title: Clinical implication of prolonged fever in children with cat scratch disease.
abstract: Cat scratch disease, caused by Bartonella henselae, typically presents with a localized lymphadenopathy with a brief period of fever and general symptoms. However, there are atypical cases with a wide spectrum of clinical manifestations including prolonged fever (> or =37.5 degrees C, for more than 7 days), or with systemic complication, or without lymphadenopathy. We analyzed relationships among those manifestations in children with cat scratch disease. A total of 127 patients were serologically diagnosed as having Bartonella infection between 1997 and 2003. Relationships among clinical manifestations were analyzed by use of multiple regression and multiple logistic regression analyses. Of the 127 seropositive cases, 75 (59.1%) had typical cat scratch disease and 52 (40.9%) had an atypical one. As atypical manifestations, 46 (36.2%) had prolonged fever, 23 (18.1%) had no lymphadenopathy, and 21 (16.5%) had complications: hepatic/splenic abscesses or low-echoic lesions, hepatic granuloma, and central nervous system involvements. Prolonged fever was observed in 20 (87%) of the 23 cases without lymphadenopathy and 16 (76.2%) of the 21 cases with complications. By multiple regression analysis, the duration of fever was significantly associated with both the absence of lymphadenopathy and the presence of complications. The child suffering from cat scratch disease without lymphadenopathy or with complication tends to have prolonged fever. Conversely, when a child has a prolonged fever of unknown origin, possibility of cat scratch disease should be considered, and a search for underlying systemic complications is recommended for prompt diagnosis and appropriate treatment.
authors.affiliation: Department of Pathology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan. tsujino@yamaguchi-u.ac.jp
authors.forename: Kumiko
authors.initials: K
authors.lastname: Tsujino
authors.forename: Masato
authors.initials: M
authors.lastname: Tsukahara
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Tsuneoka
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ichihara
authors.forename: Tomoko
authors.initials: T
authors.lastname: Furuya
authors.forename: Shigeto
authors.initials: S
authors.lastname: Kawauchi
authors.forename: Atsunori
authors.initials: A
authors.lastname: Oga
authors.forename: Kohsuke
authors.initials: K
authors.lastname: Sasaki
mesh_terms: D000293:Adolescent; D000907:Antibodies, Bacterial / Q000097:blood*; D018416:Bartonella henselae / Q000276:immunology*; D002372:Cat-Scratch Disease / Q000150:complications* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D007223:Infant; D008206:Lymphatic Diseases / Q000209:etiology; D008297:Male; D015999:Multivariate Analysis
chemical_list: D000907:Antibodies, Bacterial