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
- Title & Authors
- Abstract
- Patient Information
- Chronological Timeline
- History of Present Illness (concise)
- Examination (representative findings)
- Investigations
- Differential Diagnosis
- Treatment
- Outcome and Follow-up
- Key Learning Points
- Slide-Ready "One-Slide" Summary
- Discussion
- Diagnosis
- Histological Findings in Cat-Scratch Disease (Bartonella henselae)
- Complementary Techniques
- References
Objective & Thematic Focus
This work fundamentally presents a case report of a previously healthy 10-year-old boy diagnosed with Cat-Scratch Disease (CSD), manifesting as progressive left posterior cervical lymphadenitis following recent COVID-19 infection and kitten exposure. The primary objective is to underscore the importance of considering zoonotic infections, particularly CSD, in the differential diagnosis of persistent pediatric cervical lymphadenitis with cat exposure, and to highlight the value of early recognition and targeted antimicrobial therapy to prevent complications.
- Cat-Scratch Disease (CSD) and its etiology.
- Pediatric cervical lymphadenitis.
- Zoonotic infections, specifically those transmitted by cats.
- Diagnostic methods for CSD, including serology and imaging.
- Antimicrobial therapy and management strategies for CSD.
- The role of concurrent viral infections (e.g., COVID-19) in clinical presentation.
Excerpt from the Book
Cat-Scratch Disease Presenting as Progressive Left Cervical Lymphadenitis in a Child
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 Ol 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
Title & Authors: This section introduces the case report focusing on Cat-Scratch Disease (CSD) presenting as progressive left cervical lymphadenitis in a child, alongside the names of the contributing authors.
Abstract: It provides a concise summary of the case, detailing the patient's presentation, diagnosis of CSD following kitten exposure and COVID-19, and highlights the significance of early diagnosis and targeted therapy.
Patient Information: This part outlines the patient's demographic details, relevant medical history, known allergies, social exposure to kittens, and medications taken prior to hospital admission.
Chronological Timeline: This section presents a detailed, date-ordered sequence of events, clinical findings, laboratory results, and medical management decisions throughout the patient's illness.
History of Present Illness (concise): A brief narrative describing the onset and progression of the patient's neck swelling and fever, initial medical interventions, and the rationale for hospitalization and subsequent improvement.
Examination (representative findings): This segment details the pertinent physical examination findings, specifically focusing on the characteristics of the cervical lymphadenopathy and the patient's overall appearance.
Investigations: This chapter lists the various diagnostic tests performed, including hematology, microbiology, serology for Bartonella henselae, and ultrasound imaging, along with their key results supporting the CSD diagnosis.
Differential Diagnosis: It discusses the other potential causes considered for the patient's symptoms, explaining why Cat-Scratch Disease was ultimately determined to be the most fitting diagnosis.
Treatment: This section describes the specific outpatient and inpatient antibiotic regimens administered to the patient, including intravenous and oral medications, and outlines the discharge treatment plan.
Outcome and Follow-up: It summarizes the patient's clinical and sonographic improvement post-treatment and details the planned follow-up care with infectious disease specialists and the pediatrician.
Key Learning Points: This chapter presents a bulleted list of essential educational takeaways from the case, emphasizing critical considerations for diagnosing and managing CSD in pediatric patients.
Slide-Ready "One-Slide" Summary: A concise, bulleted summary providing the final diagnosis, key clinical clues, and salient imaging findings for quick reference.
Discussion: This comprehensive section elaborates on Cat-Scratch Disease, covering its epidemiology, transmission, incidence, and general treatment guidelines, contextualizing the presented case within broader medical knowledge.
Diagnosis: It details the diagnostic criteria for CSD, including the importance of clinical presentation, cat exposure history, serological testing interpretation, and the utility of ultrasound in characterizing lymphadenopathy.
Histological Findings in Cat-Scratch Disease (Bartonella henselae): This part describes the characteristic microscopic features observed in lymph node biopsies of CSD patients, such as suppurative necrotizing lymphadenitis and granulomas.
Complementary Techniques: It lists additional specialized laboratory methods, like Warthin-Starry silver stain, immunohistochemistry, or PCR, that can be employed to confirm the diagnosis of CSD in complex cases.
References: This section provides a list of academic and clinical sources cited throughout the case report, supporting the medical information and recommendations presented.
Keywords
Cat-Scratch Disease, CSD, Bartonella henselae, Pediatric Lymphadenitis, Cervical Lymphadenopathy, Zoonotic Infection, Azithromycin, Case Report, Kitten Exposure, Suppurative Lymphadenitis, Diagnostic Imaging, Serology, Antimicrobial Therapy, COVID-19, Adenopathy.
Frequently Asked Questions
What is this work fundamentally about?
This work is a case report detailing a pediatric patient who developed progressive cervical lymphadenitis due to Cat-Scratch Disease (CSD) after exposure to kittens, highlighting diagnostic challenges and effective treatment strategies.
What are the central thematic areas?
The central thematic areas include the diagnosis and management of Cat-Scratch Disease, pediatric cervical lymphadenitis, the role of zoonotic infections in human health, and the application of diagnostic imaging and serology in infectious diseases.
What is the primary objective or research question?
The primary objective is to emphasize the importance of considering Cat-Scratch Disease in the differential diagnosis of pediatric cervical lymphadenitis, particularly with a history of cat exposure, and to highlight the benefits of early recognition and targeted antimicrobial therapy to prevent complications.
Which scientific method is used?
This work utilizes a case report methodology, presenting a detailed clinical narrative, diagnostic process, and treatment outcome for an individual patient to illustrate key medical principles and learning points.
What is covered in the main body?
The main body covers the patient's detailed clinical history, physical examination findings, extensive investigations including laboratory and imaging results, the differential diagnosis process, the specific treatment administered, the patient's clinical outcome, and key learning points derived from the case.
Which keywords characterize the work?
Key terms characterizing this work include Cat-Scratch Disease, Bartonella henselae, Pediatric Lymphadenitis, Cervical Lymphadenopathy, Zoonotic Infection, Azithromycin, Case Report, Kitten Exposure, Diagnostic Imaging, and Serology.
What role did the COVID-19 infection play in this patient's presentation?
The recent COVID-19 infection may have complicated the initial presentation by causing persistent fever and elevated inflammatory markers, but it did not alter the main management once Bartonella infection was confirmed as the cause of the lymphadenitis.
Why is azithromycin considered an appropriate first-line therapy for CSD lymphadenitis?
Azithromycin is recommended as first-line therapy for CSD lymphadenitis because it has been shown in clinical trials to accelerate lymph node volume reduction and aligns with established pediatric dosing guidelines.
How does ultrasound aid in the diagnosis and management of CSD?
Ultrasound is crucial in characterizing the lymphadenopathy, helping to distinguish suppurative/necrotic nodes and rule out abscesses, which guides the decision between drainage and continued medical therapy, and also helps monitor treatment response.
What are the key histological findings of Cat-Scratch Disease?
Characteristic histological features of CSD include suppurative necrotizing lymphadenitis with central stellate areas of necrosis, poorly formed granulomas, micro abscesses with neutrophilic infiltrates, and epithelioid cells and histiocytes around necrotic zones.
- Arbeit zitieren
- Manuel Medina Suárez (Autor:in), Pablo Arango (Autor:in), Amanda Menéndez (Autor:in), Manuel Javier Medina Rodriguez (Autor:in), Helen Aguila (Autor:in), 2025, Cat scratch disease and suppurative cervical lymphadenopathy, München, GRIN Verlag, https://www.grin.com/document/1618295
