Was There an Increase in Cat-scratch Disease in Children During the COVID-19 Pandemic?

Abstract

Background: Cat-scratch disease (CSD) is a zoonotic infection caused by Bartonella henselae that presents as usually local lymphadenopathy and is classified as localized, dissemine (hepatosplenic) or atypical syndrome according to clinical presentation. In this study, we present the cases of CSD that occurred during the COVID-19 pandemic. Methods: This retrospective single-center study was performed between January 2014 and December 2022 and included 23 patients aged <18 years diagnosed with CSD. Results: Among the 23 patients, 86% (n=20) were admitted between 2020 and 2022, had a mean age of 143.82±47.5 months, and 47.8% (n=11) were female. The most common symptoms were lymphadenopathy (87%), fever (8.7%), stomach aches (8.7%), and weight loss (13%). According to the clinical classification of CSD, 82% of the patients had localized CSD, 15% had disseminated CSD, and 0.04% had atypical (uveitis) CSD. Azithromycin therapy was preferred for localized CSD, combination therapy (rifampin or gentamycin) for disseminated CSD, and steroids for uveitis. Overall, the treatment outcomes were favorable, and a curing was achieved in the localized group. Notably, splenic lesions persisted for over 2 years in one patient. Conclusions: Our study highlights the significant emergence of CSD during the COVID-19 pandemic and emphasizes its importance in children. The increase in cases may be attributed to alterations in pet acquisition practices and a surge in outdoor activities after lockdown restrictions were lifted.

Keywords

• Bartonella henselae
• cat-scratch disease
• children
• COVID-19
• lymphadenopathy

COVID-19 Pandemisi Sırasında Çocuklarda Kedi Tırmığı Hastalığı’nda Artış Oldu Mu?

Abstract

Giriş: Kedi tırmığı hastalığı (KTH), Bartonella henselae'nın etken olduğu, genellikle lokal lenfadenopati şeklinde ortaya çıkan ve klinik tabloya göre lokalize, yaygın (hepatosplenik) veya atipik sendrom olarak sınıflandırılan zoonotik bir enfeksiyondur. Bu çalışmada, COVID-19 pandemisi sırasında ortaya çıkan CSD vakalarını sunulmuştur. Yöntemler: Bu retrospektif tek merkezli çalışma Ocak 2014 ile Aralık 2022 tarihleri arasında yürütülmüş olup KTH tanısı alan 18 yaş altı 23 hastay dahil edildi. Bulgular: Hastanın %86'sı (n=20) 2020 ile 2022 yılları arasında başvurmuş olup, ortalama yaşları 143,82±47,5 ay ve hastaların %47,8'i (n=11) kadındı. En sık görülen semptomlar lenfadenopati (%87), ateş (%8,7), mide ağrısı (%8,7) ve kilo kaybı (%13) idi. Klinik sınıflandırmasına göre hastaların %82'sinde lokalize, %15'inde yaygın ve %0,04'ünde atipik KTH vardı. Lokalize KTH için azitromisin tedavisi, yaygın KTH için kombinasyon tedavisi (rifampin veya gentamisin) ve üveit için steroidler tercih edildi. Genel olarak, tedavi sonuçları olumlu ve lokalize grupta kür sağlandığı görülse de bir hastada dalak lezyonları 2 yıldan uzun süre devam etti. Sonuçlar: Çalışmamız, KTH’nın çocuklarda önemini ve COVID-19 pandemisi sırasındaki artışına dikkat çekmektedir. Bu durum evcil hayvan edinme davranışlarındaki değişikliklere ve karantina kısıtlamalarının kaldırılmasından sonra açık hava aktivitelerindeki artışa bağlanabilir.

Keywords

• Bartonella henselae
• kedi tırmığı hastalığı
• çocuklar
• COVID-19
• lenfadenopati.

References

1. 1.Leigh,M., Howard& Kathryn, M. Edwards.Bartonella infections. In: Feigin, R.D., Cherry, J.D.,eds. Textbook of Pediatric Infectious Diseases. 8thed. Philadelphia: Elsevier; 2019:1240-45.
2. 2.Bass JW, Vincent JM, Person DA. The expandingspectrum of Bartonella infections: II. Cat-scratchdisease. Pediatr Infect Dis J. 1997 Feb;16(2):163-79.
3. 3.Klotz SA, Ianas V, Elliott SP. Cat-scratch Disease.Am Fam Physician. 2011;83(2):152-155. PMID:21243990.
4. 4.Zangwill KM, Hamilton DH, Perkins BA, et al. Catscratch disease in Connecticut. Epidemiology, riskfactors, and evaluation of a new diagnostic test. NEngl J Med. 1993 Jul 1;329(1):8-13.
5. 5.Fusani L, Venturini E, Chiappini E, Galli L. Catscratch disease in childhood: a 10-year experienceof an Italian tertiary care children's hospital. WorldJ Pediatr. 2023 Feb;19(2):189-193.
6. 6.Nelson CA, Saha S, Mead PS. Cat-Scratch Disease in the United States, 2005-2013. Emerg Infect Dis.2016 Oct;22(10):1741-6.
7. 7.Uluğ M. Evaluation of Cat Scratch Disease CasesReported from Turkey between 1996 and 2013 andReview of the Literature. Cent Eur J Public Health.2015 Jun;23(2):170-5.
8. 8.Arıcı N, Aksaray S, Ankaralı H. Bartonella henselaeIgM seropositivity in both adult and pediatricpatients with diverse clinical conditions in Turkey.Acta Microbiol Immunol Hung. 2021 Mar 2.

9. 9.Praino ML, Infectologist P, Julia G, et al. 1357.Collateral consequence of COVID pandemic:Increased incidence of cat scratch disease. OpenForum Infect Dis. 2022 Dec 15;9(Suppl2):ofac492.1186.
10. 10.Spach DH, Kaplan SL. Microbiology,epidemiology, clinical manifestations, and diagnosisof cat scratch disease. Uptodate, Ed. Edwards MS,Stout J [updated 2024 Nov]. Available at: (Accessedon Nov 24).
11. 11.Sandoval AC, Reyes FT, Prado MA, Peña AL,Viviani TN. Cat-scratch Disease in the PediatricPopulation: 6 Years of Evaluation and Follow-up in a Public Hospital in Chile. Pediatr Infect Dis J. 2020Oct;39(10):889-893.
12. 12. Rodríguez Alonso B, Alonso-Sardón M, Rodrigues Almeida HM, et al. Epidemiological of cat scratchdisease among inpatients in the Spanish healthsystem (1997-2015). Eur J Clin Microbiol Infect Dis.2021 Apr;40(4):849-857.
13. 13.Deregibus MI, Bagnara EI, Buchovsky A. Cat-scratch disease: Experience in a tertiary care children's hospital. Arch Argent Pediatr. 2023 Feb 1;121(1):e202202592.
14. 14.Florin TA, Zaoutis TE, Zaoutis LB. Beyond catscratch disease: widening spectrum of Bartonellahenselae infection. Pediatrics. 2008May;121(5):e1413-25.
15. 15.Nawrocki CC, Max RJ, Marzec NS, Nelson CA.Atypical Manifestations of Cat-Scratch Disease,United States, 2005-2014. Emerg Infect Dis. 2020Jul;26(7):1438-1446.
16. 16.Margileth AM. Recent Advances in Diagnosis andTreatment of Cat Scratch Disease. Curr Infect DisRep. 2000 Apr;2(2):141-146.
17. 17.Yilmaz C, Ergin C, Kaleli I. PamukkaleUniversitesi Kan Merkezine başvuran donörlerdeBartonella henselae seroprevalansinin araştirilmasive risk faktörlerinin irdelenmesi [Investigation ofBartonella henselae seroprevalence and related riskfactors in blood donors admitted to PamukkaleUniversity Blood Center]. Mikrobiyol Bul. 2009Jul;43(3):391-401. Turkish. PMID: 19795614.
18. 18.Del Pozo AA, Angulo-Cruzado M, Amenero-VegaR, et al. Hepatosplenic abscesses in animmunocompetent child with cat-scratch diseasefrom Peru. Ann Clin Microbiol Antimicrob. 2019 Jul15;18(1):23.
19. 19.Choi JH, Thomas P, Gray JM, et al. Hepatic Lesionsin an Immunocompetent Child Previously Treatedfor Cat Scratch Disease With Azithromycin. ClinPediatr (Phila). 2023 Mar;62(3):191-194.
20. 20.Johnson SC, Kosut J, Ching N. Disseminated CatScratch Disease in Pediatric Patients in Hawai'i.Hawaii J Health Soc Welf. 2020;79(5 Suppl 1):64-70.PMID: 32490388
21. 21.Arisoy ES, Correa AG, Wagner ML, Kaplan SL.Hepatosplenic cat-scratch disease in children:selected clinical features and treatment. Clin InfectDis. 1999 Apr;28(4):778-84.
22. 22.VanderHeyden TR, Yong SL, Breitschwerdt EB, etal. Granulomatous hepatitis due to Bartonellahenselae infection in an immunocompetent patient.BMC Infect Dis. 2012 Jan 23;12:17.
23. 23.Habot-Wilner Z, Trivizki O, Goldstein M, et al.Cat-scratch disease: ocular manifestations andtreatment outcome. Acta Ophthalmol. 2018Jun;96(4):e524-e532.
24. 24.Carithers HA. Cat-scratch disease. An overviewbased on a study of 1,200 patients. Am J Dis Child.1985 Nov;139(11):1124-33.
25. 25.Weiss AH, Beck RW. Neuroretinitis in childhood.J Pediatr Ophthalmol Strabismus. 1989 Jul-Aug;26(4):198-203.
26. 26.Acar A, Çakar Özdal P, Başarır B, et al. A CaseSeries of Cat-Scratch Disease with OcularManifestations: Clinical Findings and TreatmentApproach. Turk J Ophthalmol. 2023 Aug19;53(4):226-233.
27. 27.Kalogeropoulos D, Asproudis I, Stefaniotou M, etal. Bartonella henselae- and quintana-associateduveitis: a case series and approach of a potentiallysevere disease with a broad spectrum of ocularmanifestations. Int Ophthalmol. 2019Nov;39(11):2505-2515.
28. 28.Bass JW, Freitas BC, Freitas AD, et al. Prospective randomized double blind placebo-controlledevaluation of azithromycin for treatment of cat-scratch disease. Pediatr Infect Dis J. 1998Jun;17(6):447-52.
29. 29.Rolain JM, Brouqui P, Koehler JE, et al.Recommendations for treatment of humaninfections caused by Bartonella species. AntimicrobAgents Chemother. 2004 Jun;48(6):1921-33.
30. 30.Liao HM, Huang FY, Chi H, Wang NL, Chen BF.Systemic cat scratch disease. J Formos Med Assoc.2006 Aug;105(8):674-9.