics CSD should be suspected. Cat contact history and serological and ultrasonographic findings are useful for diagnosis. Even if CSD responds well to azithromycin, sometimes prolongation of azithromycin and addition of other antibiotic or steroid may be required.
