Donà D, Nai Fovino L, Mozzo E, Cabrelle G, Bordin G, Lundin R, Giaquinto C, Zangardi T, Rampon O
Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy.
Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, Padua, Italy.
Case Rep Pediatr. 2018 Apr 1;2018:1679306. doi: 10.1155/2018/1679306. eCollection 2018.
We performed a review of published case studies of osteomyelitis associated with cat-scratch disease to consolidate existing information on clinical presentation, diagnostic tools, therapy, and outcome, as well as presenting a case of disseminated cat-scratch disease in a 12-year-old female with skull osteomyelitis and spleen involvement.
A search for articles indexed in PubMed, Embase, and Google Scholar was performed with the search terms "," "bone," "osteomyelitis," "osteolytic," and "cat-scratch disease" limited to the immunocompetent pediatric population and articles in English.
51 cases were identified. The average age was 7.8 years with equal sex distribution. Fever (84.3%), often with a prolonged course (64.7%), and osteoarticular pain (88.2%) were the most common clinical findings. Lymphadenopathy was present in 64.7% of patients. Vertebral body was mainly involved (51.9%). MRI (50%) and bone scintigraphy (48.1%) were favored to confirm osteomyelitis, while serology was the preferred microbiological diagnostic. Various antibiotics were prescribed in combined or sequential regimens, with median duration of therapy of 23 days. About 12.5% of patients did not receive any treatment. Most patients had excellent prognosis; in particular, all patients not receiving any therapy showed complete recovery and no recurrence of symptoms.
should be considered in differential diagnosis of localized lymphadentitis. Osteoarticular pain or limitation during cat-scratch disease in children should always be investigated for bone spreading. Owing to good prognosis, invasive procedures to obtain the bone material should be avoided. Serology is the gold standard diagnostic tool and MRI is the best radiographic technique to define bone and surrounding tissue involvement. Treatment represents a never-ending dilemma: surgical intervention or use of antibiotics is still controversial, and more studies are needed to define the best antimicrobial regimen.
我们对已发表的与猫抓病相关的骨髓炎病例研究进行了综述，以整合有关临床表现、诊断工具、治疗及预后的现有信息，并报告一例12岁患颅骨骨髓炎和脾脏受累的播散性猫抓病女性病例。
在PubMed、Embase和谷歌学术中检索索引文章，检索词为“猫抓病”“骨”“骨髓炎”“溶骨性”，检索限于免疫功能正常的儿科人群及英文文章。
共识别出51例病例。平均年龄为7.8岁，性别分布均衡。发热（84.3%），通常病程较长（64.7%），以及骨关节疼痛（88.2%）是最常见的临床表现。64.7%的患者存在淋巴结病。椎体是主要受累部位（51.9%）。MRI（50%）和骨闪烁显像（48.1%）有助于确诊骨髓炎，而血清学是首选的微生物学诊断方法。采用联合或序贯方案使用了各种抗生素，中位治疗疗程为23天。约12.5%的患者未接受任何治疗。大多数患者预后良好；特别是，所有未接受任何治疗的患者均完全康复且症状未复发。
在局限性淋巴结炎的鉴别诊断中应考虑猫抓病。儿童猫抓病期间的骨关节疼痛或活动受限应始终排查是否存在骨扩散。鉴于预后良好，应避免采用侵入性方法获取骨材料。血清学是金标准诊断工具，MRI是界定骨及周围组织受累情况的最佳影像学技术。治疗仍然是一个无休止的难题：手术干预或使用抗生素仍存在争议，需要更多研究来确定最佳抗菌方案。
