1 Pediatric Infectious Diseases Unit, Hospital Dona Estefânia – CHLC - EPE, Lisbon, Portugal
2 Dr. Ricardo Jorge Institute, Águas de Moura
Background:. Cat-scracht disease (CSD) caused by Bartonella henselae is usually a self-limited lymphadenitis among children. However, atypical presentations of infection can occur, including osteomyelitis.
Methods: During 2010 to 2012 four children were diagnosed with atypical CSD. Epidemiological, clinical and laboratory data are described.
Results: Four children of 2 – 15 years old are reported. Three children had contact with cats and one had contact with dogs. All of them had an indolent (>2 weeks) semiology of local pain, three children had fever and one had multiple cervical adenopathies and splenomegaly. MRI revealed osteomyelitis of spinal column in two children, osteomyelitis of clavicle in one and bilateral iliac osteomyelitis and right sacroiliac arthritis in other. Clinical diagnosis was confirmed in all of the patients by seroconversion (four-fold increase) demonstrated by the appearance or increasing levels of IgM and IgG antibodies against B. henselae. In one patient diagnosis was also confirmed by molecular detection of B. henselae in a bone biopsy. They all made different antibiotic schemes: cotrimoxazole and gentamicin in one case; rifampicin was added to ciprofloxacin or azitromycin or doxycicline in others. Duration of treatment varied between 4 and 10 weeks.
Conclusion: Bone infection is rare but should be considered when bone pain and fever are present in patients with epidemiological context or nodal CSD. Laboratory diagnosis by serological or molecular methods are essential to confirm the diagnosis and differentiate from other serious disorders that CSD may mimic. Antibiotic treatment type and duration still a controversial issue.