Cat scratch disease in childhood: a 10-year experience of an Italian tertiary care children's hospital

Cat scratch disease (CSD), an infection caused by Bartonella henselae, is uncommon in Europe, whereas 24,000 cases per year have been reported in the United States [1, 2]. The typical manifestation of CSD consists of fever and subacute, solitary or regional, painful and self-limited lymphadenopathy in a patient with a history of previous scratching, biting, or contact with a kitten or cat [3]. In 85% of patients, only one regional lymph node is involved, which is located in the axillary and epitrochlear regions in approximately half of the cases [4, 5]. One or more round, red-brown nontender papules can develop at the inoculation site or near the scratch after a few days and may persist until two to three weeks [6]. B. henselae may cause, as a result of hematogenous diffusion, systemic CSD presenting as fever of unknown origin (FUO) without nodal involvement, hepatic and splenic abscesses, endocarditis, osteomyelitis, granulomatous conjunctivitis and neuroretinitis. The lack of connection with the vector can make the diagnosis of systemic CSD very difficult [3]. Moreover, the heterogeneity of CSD clinical manifestations could make it mistakenly confused with more serious conditions, such as lymphoproliferative disorders, thus delaying appropriate treatment [7, 8]. The usefulness of antibiotic therapy is debated, because in the majority of cases, CSD resolve spontaneously. However, in systemic CSD, antibiotic therapy seems to reduce the length of the disease [9, 10].