Abscess-forming lymphadenopathy and osteomyelitis in children with Bartonella henselae infection.
Bartonella henselae is the agent of cat-scratch disease (CSD), a chronic lymphadenopathy among children and adolescents. A systemic infection is very rare and most of these cases are found in patients with immunodeficiency. Here, cases involving four children of 6-12 years of age are reported. Three of the children had an abscess-forming lymphadenopathy and surrounding myositis in the clavicular region of the upper arm. The diagnosis was made serologically and, in one case, using eubacterial universal PCR. One child was treated with erythromycin for 10 days, the second received cefotaxime and flucloxacillin for 14 days and the third child was not treated with antibiotics. The fourth child had a different course: a significantly elevated signal intensity affecting the complete humerus was found in magnetic resonance imaging, consistent with osteomyelitis. A lymph node abscess was also found in the axilla. Diagnosis was established by indirect fluorescence assay and lymph node biopsy. Antibiotic therapy using clarithromycin, clindamycin and rifampicin was gradually successful. Immunodeficiency was excluded. All described lesions healed without residues. In immunocompetent patients, infection affects skin and draining lymph nodes; however, prolonged fever of unknown origin as in the fourth patient indicated a systemic complication of CSD.
Ridder-Schröter
Regina
R
Children's Hospital, University of Würzburg, 97080 Würzburg, Germany.
Marx
Aleander
A
Institute of Pathology, University of Würzburg, 97080 Würzburg, Germany.
Beer
Meinrad
M
Department of Radiology, Section of Pediatric Radiology, University of Würzburg, 97080 Würzburg, Germany.
Tappe
Dennis
D
Institute of Hygiene and Microbiology, University of Würzburg, 97080 Würzburg, Germany.
Kreth
Hans-Wolfgang
HW
Children's Hospital, University of Würzburg, 97080 Würzburg, Germany.
Girschick
Hermann J
HJ
Children's Hospital, University of Würzburg, 97080 Würzburg, Germany.
D000038:Abscess / Q000382:microbiology*; D018416:Bartonella henselae / Q000472:pathogenicity*; D002372:Cat-Scratch Disease / Q000150:complications* / Q000382:microbiology; D002648:Child; D005260:Female; D006801:Humans; D006811:Humerus / Q000382:microbiology; D008198:Lymph Nodes / Q000382:microbiology*; D008206:Lymphatic Diseases / Q000382:microbiology*; D010019:Osteomyelitis / Q000382:microbiology*