The significance of Bartonella henselae bacterias for oncological diagnosis in children

Abstract

Background: Cat-scratch disease (CSD) is a common infection in children; however, the wide spectrum of its clinical picture may lead to delayed diagnosis. An unusual presentation of CSD includes in the differential diagnosis malignant diseases, Epstein-Barr and cytomegalovirus infections, tuberculosis, and mycobacterioses. The diagnostic procedure is difficult, and it is important to consider CSD as the etiology of untypical lesion.

Patients and method: We present the analysis of 22 immunocompetent children treated with the clinical diagnosis of CSD in our hospital. Their ages were 2 to 16 years (mean 9.15 ± 2.2 years). Four of them presented classical papulas at admission time. Asymmetric, local lymphadenopathy was present in 16 patients. Five children, who presented an untypical course of CSD mimicking the oncological process, were analysed carefully. There were 3 patients with skull osteomyelitis, 1 with inflammation of the parotid gland, and 1 with an extra peripharyngeal mass. The diagnosis in these children was based on epidemiological, radiological, serological, and histological factors.

Results: About 25 % of children with bartonellosis present an untypical spectrum of symptoms, including the lack of documented cat contact, primary lesions, or peripheral lymphadenopathy. Radiological methods like USG, CT, MRI present the unspecific masses, but they are not enough to distinguish the Bartonella inflammatory and oncological process. The final diagnosis was based on a histological method with additional polymerase chain reaction test.

Conclusion: CSD should be considered in differential diagnosis of any patient with untypical lesions located on the head, neck, and upper extremities.

Keywords: Bartonella henselae; CSD; Children.

Fig. 1

Cat scratch disease – active skin lesions (one week after inoculation)

Fig. 2

Peripheral, axillary lymphadenopathy in 5-years old child with CSD

Fig. 3

The ultrasound picture of hypoechoic lymph node in the 5-years-old child with CSD

Fig. 4

The cranial CT scan presented the solitary tissue mass overlying a skull lesion suggesting histiocytosis X in 12-years-old girl

Fig. 5

MRI scan of the head and neck of 5-years old child presented the solid mass in the peripharyngeal area.  Sized 20 × 14 × 30 mm lesion modulatesd the left neck vessels and left tonsil