title: Intra-nodal injection of gentamicin for the treatment of suppurated cat scratch disease's lymphadenitis.
abstract: OBJECTIVE
  Cat scratch disease (CSD)'s lymphadenitis may have a protracted course with painful suppuration necessitating several needle aspirations or surgical drainage. The objective of this study was to evaluate the benefit of an intra-nodal injection of gentamicin add-on oral azithromycin treatment on the outcome of suppurated CSD's lymphadenitis.
  
  
  METHODS
  We performed a retrospective monocentric study including 51 consecutive patients diagnosed between Jan 2009 and Mar 2014 with suppurated CSD who had a positive PCR for Bartonella henselae DNA in pus collected from lymph node by needle aspiration, and who were treated with azithromycin.
  
  
  RESULTS
  Among them, 26/51 patients (51%) received oral azithromycin only, of whom 8 patients (31%) were cured and 18 patients (69%) had complications, while 25/51 patients (49%) received an intra-nodal injection of gentamicin add-on oral azithromycin, of whom 16 patients (64 %) were cured and 9 patients (36%) had complications. In univariate analysis, the combined treatment was the only variable related to cure without complications (64 versus 31%, p = 0.01), but this difference did not remain statistically significant in multivariate analysis (OR = 3.84, 95% CI: 0.95-15.56, p = 0.06).
  
  
  CONCLUSIONS
  Intra-nodal injection of gentamicin add-on oral azithromycin treatment might improve the outcome of patients with suppurated CSD's lymphadenitis, deserving further randomized studies.
authors.affiliation: Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac TSA 40031, 31059, Toulouse Cedex 9, France. garnier.cml@gmail.com.
authors.forename: Camille
authors.initials: C
authors.lastname: Garnier
authors.affiliation: Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac TSA 40031, 31059, Toulouse Cedex 9, France. martin-blondel.g@chu-toulouse.fr.|INSERM U1043-CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France. martin-blondel.g@chu-toulouse.fr.|Université Toulouse III, 31000, Toulouse, France. martin-blondel.g@chu-toulouse.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Martin-Blondel
authors.affiliation: Department of Paediatrics, Toulouse University Hospital, Toulouse, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Debuisson
authors.affiliation: INSERM U1043-CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France.|Department of Bacteriology, Toulouse University Hospital, Toulouse, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Dubois
authors.affiliation: Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac TSA 40031, 31059, Toulouse Cedex 9, France.
authors.forename: Alexa
authors.initials: A
authors.lastname: Debard
authors.affiliation: Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac TSA 40031, 31059, Toulouse Cedex 9, France.
authors.forename: Lise
authors.initials: L
authors.lastname: Cuzin
authors.affiliation: Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac TSA 40031, 31059, Toulouse Cedex 9, France.|Université Toulouse III, 31000, Toulouse, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Massip
authors.affiliation: Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac TSA 40031, 31059, Toulouse Cedex 9, France.|INSERM U1043-CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France.|Université Toulouse III, 31000, Toulouse, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Delobel
authors.affiliation: Department of Infectious and Tropical Diseases, Toulouse University Hospital, Place du Docteur Baylac TSA 40031, 31059, Toulouse Cedex 9, France.|Université Toulouse III, 31000, Toulouse, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Marchou
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage; D018416:Bartonella henselae / Q000187:drug effects / Q000302:isolation & purification; D002372:Cat-Scratch Disease / Q000150:complications* / Q000188:drug therapy*; D002415:Cats; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007267:Injections / Q000379:methods*; D008199:Lymphadenitis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013492:Suppuration / Q000382:microbiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D017963:Azithromycin
keywords: Bartonella henselae; Gentamicin; Intra-nodal injection; Lymphadenitis; Suppurated cat scratch disease