title: Epidemiology of cat-scratch disease hospitalizations among children in the United States.
abstract: BACKGROUND
  Cat-scratch disease (CSD), caused by infection with Bartonella henselae, affects both children and adults but is principally a pediatric disease. Typical CSD is generally benign and self-limited and is characterized by regional lymphadenopathy with fever. Infections can, however, be accompanied by focal or diffuse inflammatory responses (atypical CSD) involving neurologic, organ (liver/spleen), lymphatic or skeletal systems.
  
  
  METHODS
  Pediatric hospitalizations with CSD listed as a diagnosis were examined using the Kids' Inpatient Database for the year 2000. National estimates of CSD-associated hospitalizations, hospitalization rates and various hospitalization statistics were examined for patients younger than 18 years of age.
  
  
  RESULTS
  During 2000, an estimated 437 (SE 43) pediatric hospitalizations associated with CSD occurred among children younger than 18 years of age in the United States. The national CSD-associated hospitalization rate was 0.60/100,000 children younger than 18 years of age (95% confidence interval, 0.49-0.72) and 0.86/100,000 children younger than 5 years of age (95% CI 0.64-1.07). Accompanying diagnoses included neurologic complications (12%), organ (liver/spleen) involvement (7%) and "other" (5%). Atypical CSD accounted for approximately 24% of the CSD-associated hospitalizations. The median charge for a CSD-associated hospitalization was 6140 dollars with total annual hospital charges of approximately 3.5 million dollars among children in the United States.
  
  
  CONCLUSIONS
  The CSD-associated hospitalization rate among children during 2000 appeared similar to those estimated for the 1980s in the United States, despite significant increases in cat ownership in the intervening time. Early serologic and molecular testing for CSD in children is suggested to minimize unnecessary interventions and promote optimally effective care when supportive measures are required.
authors.affiliation: Viral and Rickettsial Zoonoses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA 30333, USA. nzr6@cdc.gov
authors.forename: Mary G
authors.initials: MG
authors.lastname: Reynolds
authors.forename: Robert C
authors.initials: RC
authors.lastname: Holman
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Curns
authors.forename: Michael
authors.initials: M
authors.lastname: O'Reilly
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: McQuiston
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Steiner
mesh_terms: D000293:Adolescent; D002372:Cat-Scratch Disease / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D013997:Time Factors; D014481:United States / Q000453:epidemiology