Cat-Scratch Disease

Abstract

1. Robin English, MD* 1. *Associate Professor of Clinical Pediatrics, Louisiana State University Health Sciences Center, New Orleans, La After completing this article, readers should be able to: 1. Describe the etiology and epidemiology of cat-scratch disease. 2. Recognize the clinical presentation of cat-scratch disease in immunocompetent patients, including chronic lymphadenopathy and numerous atypical manifestations. 3. Know the various laboratory tests that can aid in the diagnosis of cat-scratch disease. 4. Discuss the therapies that may be useful in the management of cat-scratch disease, realizing that the disease generally is a self-limited infection that resolves without antibiotics. 5. Know the conditions that immunocompromised patients can develop after infection with Bartonella henselae or B quintana. Cat-scratch disease (CSD) is a common infection in children. Immunocompetent children who are affected typically have a self-limited course, but immunocompromised patients can develop serious systemic disease following infection. Although antibiotic treatment often is prescribed, very little evidence of its effectiveness in controlled trials has been published in the literature. The most common clinical feature of CSD is regional lymphadenopathy, but reports of other clinical manifestations associated with this infection are increasing. A 7-year-old boy presents in January with a daily fever to 103°F (39.5°C) for 3 weeks. He initially complained of sore throat and diffuse abdominal pain followed by right hip, right leg, and back pain. During this illness, he had received brief courses of amoxicillin-clavulanate and azithromycin without relief of symptoms. His past medical history is noncontributory. He has one cat at home. His physical examination findings are within normal limits. He has no tenderness of the extremities or back and no lymphadenopathy. A complete blood count, purified protein derivative skin test, lactate dehydrogenase level, and uric acid value are normal. The erythrocyte sedimentation rate is 95 mm/hr, and the C-reactive protein is 2.7 mg/L. A bone scan shows increased uptake in the right eighth rib, the right ilium, and the T9 vertebral body. He is hospitalized with …