Cat-scratch disease in Hawaii: etiology and seroepidemiology.
OBJECTIVE
To study the etiology and seroepidemiology of cat-scratch disease (CSD) in Hawaii.


METHODS
Blood and fine-needle aspirate (FNA) from the lymph nodes of 39 consecutive patients with clinical CSD were cultured for Bartonella henselae, and blood samples from index cats, stray cats, and dogs were cultured and their sera were tested by indirect fluorescence antibody test for antibodies to B. henselae and Afipia felis. Sera from age- and sex-matched human subjects without cat exposure served as controls.


RESULTS
Warthin-Starry staining showed positive results in only 4 of 32 FNAs, and B. henselae was isolated from only one FNA specimen. All of 38 patients who had two or more sera tested had elevated titers of antibody to B. henselae. Only 1 of 48 human control sera had antibody to B. henselae. Of 31 kittens, 21 had positive blood culture results and elevated antibody titers to B. henselae. Of three adult cats, all had negative blood culture results, but they had serologic evidence of past infection. Of 23 adult stray cats, 18 had elevated titers of antibody to B. henselae, but in only one was the blood culture result positive. Results of IFA tests were marginally positive for A. felis in 1 of 29 patients with CSD and in one adult stray cat and one dog.


CONCLUSIONS
This study shows that the B. henselae IFA test is both highly sensitive and specific for the detection of infection caused by B. henselae and for the laboratory diagnosis of CSD, and that FNA is seldom helpful in confirming the diagnosis. We further demonstrated that CSD in Hawaii is due to B. henselae and that infection is directly linked to the scratch or bite of a kitten. Older cats seldom have bacteremia but often have serologic evidence of past infection. Our study fails to implicate dogs in the epidemiology of CSD in Hawaii, and A. felis was not etiologically implicated in CSD in the human subjects and animals we studied.
Demers
D M
DM
Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii 96859-5000.
Bass
J W
JW
Vincent
J M
JM
Person
D A
DA
Noyes
D K
DK
Staege
C M
CM
Samlaska
C P
CP
Lockwood
N H
NH
Regnery
R L
RL
Anderson
B E
BE
D000293:Adolescent; D000328:Adult; D000818:Animals; D001473:Bartonella / Q000276:immunology / Q000302:isolation & purification; D002372:Cat-Scratch Disease / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D002415:Cats; D002648:Child; D002675:Child, Preschool; D004285:Dogs; D005260:Female; D005455:Fluorescent Antibody Technique; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D015994:Incidence; D007223:Infant; D008297:Male; D011446:Prospective Studies; D016036:Seroepidemiologic Studies
D007074:Immunoglobulin G