Figure 2
Geographic distribution of cat-scratch disease cases by US census division, United States, 2005-2013. Rates are reported as average incidence per 100,000 population per year. During the study period, there were <10 cases in Alaska and <10 cases in Hawaii.
Source publication
Cat-scratch disease (CSD) is mostly preventable. More information about the epidemiology and extent of CSD would help direct prevention efforts to those at highest risk. To gain such information, we reviewed the 2005-2013 MarketScan national health insurance claims databases and identified patients <65 years of age with an inpatient admission or ou...
Contexts in source publication
Context 1
... was highest in the West South Central, East South Central, and South Atlantic divisions (6.1-6.4 cases/ 100,000 population) and lowest in the more arid Mountain division, where cat fleas are less common (2.2 cases/100,000 population) (Figure 2). The highest overall proportion of cas- es occurred in the South Atlantic division (26.3%), followed by the West South Central division (19.7%). ...
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Background
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Background and purpose — Cat scratch disease (CSD) is a self-limiting disease caused by Bartonella (B.) henselae. It is characterized by granulomatous infection, most frequently involving lymph nodes. However, it can present with atypical symptoms including musculoskeletal manifestations, posing a diagnostic challenge. We describe the prevalence an...
Systemic Bartonella henselae infection, also known as cat-scratch disease (CSD), presents a diagnostic challenge due to the variability of clinical manifestations and the potential for serological cross-reactivity with other organisms. This study aimed to retrospectively analyze the epidemiological, clinical, laboratory, and imaging characteristics...
Background:
Cat-scratch disease (CSD) is a zoonotic infection caused by Bartonella henselae and B. clarridgeiae. The typical manifestations of CSD include regional lymphadenitis and fever. However, CSD can have a wide variety of clinical manifestations that can lead to incorrect diagnoses and prolonged hospital stays.
Case presentation:
We prese...
Citations
... У США захворюваність становить 10:100000 населення і щорічно через неї звертаються амбулаторно по лікарську допомогу 22-25 тисяч хворих, а 2 тисячі потребують стаціонарного лікування із показником госпіталізації 0,86/100000 [7]. Нерідко захворювання фіксується в Україні, однак статистичні дослідження не проводяться. ...
Збудником хвороби котячої подряпини є Bartonella henselae., основним проявом якої є лімфоаденопатія, яка може проявлятися бацилярним ангіоматозом, ураженням внутрішніх органів, суглобів, очей, серця, нирок. Дане захворювання часто зустрічається в практичній роботі лікарів, проте при атиповій формі, яка спостерігається у 20% пацієнтів населення буває вчасно недіагностована, імітує лімфоаденопатії спричинені пухлинами м`яких тканин та кісток, іншими бактерійними збудниками. Причинами запізнілої діагностики та лікування хвороби котячої подряпини часто буває недостатній збір епіданамнезу, відсутність настороженності лікарів, насамперед, хірургів щодо клінічних проявів хвороби та пізнє проведення обстежень для з’ясування етіологічного чинника захворювання. Інфікування Bartonella henselae варто враховувати в усіх випадках лімфаденіту нез’ясованої етіології, що супроводжується підвищеною температурою тіла, інтоксикаційним синдромом та тривалим перебігом. Для запобігання розвитку гнійних ускладнень, уникнення необгрунтованих інвазивних процедур, важливим є своєчасна діагностика та проведення відповідного антибактерійного лікування на початковому етапі маніфестації клінічних проявів хвороби котячої подряпини.
... They also noted that highly bacteremic cats, in absence of fleas, were unable to infect SPF cats [24]. The seasonality of CSD diagnosis, interestingly, has also been extensively studied by Nelson A., Saha S. and Mead P. in the United States spanning from 2005 to 2013 [25]. It was observed that the largest proportion of CSD diagnosis was made during January, followed by August and November, which they attributed to adoption pattern and age susceptibility of kittens, and peaking of fleas during fall and winter [26]. ...
Cat scratch disease (CSD) is caused by Bartonella henselae (B. henselae) and presents as lymphadenopathy following close contact with cats. However, in context of the global COVID-19 pandemic, clinical manifestations of CSD may vary, posing new challenges for healthcare professionals. Here we describe a case of a 54-year-old male with painful left upper arm mass, which gradually resolved until he was infected with COVID-19. The mass then rapidly progressed before admission. Meanwhile, pulmonary symptoms including pleural effusion emerged simultaneously. The cause was undetermined with routine blood culture and pathological test until the next generation sequencing (NGS) confirmed the presence of B. henselae. We believe this case is the first to report localized aggravation of CSD after COVID-19 infection and hopefully, offers treatment experience for clinicians worldwide.
... In 85-90% of cases, regional lymphadenopathy is the characteristic clinical sign of Bartonella infection, which is a benign self-limiting illness [3,5,6]. About one-third of the time, lymphadenopathy is accompanied by other symptoms such as fever, malaise, headache, nausea, and stomach discomfort. ...
Systemic Bartonella henselae infection, also known as cat-scratch disease (CSD), presents a diagnostic challenge due to the variability of clinical manifestations and the potential for serological cross-reactivity with other organisms. This study aimed to retrospectively analyze the epidemiological, clinical, laboratory, and imaging characteristics of pediatric patients diagnosed with systemic B. henselae infection, to improve understanding and facilitate timely diagnosis and treatment. We conducted a 10-year retrospective study at the “Louis Turcanu” Children’s Emergency Hospital and private clinics in Timisoara, Romania, reviewing records for confirmed cases of B. henselae infection from January 2014 to January 2024. The study adhered to the Declaration of Helsinki and received approval from the Institutional Review Board. Diagnostic criteria included contact with animals, prolonged fever, hematological and/or hepatosplenic manifestations, and positive serological tests for B. henselae. Nineteen pediatric patients were identified with a median age of 8.1 years. The majority were exposed to felines (94.7%), reflecting the disease’s epidemiological profile. Clinical findings highlighted fever (47.4%), lymphadenopathy (78.9%), and less frequently, abdominal pain and headache (both 10.5%). Laboratory analyses revealed a mean hemoglobin of 12.6 mg/dL, WBC count of 13.1 × 103 cells/microliter, and platelet count of 340.6 × 103 per microliter. Significant findings included elevation in ESR and CRP in 47.4% and 21.1% of patients, respectively, and high seropositivity rates for B. henselae IgM (63.2%) and IgG (94.7%). Imaging studies demonstrated widespread lymphadenopathy and occasional splenomegaly and hepatic microabscesses. All patients received antibiotic therapy, with azithromycin being the most commonly used (94.7%). Co-infections with Epstein–Barr Virus, Cytomegalovirus, and Toxoplasma gondii were documented, indicating the complex infectious status of the patients. Systemic B. henselae infection in children predominantly manifests with fever and lymphadenopathy, with a significant history of exposure to felines. Laboratory and imaging findings support the diagnosis, which is further complicated by potential co-infections. Effective antibiotic therapy, primarily with azithromycin, underscores the need for comprehensive diagnostic and treatment strategies. This study emphasizes the importance of considering systemic B. henselae infection in pediatric patients with prolonged fever and contact with cats, to ensure timely and appropriate treatment.
... Pathogen epidemiology and phylogenetics C. felis-associated Bartonella displays a geographic distribution similar to that of C. felis, with increased flea and bartonellosis prevalence in areas of higher temperature and humidity [72][73][74][75] (reviewed in [73]). Phylogenetic analysis historically utilizes multiple locus sequence typing (MLST), the sequencing of multiple molecular markers [e.g., rpoB, gltA, and 16S-23S intergenic spacer (ITS)] from pure culture, vector, or host samples for comparison with known sequences [75]. ...
... Pathogen epidemiology and phylogenetics C. felis-associated Bartonella displays a geographic distribution similar to that of C. felis, with increased flea and bartonellosis prevalence in areas of higher temperature and humidity [72][73][74][75] (reviewed in [73]). Phylogenetic analysis historically utilizes multiple locus sequence typing (MLST), the sequencing of multiple molecular markers [e.g., rpoB, gltA, and 16S-23S intergenic spacer (ITS)] from pure culture, vector, or host samples for comparison with known sequences [75]. ...
Ctenocephalides felis, the cat flea, is among the most prevalent and widely dispersed vectors worldwide. Unfortunately, research on C. felis and associated pathogens (Bartonella and Rickettsia spp.) lags behind that of other vectors and vector-borne pathogens. Therefore, we aimed to review fundamental aspects of C. felis as a vector (behavior, epidemiology, phylogenetics, immunology, and microbiome composition) with an emphasis on key techniques and research avenues employed in other vector species. Future laboratory C. felis experimental infections with Bartonella, Rickettsia, and Wolbachia species/strains should examine the vector-pathogen interface utilizing contemporary visualization, transcriptomic, and gene-editing techniques. Further environmental sampling will inform the range and prevalence of C. felis and associated pathogens, improving the accuracy of vector and pathogen modeling to improve infection/ infestation risk assessment and diagnostic recommendations. C. felis and associated bacteria As of 14 November 2023, a PubMed search for the term 'flea' returned only 6167 results compared with 'tick' (42 916 results) and 'mosquito' (69 994 results). This almost sevenfold disparity between flea and tick research reflects a lack of funding from the National Institutes of Health (NIH) dedicated to flea and flea-borne pathogen research (Figure 1), despite fleas infesting more cats and dogs worldwide and serving as the vector for multiple zoonotic pathogens [1]. C. felis is the most common flea infesting domestic cats and dogs around the world [2,3], and is well appreciated as the cause of flea allergy dermatitis (FAD), yet it remains underappreciated as the vector of multiple zoonotic Bartonella and Rickettsia species [4-7]. Therefore, we aim to review the behavior, anatomy, immunology, and microbiome of C. felis as well as C. felis and pathogen epidemiology and phylogenetic diversity to identify future directions in C. felis research, highlighting key findings and techniques utilized in other vector species that may be adapted to C. felis and associated pathogen research efforts. The C. felis life cycle begins with egg laying, followed by larval development, pupation, and finally adult emergence. Adult C. felis of both sexes are hematophagous (see Glossary) and reside on the host. The larval C. felis diet consists primarily of adult flea feces. C. felis is known to transmit bacterial pathogens from two genera: Bartonella and Rickettsia. Three Bartonella spp. are transmitted by C. felis (Bartonella henselae, Bartonella clarridgeiae, and Bartonella koehlerae), all of which utilize the cat as a reservoir host [5,6,8]. Horizontal transmission from an infected cat to a naive flea is the only confirmed source of C. felis infection with Bartonella [4]. Medically, B. henselae is the best described of these species, typically causing self-limiting cat scratch disease. Atypical manifestations in humans and other mammals have been reviewed previously (Figure 2) [9-11]. Stercorarian transmission via inoculation with flea feces is likely the primary mode of infection for mammals, as transmission by C. felis saliva or regurgitation during feeding are unconfirmed [12,13]. Laboratory C. felis has been successfully colonized by Bartonella birtlesii, Bartonella tribocorum, and Bartonella quintana Highlights Ctenocephalides felis is among the most prevalent vector species and transmits multiple zoonotic Bartonella and Rickettsia spp. Research regarding C. felis and pathogen biology, including the response to environmental conditions, is necessary to understand disease risk and epidemiology. The diversity of C. felis and associated bacterial species is high and the impact on pathogen transmission and C. felis survival is unknown. Implementing contemporary visualiza-tion, DNA and RNA sequencing, and ge-nomic/transcriptomic manipulation is necessary to expand our understanding of the C. felis-pathogen interaction.
... CSD leads to approximately 12, 000 outpatient diagnoses and 500 hospitalizations annually in the United States. The highest incidence of CSD is observed in southern United States (0.0064%), especially among children aged 5-9 years (0.0094%) [9]. Nonetheless, the incidence of trench fever caused by B. quintana has dropped considerably since World War I. Currently, it is primarily associated with homelessness, alcoholism, destitution, and unfavourable living conditions, particularly in terms of health and hygiene, within the marginalized population of developed nations [10][11][12]. ...
Gram-negative Bartonella species are facultative intracellular bacteria that can survive in the harsh intracellular milieu of host cells. They have evolved strategies to evade detection and degradation by the host immune system, which ensures their proliferation in the host. Following infection, Bartonella alters the initial immunogenic surface-exposed proteins to evade immune recognition via antigen or phase variation. The diverse lipopolysaccharide structures of certain Bartonella species allow them to escape recognition by the host pattern recognition receptors. Additionally, the survival of mature erythrocytes and their resistance to lysosomal fusion further complicate the immune clearance of this species. Certain Bartonella species also evade immune attacks by producing biofilms and anti-inflammatory cytokines and decreasing endothelial cell apoptosis. Overall, these factors create a challenging landscape for the host immune system to rapidly and effectively eradicate the Bartonella species, thereby facilitating the persistence of Bartonella infections and creating a substantial obstacle for therapeutic interventions. This review focuses on the effects of three human-specific Bartonella species, particularly their mechanisms of host invasion and immune escape, to gain new perspectives in the development of effective diagnostic tools, prophylactic measures, and treatment options for Bartonella infections.
... Bartonella henselae, B. quintana and B. bacilliformis the most common human pathogens of the genus, with Bartonella henslae contributing to approximately 12,500 infections in the US annually [1]. First defined in 1950, our understanding of the epidemiology of bartonellosis has changed dramatically since diagnostic tests emerged in the mid-1980s and technologies continue to improve diagnosis of this fastidious Gram-negative bacillus ( [2]). Host immune status drives clinical presentation of Bartonella spp. ...
Bartonella spp., renowned for cat-scratch disease, has limited reports of dissemination. Tissue and blood cultures have limitations in detecting this fastidious pathogen. Molecular testing (polymerase chain reaction, PCR) and cell-free DNA have provided an avenue for diagnoses. This retrospective observational multicenter study describes the incidence of disseminated Bartonella spp. and treatment-related outcomes.
Inclusion criteria were diagnosis of bartonellosis via diagnosis code, serology testing of blood, polymerase chain reaction (PCR) of blood, 16/18S tests of blood or tissue, cultures of blood or tissue, or cell-free DNA of blood or tissue from January 1, 2014, through September 1, 2021. Exclusions were patients who did not receive treatment, insufficient data on treatment course, absence of dissemination, or retinitis as dissemination.
Patients were primarily male (n = 25, 61.0%), white (n = 28, 68.3%), with mean age of 50 years (SD 14.4), and mean Charlson comorbidity index of 3.5 (SD 2.1). Diagnosis was primarily by serology (n = 34, 82.9%), with Bartonella henselae (n = 40, 97.6%) as the causative pathogen. Treatment was principally doxycycline with rifampin (n = 17, 41.5%). Treatment failure occurred in 16 (39.0%) patients, due to escalation of therapy during treatment (n = 5, 31.3%) or discontinuation of therapy due to an adverse event or tolerability (n = 5, 31.3%).
In conclusion, this is the largest United States-based cohort of disseminated Bartonella spp. infections to date with a reported 39% treatment failure. This adds to literature supporting obtaining multiple diagnostic tests when Bartonella is suspected and describes treatment options.
... In both cats and humans, infection primarily occurs following a cat scratch, since multiplied bacteria from flea feces contaminate the cat's claws and then enter the injured skin [2,14,17]. Humans exposed to infected cats can develop catscratch disease [3,4,10,15,16]. Ticks are also recognized as possible vectors of Bartonella spp. [3,5,10], but there is currently no consensus on the ability of Ixodes ricinus ticks to transmit B. henselae to cats [8,[12][13][14][15]70]. ...
... Both cats and humans were diagnosed in the autumn and winter. Two of the three patients were minors (12 and 16 years old), consistent with the greater prevalence of cat-scratch disease among children and young people [10,16,31,32,55]. ...
Background
Cats are the primary reservoirs of the bacterium Bartonella henselae, the main cause of cat-scratch disease in humans. The main vector of the bacterium is the cat flea, Ctenocephalides felis. In southeastern Europe, data are lacking on the prevalence of B. henselae infection in cats, the strains of B. henselae involved and the risk factors associated with the infection.
Methods
Blood samples collected in ethylenediaminetetraacetic acid-containing tubes from 189 domestic cats (156 pet cats and 33 stray cats) from Zagreb, the capital city of Croatia, and 10 counties throughout Croatia were cultured for Bartonella spp. Following culture, bacterial isolates were genotyped at eight loci after using PCR to amplify 16S ribosomal RNA (rRNA) and the internal transcribed spacer region between the 16S and 23S rRNA sequences. Univariate and multivariate logistic regression were used to identify risk factors for B. henselae infection in cats.
Results
Bartonella spp. was detected in 31 cats (16.4%), and subsequent genotyping at the eight loci revealed B. henselae in all cases. Thirty complete multilocus sequence typing profiles were obtained, and the strains were identified as four sequence types that had been previously reported, namely ST5 (56.7%), ST6 (23.3%), ST1 (13.3%) and ST24 (3.3%), as well as a novel sequence type, ST33 (3.3%). The univariate analysis revealed a significantly higher risk of B. henselae infection in cats residing in coastal areas of Croatia (odds ratio [OR] 2.592, 95% confidence interval [CI] 1.150–5.838; P = 0.0191) and in cats with intestinal parasites (OR 3.207, 95% CI 1.088–9.457; P = 0.0279); a significantly lower risk was identified in cats aged > 1 year (OR 0.356, 95% CI 0.161–0.787; P = 0.0247) and in cats sampled between April and September (OR 0.325, 95% CI 0.147–0.715; P = 0.005). The multivariate analysis that controlled for age showed a positive association with the presence of intestinal parasites (OR 4.241, 95% CI 1.243–14.470; P = 0.0119) and coastal residence (OR 2.567, 95% CI 1.114–5.915; P = 0.0216) implying increased risk of infection, and a negative association with sampling between April and September (OR 0.379, 95% CI 0.169–0.848; P = 0.018) implying a decreased risk of infection. After controlling for the season, an increased risk of infection remained for the coastal region (OR 2.725, 95% CI 1.200–6.186; P = 0.012).
Conclusions
Bartonella henselae is prevalent throughout Croatia and is a public health threat. Environmental and host factors can significantly affect the risk of infection, and these should be explored in more detail. The presence of intestinal parasites highlights the need to eliminate the flea vector, Ctenocephalides felis, as the most effective approach to control infections in cats and humans.
Graphical Abstract
... 2 Among adults, the highest incidence was found among women aged 60-64 years (6.6 cases/100,000 for outpatients and 0.3 cases/100,000 for inpatients). 4 In immunocompetent patients, subacute regional lymphadenopathy and fever are common findings, which were absent in our 11 Timely diagnosis of ICC is often challenging because of its silent clinical characteristics and low specificity of imaging modalities. Early-stage ICC may be asymptomatic, while at more advanced stages patients may experience weight loss, abdominal discomfort, malaise, jaundice, hepatomegaly, or a palpable mass. ...
Cat-scratch disease (CSD) is a bacterial infection which primarily transmitted to humans through scratches, bites, or licks from infected cats. Even though CSD is generally a mild condition, atypical symptoms may appear and must be distinguished from other diseases. We encountered a 57-year-old woman who presented with intermittent pain in the right upper quadrant and epigastric part of the abdomen, and had lost 11 kg within a few months. She never had a cat and did not recall being scratched by a cat. Radiologic examinations strongly suggest a malignant bile duct tumor, thus liver resection was done. However, the result of histopathology was a CSD. At follow-up, the patient was stable and also showed improvement in her general condition. Hence, proper preoperative examinations of the patients are crucial in order to avoid excessive or inadequate treatment.
... habitantes na população adulta e de 9,4 casos/100.000 em crianças de 5 a 9 anos de idade 8,9 . No Brasil, a incidência é desconhecida e o número de casos é subestimado 1,10 . ...
... As medidas de prevenção constituem-se no controle das pulgas dos gatos, educação em saúde, higiene das mãos após contato com os felinos e a supervisão das crianças durante as brincadeiras com os animais de estimação 2,8 . ...
INTRODUCTION: Cat Scratch Disease (CSD) presents most commonly with fever and lymphadenopathy, but up to 25% of cases develop systemic manifestations. OBJECTIVE: to report a pediatric case of hepatosplenic form of CSD. METODOLOGY: this is a case report of a nine-year-old child hospitalized from October to November 2019. The report was written based on medical records and literature review, through Pubmed platform. Informed consent was given by the legal sponsor and the assent by the child. RESULT: a nine-year-old girl presents with swollen, tender and erythematous nodes in the right popliteal fossa and fever. Initial suspicion was of cellulitis, complicated with a popliteal abscess. Treatment was initiated with oxacillin for 3 days and later on with clindamycin and ceftriaxone for 11 days. On the eleventh day of hospital stay, the patient manifested hepatosplenic abscesses and antibiotic treatment was upscaled to vancomycin and piperacillin-tazobactam until she was diagnosed with a hepatosplenic form of CSD, which happened seventeen days after admission. Therefore, treatment was provided with Rifampicin and Clarithromycin for 14 days, with significant clinical improvement. CONCLUSION: this report aims to raise awareness regarding the wide clinical spectrum of this infection and how to better manage it.
... У США захворюваність становить 10:100000 населення і щорічно через неї звертаються амбулаторно по лікарську допомогу 22-25 тисяч хворих, а 2 тисячі потребують стаціонарного лікування з показником госпіталізації 0,86/100000 [7]. Нерідко захворювання фіксується в Україні, однак статистичні дослідження не проводяться. ...
Bartonella henselae is the causative agent of cat scratch disease, the main manifestation of which is lymphadenopathy, but it can manifest as bacillary angiomatosis, injury to internal organs, joints, eyes, heart, kidneys. This disease is often encountered in the practical work of doctors, especially with an atypical form of the course, which occurs in 20% of adult patients. Often the disease is undiagnosed, mimicking lymphadenopathies caused by tumors of soft tissues and bones or other bacterial pathogens. The purpose of the work was to analyze clinical cases of cat scratch disease by the results of inpatient records data based on the leading clinical symptom – lymphadenitis, to summarize literature data related to morbidity, features of the clinical course and treatment of this disease. The description of two clinical cases of cat scratch disease in adult women aged 19 and 59 is given. The typical course of the disease in one of them at the beginning of the disease, was manifested by symptoms of general intoxication, fever, an increase in lymph nodes in the neck and axillary area, which coincided in time with the previously diagnosed bacterial angina. The diagnostic search ended with the set diagnosis and surgical operation three months after the onset of clinical manifes¬tations of the disease. In the second case, a subfebrile body temperature, a painful lymph node in the right axillary area for 3 weeks, were the reason to perform an invasive surgery twice, diagnosed as a bacterial process of unknown etiology. The reasons for late diagnosis and treatment of cat scratch disease in our patients were insufficient collection of epi¬demiological anamnesis, lack of vigilance of doctors, first of all, surgeons, regarding the clinical manifestations of the disease and late examination to find out the etiological factor of the disease. An elevated titer of IgM antibodies to Bartonella henselae 1:160 and 1:140 in two cases was the basis for confirming cat scratch disease. Based on the results of the literature analysis, an overview of typical and atypical manifestations of cat scratch disease, its diagnosis and treat¬ment is presented. Bartonella henselae infection should be considered in all cases of lymphadenitis of unknown etiology, accompanied by high temperature, intoxication syndrome and a long course. In order to prevent the development of purulent complications and to avoid unreasonable invasive procedures, it is important to make a timely diagnosis and carry out appropriate antibacterial treatment at the initial stage of the manifestation of clinical symptoms of cat scratch disease.
