696. Epidemiology, clinical manifestations, and outcomes of Bartonella henselae infection in children
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
Background: Cat scratch disease (CSD) is a zoonotic illness caused by Bartonella henselae. Limited contemporary data from large pediatric series are available on the epidemiology, clinical manifestations, and outcomes of CSD.

Methods: This is a retrospective record review of children diagnosed with CSD who were evaluated in the Emergency Center (EC) or admitted at Texas Children’s Hospital (TCH) from 1/1/10 to 12/31/15.

Results: 130 patients with CSD required 80 EC visits and 93 admissions (7 ICU). Mean age was 8.1 yrs (1.3-17.9 yrs), and 74 patients (57%) were male. Seventy-four patients (57%) presented in July-September. 103 (79%) had cat exposure documented (34% with scratches), and 5 had family members with recent CSD. Common presenting symptoms included lymphadenopathy (77%), fever (55%), and abdominal pain (21%).

115 patients (88%) had positive serology and 26 (20%) had positive Bartonella PCR. Thirty patients underwent biopsy; necrotizing granulomatous inflammation was the most common finding followed by suppurative necrosis and reactive lymphoid tissue.

83 patients (64%) presented with lymphadenitis: cervical/ submental 27, axillary 19, inguinal 14, epitrochlear 13, pre/postauricular 6, supraclavicular 3, and infraclavicular 1. Nineteen (23%) underwent incision and drainage (I&D). Of those with documented follow-up (34), the average time to resolution with trimethoprim/sulfamethoxazole (TMP/SMX) or azithromycin therapy was 7.3 wks (2-16 wks) vs. 8 wks (3-16 wks) with no therapy (NS). Time to resolution after I&D was 4 wks (2.5-10 wks) (p=0.02).

Other presentations included: 11 hepatosplenic (HS) CSD, 9 systemic febrile illness/ fever of unknown origin (FUO), 9 meningoencephalitis (7 status epilepticus, 2 ataxia), 7 neuroretinitis, 5 myositis/ soft tissue mass, 3 Parinaud oculoglandular syndrome, 2 vertebral osteomyelitis, and 1 pulmonary nodules. Mean duration of fever for HS-CSD and FUO was 45 days (8-90 days). All patients with HS-CSD received therapy with azithromycin + rifampin, doxycycline + rifampin, or TMP/SMX +/- rifampin. Only 4 patients with meningoencephalitis returned to baseline prior to discharge; others improved by 3-6 months post-infection. Five neuroretinitis patients had sequelae at 1 year after diagnosis.

Conclusion: CSD is common with a wide variety of clinical presentations and can cause significant morbidity in children.

Meggie Hixson, MD1, Norma Quintanilla, MD1 and Claire E. Bocchini, MD2, (1)Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (2)Pediatrics, Section of Infectious Disease, Baylor College of Medicine and Texas Children's Hospital, Houston, TX


M. Hixson, None

N. Quintanilla, None

C. E. Bocchini, None

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