Weinspach S, Tenenbaum T, Schönberger S, Schaper J, Engers R, Rueggeberg J, Mackenzie C R, Wolf A, Mayatepek E, Schroten H
Department of General Pediatrics, University Children's Hospital, Heinrich Heine University Düsseldorf, Moorenstrasse 5, Düsseldorf, Germany.
Klin Padiatr. 2010 Mar;222(2):73-8. doi: 10.1055/s-0029-1233488. Epub 2009 Sep 29.
Cat-scratch disease (CSD) is common in children, however the wide spectrum of the clinical presentation of CSD may lead to delayed diagnosis. An atypical presentation of CSD includes in its differential diagnosis diseases such as tuberculosis, other mycobacterioses, Epstein-Barr-Virus infection (EBV) or malignant disease. Since, in a small number of cases, these diseases may be present concurrently with an active CSD, it is important to consider CSD early in the differential diagnosis and order the appropriate tests. These tests include serology and, where possible, histology including molecular diagnostic methods on tissue specimens.
We performed a case series of five patients treated in our hospital with a clinical diagnosis of cat-scratch disease, confirmed by serology. An analysis of the history and clinical symptoms associated specifically with an atypical presentation of CSD was performed.
The clinical presentation of CSD no longer encompasses the original typical description from 1950, but rather presents with a wide spectrum of signs and symptoms, including the absence of a documented cat scratch, fever, primary lesions or peripheral lymphadenopathy. Low density lesions in spleen, liver and lymph nodes are typical findings in ultrasound, MRI, or CT. Ignoring CSD as a possibility in investigating possible malignancy or tuberculosis could lead to unnecessary hospitalisation and delay in the proper treatment.
CSD should also be considered in differential diagnosis of any patient with intraabdominal lymphadenopathy, abdominal pain and fever of unknown origin. A careful history is important, however, often patients with CSD have no history of contact with cats. Therefore in atypical cases of CSD the finding of other clinical symptoms and performance of specific diagnostic tests is important. Our experience suggests that early serological testing for Bartonella henselae should be performed and may avoid invasive diagnostic procedures.
猫抓病（CSD）在儿童中很常见，然而CSD临床表现的广泛多样性可能导致诊断延迟。CSD的非典型表现包括在其鉴别诊断中需考虑的疾病，如结核病、其他分枝杆菌病、爱泼斯坦 - 巴尔病毒感染（EBV）或恶性疾病。由于在少数情况下，这些疾病可能与活动性CSD同时存在，因此在鉴别诊断早期考虑CSD并进行适当的检查很重要。这些检查包括血清学检查，以及在可能的情况下进行组织学检查，包括对组织标本进行分子诊断方法。
我们对在我院接受治疗的5例临床诊断为猫抓病且经血清学确诊的患者进行了病例系列研究。对与CSD非典型表现相关的病史和临床症状进行了分析。
CSD的临床表现不再局限于1950年最初的典型描述，而是呈现出广泛的体征和症状，包括无明确记录的猫抓史、发热、原发性皮损或外周淋巴结病。脾脏、肝脏和淋巴结的低密度病变是超声、MRI或CT的典型表现。在调查可能的恶性肿瘤或结核病时忽略CSD的可能性可能导致不必要的住院治疗和适当治疗的延迟。
在对任何有腹腔淋巴结肿大、腹痛和不明原因发热的患者进行鉴别诊断时，也应考虑CSD。仔细询问病史很重要，然而，CSD患者通常没有与猫接触的病史。因此，在CSD的非典型病例中，发现其他临床症状并进行特定的诊断检查很重要。我们的经验表明，应尽早进行针对汉赛巴尔通体的血清学检测，这可能避免侵入性诊断程序。
