A previously healthy 10-year-old boy presented with progressive left posterior cervical lymphadenitis following recent COVID-19 infection and kitten exposure. Despite oral cefdinir, he developed persistent fever and enlarging lymph nodes. Imaging showed suppurative/partially necrotic adenitis without drainable collection. Hospital therapy with IV ampicillin–sulbactam and azithromycin led to clinical improvement. Serology later returned with high Bartonella henselae titters, consistent with cat-scratch disease (CSD). He was discharged on oral antibiotics with infectious diseases follow-up and completed a 10-day azithromycin course.
Table of Contents
1. Abstract
2. Patient Information
3. Chronological Timeline
4. History of Present Illness (concise)
5. Examination (representative findings)
6. Investigations
7. Differential Diagnosis
8. Treatment
9. Outcome and Follow-up
10. Key Learning Points
11. Slide-Ready “One-Slide” Summary
12. Discussion
13. Diagnosis
14. Histological Findings in Cat-Scratch Disease (Bartonella henselae)
14.1 Characteristic Histological Features
14.2 Complementary Techniques
15. Differential Diagnosis and Considerations
16. Outcome and Follow-Up
Objectives & Research Topics
The primary objective of this clinical report is to illustrate the diagnostic and therapeutic approach to pediatric cervical lymphadenitis caused by Bartonella henselae. It seeks to highlight the necessity of including Cat-Scratch Disease (CSD) in the differential diagnosis for persistent pediatric lymphadenopathy, especially when a history of kitten exposure is present, and to demonstrate the efficacy of targeted antimicrobial therapy.
- Clinical presentation of CSD in a pediatric patient with recent COVID-19 history.
- Role of imaging (ultrasound) in characterizing lymph node necrosis and excluding abscesses.
- Importance of serological testing for confirming Bartonella henselae infection.
- Treatment strategies, including the use of azithromycin as first-line therapy.
- Differential diagnosis considerations for persistent pediatric cervical lymphadenitis.
Excerpt from the Book
Discussion
Cat scratch disease (CSD) is a zoonosis caused by Bartonella henselae, which is primarily transmitted through scratches or bites by kittens, often through contamination with flea feces (CDC, 2024). The CDC has a worldwide distribution, and feline infection varies widely by region (higher in warm, humid climates), with seroprevalence in US domestic cats ranging from 4% to 60% depending on region (e.g., Southeast >50%). In the United States, burden of disease analyses estimate approximately 12,000 outpatient diagnoses and approximately 500 hospitalizations annually, with an incidence of approximately 4–5 per 100,000 person-years and higher rates in southern states; most patients are children younger than 15 years (Nelson et al., 2016; CDC Newsroom, 2016). In Florida, seropositivity has been reported in domestic cats in approximately one-third (≈35%), supporting a substantial local reservoir (Jameson et al., 1995).
While most pediatric cases are self-limited, moderate to severe presentations with persistent fever, suppurative or necrotic lymphadenitis, or systemic involvement warrant targeted therapy (StatPearls, 2023). Current recommendations include azithromycin as first-line treatment, supported by an RCT showing more rapid lymph node volume reduction, and aligned dosing guidance (Bass et al., 1998; CDC, 2024). Severe or complicated disease may require broader, or combination regimens tailored to location and severity (e.g., doxycycline-based combinations in selected settings) (NIH OI Guidelines, 2023; StatPearls, 2023). This case underscores the need to consider CSD in persistent pediatric cervical lymphadenitis, especially in regions with robust feline reservoirs, and the importance of early recognition plus appropriate antimicrobial therapy to prevent complications.
Summary of Chapters
Abstract: Provides a concise overview of the case report involving a 10-year-old boy diagnosed with Cat-Scratch Disease.
Patient Information: Outlines the demographic and clinical background of the patient.
Chronological Timeline: Tracks the progression of symptoms, testing, and treatment steps from August to September 2025.
History of Present Illness (concise): Summarizes the clinical history of progressive neck swelling and fever following kitten exposure.
Examination (representative findings): Describes the physical assessment of the patient's cervical lymphadenopathy.
Investigations: Details the hematological, microbiological, serological, and imaging findings utilized for diagnosis.
Differential Diagnosis: Discusses alternative diagnostic considerations such as viral lymphadenitis and bacterial cervical adenitis.
Treatment: Explains the therapeutic plan, including both outpatient and inpatient management.
Outcome and Follow-up: Reports on the clinical improvement and the plan for continued care.
Key Learning Points: Lists five critical takeaways regarding the identification and management of CSD.
Slide-Ready “One-Slide” Summary: A condensed summary format for educational presentation.
Discussion: Analyzes the epidemiology and clinical relevance of Bartonella henselae infections.
Diagnosis: Explains the diagnostic criteria for CSD, focusing on clinical-epidemiological factors and serology.
Histological Findings in Cat-Scratch Disease (Bartonella henselae): Details the pathological features and complementary diagnostic techniques for CSD.
Differential Diagnosis and Considerations: Re-evaluates the diagnostic process and exclusionary criteria for other potential pathologies.
Outcome and Follow-Up: Provides final guidance on post-treatment follow-up and monitoring.
Keywords
Cat-Scratch Disease, Bartonella henselae, cervical lymphadenitis, pediatric, kitten exposure, zoonosis, azithromycin, suppurative lymphadenitis, lymphadenopathy, serology, infectious disease, antibiotic therapy, diagnostic imaging, pediatric medicine, zoonotic infections.
Frequently Asked Questions
What is the primary focus of this clinical report?
The report focuses on a pediatric case of Cat-Scratch Disease (CSD) presenting as progressive left cervical lymphadenitis, detailing the diagnostic journey and treatment outcomes.
What are the central themes discussed in the work?
The central themes include the epidemiology of Bartonella henselae, the importance of clinical suspicion in the context of kitten exposure, diagnostic imaging techniques, and appropriate antimicrobial therapy.
What is the primary goal or research question of the case study?
The goal is to illustrate the importance of early recognition of CSD in children with persistent cervical lymphadenitis to prevent complications through targeted intervention.
Which scientific methods were used to diagnose the patient?
The diagnosis was established through a combination of clinical-epidemiological assessment (kitten exposure), ultrasound imaging, and serological testing for elevated Bartonella henselae titers.
What does the main body of the work cover?
The main body covers the patient's chronological medical history, examination findings, histological characteristics of CSD, treatment regimens, and an extensive discussion on clinical management.
Which keywords best characterize this work?
Key terms include Cat-Scratch Disease, Bartonella henselae, pediatric cervical lymphadenitis, kitten exposure, zoonosis, and azithromycin.
Why was ultrasound crucial in this specific case?
Ultrasound was essential to characterize the lymph node morphology (necrosis) and to confirm the absence of a drainable abscess, which guided the decision to pursue conservative medical management rather than surgical drainage.
How does the recent COVID-19 history complicate the diagnosis?
The recent COVID-19 infection initially clouded the clinical picture, but the progression of lymphadenitis despite standard care necessitated further investigation into zoonotic causes like CSD.
- Quote paper
- Manuel Medina Suárez (Author), Pablo Arango (Author), Amanda Menéndez (Author), Manuel Javier Medina Rodriguez (Author), Helen Aguila (Author), 2025, Cat scratch disease and suppurative cervical lymphadenopathy, Munich, GRIN Verlag, https://www.grin.com/document/1618295
