Difficulties in diagnosing cat scratch disease in children

Abstract

Cat scratch disease (CSD), a zoonotic infection caused mainly by the bacterium Bartonella henselae (B.henselae), is widespread throughout the world. The main carriers of B.henselae are domestic cats that get infected by fleas. In humans, the disease occurs after a contact with a cat, typically through a bite or scratch from an infected animal. Difficulties in diagnosing the disease are associated with the variety of its clinical manifestations. Three clinical cases of CSD in children are presented, in two of them skin manifestations preceded common clinical symptoms such as fever and lymphadenopathy. In these patients, false diagnoses of scarlet fever and pityriasis rosea made it difficult to diagnose CSD in a timely manner. As a result, etiotropic treatment was started on days 16 and 21 of the illness, respectively. In the third case, a patient experienced abscess formation in one of the affected lymph nodes after prolonged fever for a month and regional lymphadenopathy, which necessitated surgical intervention. In all three cases, the family physicians did not ade­quately consider the epidemiological history, specifically failing to recognize the persistent, long-term contact of the children with cats. Patients received antibacterial therapy with clarithromycin, which led to clear positive dynamics and recovery. These clinical cases emphasize the importance of considering B.henselae infection in all cases of lymphadenopathy accompanied by skin rashes to ensure early diagnosis and appropriate treatment, thereby preventing complications, particularly when children have contact with cats.