Cat-scratch disease in elderly patients.
BACKGROUND
Cat-scratch disease (CSD) is mostly contracted by children and young adults. To our knowledge, CSD in elderly patients has never been characterized, and it may be underrecognized in this age group.


METHODS
The study population included all patients with CSD diagnosed at our reference laboratory during 1991-2002. Demographic, clinical, and laboratory data for patients with CSD aged >or=60 years (elderly group) were compared with data for patients with CSD aged <60 years (nonelderly group).


RESULTS
There were 846 immunocompetent patients with CSD included in this study. Fifty-two patients (6%) were >or=60 years old. Lymphadenopathy was less common in elderly patients than in nonelderly patients (76.5% vs. 94.4%; P<.001), and general malaise was more frequent in elderly patients (70.8% vs. 51.4%; P=.009). Atypical CSD was more common in elderly patients than in nonelderly patients (32.7% vs. 13.6%), including endocarditis (odds ratio [OR], 61.6; P<.001), encephalitis (OR, 6.3; P=.013), and fever of unknown origin (OR, 7.3; P<.001). The time period from onset of symptoms to diagnosis was >6 weeks for 29.5% of elderly patients versus 13.3% of nonelderly patients (P=.003).


CONCLUSIONS
CSD affects elderly persons as well as nonelderly persons, but clinical features differ between the patient groups. Atypical CSD, including endocarditis, is more frequent in elderly than in nonelderly patients. Conversely, lymphadenitis, the hallmark of typical CSD, is often absent in elderly patients. Lack of awareness among clinicians may delay the diagnosis of CSD in elderly persons and result in unnecessary and often invasive diagnostic procedures.
Ben-Ami
Ronen
R
Infectious Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. rbenami1@zahav.net.il
Ephros
Moshe
M
Avidor
Boaz
B
Katchman
Eugene
E
Varon
Merav
M
Leibowitz
Cecilia
C
Comaneshter
Doron
D
Giladi
Michael
M
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D018416:Bartonella henselae / Q000302:isolation & purification; D002372:Cat-Scratch Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004660:Encephalitis / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D017678:Sex Distribution