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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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SIX YEARS OF CAT SCRATCH DISEASE IN A PEDIATRIC HOSPITAL

Rui Domingues1, Catarina Gouveia1, Rita de Sousa2, Maria João Brito1

1-Pediatric Infectious Diseases Unit, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa
2-National Institute of Health Dr. Ricardo Jorge, Lisboa

- 10thWorld Congress of the World Society for Pediatric Infectious Diseases

Resumo:
Background: Cat scratch disease is an infection typically characterized by self-limited regional lymphadenopathy. In a few cases, a wide clinical spectrum and systemic involvement can occur.
Aims: Characterize Bartonella infections in a pediatric population that required hospitalization.
Methods: Descriptive study of Bartonella infection in children admitted at the hospital between January 2010 and December 2016. Epidemiologic, clinical and laboratory parameters were studied.
Results: We identified 18 cases, with average age of 8 year sold. 15/18 (83%) have contact with cats. The clinical presentations were lymphadenopathy mimicking suppurative infections (6), fever of unknown origin (3), osteomyelitis (6), neuro retinitis (2) and encephalitis (1). All cases had confirmation by seroconversion of antibodies against Bartonella and in two cases by molecular detection and sequencing. The therapeutic approach was performed based on the clinical manifestations: azithromycin in lymphadenitis infections, rifampicin plus doxycycline or ciprofloxacin in neuroretinitis and encephalitis and rifampicin plus doxycycline, ciprofloxacin or cotrimoxazole in osteomyelitis. HIV infection and interleukin deficiency were investigated in 5/18 patients and all were negative Four patient’s cats were tested and treated by the veterinarians.
Conclusions: A high clinical suspicion is needed to do the diagnosis, because of the similarities to other infections. The gold standard therapy for Bartonella infection is yet unknown. Recommendations for systemic disease are lacking, however several combinations of antibiotics have been proposed. Althoughatypicalinfectionhasclassicallybeenassociatedwithimmunodeficiency, this has not been the rule in systemic disease and the extensive evaluation must be reviewed.

Palavras Chave: Bartonella infection, Cat scratch disease, Osteomyelitis, Suppurative infections