Amin Omayma, Rostad Christina A, Gonzalez Mark, Rostad Bradley S, Caltharp Shelley, Quincer Elizabeth, Betke Briana A, Gottdenker Nicole L, Wilson Jonathan J, Shane Andi L, Elmontser Mohnd, Camacho-Gonzalez Andres, Senior Tal, Smith Oliver, Anderson Evan J, Yildirim Inci
Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Department of Clinical Microbiology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Open Forum Infect Dis. 2022 Aug 20;9(9):ofac426. doi: 10.1093/ofid/ofac426. eCollection 2022 Sep.
A more complete understanding of the epidemiology, risk factors, and clinical features of cat scratch disease (CSD) in children could help guide patient care.
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 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.
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, seroprevalence was 12 of 146 (8.2%), all among canines, with a geographic distribution that spanned the state of Georgia.
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.
更全面地了解儿童猫抓病（CSD）的流行病学、危险因素和临床特征有助于指导患者护理。
我们对2010年1月1日至2018年12月31日期间在佐治亚州亚特兰大一家三级儿科医院系统就诊的儿童进行了回顾性分析，这些儿童的血清学、聚合酶链反应和/或细胞病理学结果与巴尔通体感染一致。我们还回顾性审查了2018年至2020年在佐治亚大学进行的兽医诊断结果，以确定该州伴侣动物中巴尔通体病的负担。
我们在9年期间确定了304例CSD儿童，其中8月（304例中的41例，13.5%）和9月（304例中的47例，15.5%）诊断的比例最高。儿童病例的中位年龄为8.1岁（四分位间距[IQR]，5.4 - 12.1）；156例（51.3%）为女性；在有医疗记录记载暴露史的262例中，242例（92.4%）报告有猫接触史；250例中有55例（22%）报告有犬接触史。尽管大多数病例（78.8%）体格检查时有淋巴结病，但缺乏淋巴结病的非典型表现也很常见（304例中的63例，20.7%）。在进行影像学检查的儿童中，55例中有20例（36.4%）有脾肿大，55例中有21例（38.1%）有脾和/或肝微脓肿。在兽医数据中，146例中有12例（8.2%）血清阳性，均为犬，地理分布覆盖佐治亚州。
CSD的特征性临床表现包括夏末学龄儿童的亚急性局部淋巴结病，几乎所有患儿都有猫接触史。CSD的非典型临床表现也很常见。
