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Cluster of five children with acute encephalopathy associated with cat-scratch disease in south Florida
D L Noah1, J S Bresee, M J Gorensek
1Viral and Rickettsial Zoonoses Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Insights
Cat-scratch disease (CSD) encephalopathy, caused by Bartonella henselae, was identified in a cluster of five children in South Florida. This study highlights the potential for geographically localized outbreaks of CSD encephalitis in children.
Area of Science:
- Infectious Diseases
- Neurology
- Public Health
Background:
- Cat-scratch disease (CSD) is a bacterial infection typically transmitted by cats.
- Encephalopathy is a severe brain dysfunction, and its association with CSD requires further investigation.
- Recognizing clusters of CSD-related neurological complications is crucial for public health surveillance.
Purpose of the Study:
- To report the first recognized cluster of CSD-associated encephalopathy in the United States.
- To investigate the epidemiological link between Bartonella henselae infection and pediatric encephalopathy.
- To assess the prevalence of Bartonella henselae in the local cat population.
Main Methods:
- Case identification of five children hospitalized with encephalopathy and suspected CSD.
- Serological confirmation of Bartonella henselae infection using indirect fluorescent antibody tests.
- Epidemiological investigation of patient proximity and cat contact.
- Bacteriological and serological testing of local cats.
Main Results:
- Five pediatric cases of encephalopathy, presenting as status epilepticus, were linked to CSD.
- All patients lived within a 7-mile radius and had prior contact with cats.
- Bartonella henselae was confirmed as the causative agent.
- A high prevalence of Bartonella henselae was found in local cats (62% seropositive, 22% bacteremic).
Conclusions:
- Bartonella henselae can cause geographically focal clusters of CSD encephalitis in children.
- CSD should be considered in the differential diagnosis of acute encephalopathy in pediatric patients.
- Environmental and animal factors play a significant role in CSD transmission and outbreaks.
Abstract:
Between August 12 and September 27, 1994, five children in South Florida were hospitalized at a single hospital because of encephalopathy, presenting as status epilepticus, associated with cat-scratch disease (CSD). Diagnoses were confirmed by using an indirect fluorescent antibody test to detect antibody to Bartonella henselae, the causative agent of CSD. These cases represent the first cluster of CSD encephalopathy cases to be recognized in the United States. The patients lived within 7 miles of each other and all reported contact with pet or stray cats before developing regional lymphadenopathy and encephalopathy. All recovered fully. A high proportion of 124 cats from the local area were seropositive (62%) or bacteremic (22%). This study suggests that B. henselae can be associated with geographically focal clusters of CSD encephalitis and should be considered in the evaluation of children with acute encephalopathy.