Cat Scratch Disease: 9 Years of Experience at a Pediatric Center

Abstract

Background: A more complete understanding of the epidemiology, risk factors, and clinical features of cat scratch disease (CSD) in children could help guide patient care.

Methods: We conducted a retrospective analysis of children presenting to a tertiary pediatric hospital system in Atlanta, Georgia between January 1, 2010 and December 31, 2018 who had serology, polymerase chain reaction, and/or cytopathological results consistent with a Bartonella henselae infection. We also retrospectively reviewed veterinary diagnostic results performed at the University of Georgia from 2018 to 2020 to ascertain the burden of bartonellosis in companion animals within the state.

Results: We identified 304 children with CSD over 9 years with the largest proportion of diagnoses made during August (41 of 304, 13.5%) and September (47 of 304, 15.5%). The median age of child cases was 8.1 years (interquartile range [IQR], 5.4-12.1); 156 (51.3%) were female; 242 of 262 (92.4%) reported feline exposure; and 55 of 250 (22%) reported canine exposure of those with exposure histories documented in the medical record. Although lymphadenopathy was present on physical examination in the majority of cases (78.8%), atypical presentations lacking lymphadenopathy were also common (63 of 304, 20.7%). Among children with radiographic imaging, 20 of 55 (36.4%) had splenomegaly and 21 of 55 (38.1%) had splenic and/or hepatic microabscesses. Among veterinary data, Bartonella seroprevalence was 12 of 146 (8.2%), all among canines, with a geographic distribution that spanned the state of Georgia.

Conclusions: Distinguishing clinical features of CSD included subacute regional lymphadenopathy in school-aged children in the late summer, almost all of whom had cat exposure. Atypical clinical manifestations of CSD were also commonly identified.

Keywords: Bartonella henselae; bartonellosis; cat scratch disease; lymphadenitis; veterinary.

Figure 1.

Number of pediatric cat scratch disease cases diagnosed in each month, 2010–2018, n = 304.

Figure 2.

Selected radiological findings among children with cat scratch disease, 2010–2018. (A) Liver ultrasound with 2 hypoechoic lesions compatible with hepatic microabscesses (arrows). (B) Coronal T1 fluid-attenuated inversion recovery (FLAIR) contrast enhanced magnetic resonance imaging (MRI) through the orbits demonstrates abnormal enhancement of the right optic nerve (arrow) consistent with optic neuritis. (C) Ultrasound of the spleen demonstrates multiple hypoechoic splenic lesions consistent with microabscesses. Three of the lesions are annotated (arrows). (D) Coronal short tau inversion recovery (STIR) MRI of the left upper arm demonstrates multiple enlarged lymph nodes (arrows) above the left elbow.

Figure 3.

Bartonella testing in animal samples submitted to the University of Georgia Veterinary Diagnostic Laboratory, n = 146. (A) Results by Bartonella status and animal species. (B) Bartonella results by testing type (immunofluorescent antibody testing and polymerase chain reaction [PCR]).