Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review
Background. We performed a review of published case studies of osteomyelitis associated with cat-scratch disease to consolidate existing information on clinical presentation, diagnostic tools, therapy, and outcome, as well as presenting a case of disseminated cat-scratch disease in a 12-year-old fem...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Case Reports in Pediatrics |
| Online Access: | http://dx.doi.org/10.1155/2018/1679306 |
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| author | D. Donà L. Nai Fovino E. Mozzo G. Cabrelle G. Bordin R. Lundin C. Giaquinto T. Zangardi O. Rampon |
| author_facet | D. Donà L. Nai Fovino E. Mozzo G. Cabrelle G. Bordin R. Lundin C. Giaquinto T. Zangardi O. Rampon |
| author_sort | D. Donà |
| collection | DOAJ |
| description | Background. We performed a review of published case studies of osteomyelitis associated with cat-scratch disease to consolidate existing information on clinical presentation, diagnostic tools, therapy, and outcome, as well as presenting a case of disseminated cat-scratch disease in a 12-year-old female with skull osteomyelitis and spleen involvement. Methods. A search for articles indexed in PubMed, Embase, and Google Scholar was performed with the search terms “Bartonella,” “bone,” “osteomyelitis,” “osteolytic,” and “cat-scratch disease” limited to the immunocompetent pediatric population and articles in English. Results. 51 cases were identified. The average age was 7.8 years with equal sex distribution. Fever (84.3%), often with a prolonged course (64.7%), and osteoarticular pain (88.2%) were the most common clinical findings. Lymphadenopathy was present in 64.7% of patients. Vertebral body was mainly involved (51.9%). MRI (50%) and bone scintigraphy (48.1%) were favored to confirm osteomyelitis, while serology was the preferred microbiological diagnostic. Various antibiotics were prescribed in combined or sequential regimens, with median duration of therapy of 23 days. About 12.5% of patients did not receive any treatment. Most patients had excellent prognosis; in particular, all patients not receiving any therapy showed complete recovery and no recurrence of symptoms. Conclusions. Bartonella henselae should be considered in differential diagnosis of localized lymphadentitis. Osteoarticular pain or limitation during cat-scratch disease in children should always be investigated for bone spreading. Owing to good prognosis, invasive procedures to obtain the bone material should be avoided. Serology is the gold standard diagnostic tool and MRI is the best radiographic technique to define bone and surrounding tissue involvement. Treatment represents a never-ending dilemma: surgical intervention or use of antibiotics is still controversial, and more studies are needed to define the best antimicrobial regimen. |
| format | Article |
| id | doaj-art-179ca991f3584788961cedb6662c9a93 |
| institution | Kabale University |
| issn | 2090-6803 2090-6811 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Pediatrics |
| spelling | doaj-art-179ca991f3584788961cedb6662c9a932025-02-03T07:24:36ZengWileyCase Reports in Pediatrics2090-68032090-68112018-01-01201810.1155/2018/16793061679306Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature ReviewD. Donà0L. Nai Fovino1E. Mozzo2G. Cabrelle3G. Bordin4R. Lundin5C. Giaquinto6T. Zangardi7O. Rampon8Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, ItalyDivision of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, ItalyDivision of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, ItalyDivision of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, ItalyPediatric Emergency Department, Department for Woman and Child Health, University of Padua, Padua, ItalyPENTA Foundation, Padua, ItalyDivision of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, ItalyPediatric Emergency Department, Department for Woman and Child Health, University of Padua, Padua, ItalyDivision of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, ItalyBackground. We performed a review of published case studies of osteomyelitis associated with cat-scratch disease to consolidate existing information on clinical presentation, diagnostic tools, therapy, and outcome, as well as presenting a case of disseminated cat-scratch disease in a 12-year-old female with skull osteomyelitis and spleen involvement. Methods. A search for articles indexed in PubMed, Embase, and Google Scholar was performed with the search terms “Bartonella,” “bone,” “osteomyelitis,” “osteolytic,” and “cat-scratch disease” limited to the immunocompetent pediatric population and articles in English. Results. 51 cases were identified. The average age was 7.8 years with equal sex distribution. Fever (84.3%), often with a prolonged course (64.7%), and osteoarticular pain (88.2%) were the most common clinical findings. Lymphadenopathy was present in 64.7% of patients. Vertebral body was mainly involved (51.9%). MRI (50%) and bone scintigraphy (48.1%) were favored to confirm osteomyelitis, while serology was the preferred microbiological diagnostic. Various antibiotics were prescribed in combined or sequential regimens, with median duration of therapy of 23 days. About 12.5% of patients did not receive any treatment. Most patients had excellent prognosis; in particular, all patients not receiving any therapy showed complete recovery and no recurrence of symptoms. Conclusions. Bartonella henselae should be considered in differential diagnosis of localized lymphadentitis. Osteoarticular pain or limitation during cat-scratch disease in children should always be investigated for bone spreading. Owing to good prognosis, invasive procedures to obtain the bone material should be avoided. Serology is the gold standard diagnostic tool and MRI is the best radiographic technique to define bone and surrounding tissue involvement. Treatment represents a never-ending dilemma: surgical intervention or use of antibiotics is still controversial, and more studies are needed to define the best antimicrobial regimen.http://dx.doi.org/10.1155/2018/1679306 |
| spellingShingle | D. Donà L. Nai Fovino E. Mozzo G. Cabrelle G. Bordin R. Lundin C. Giaquinto T. Zangardi O. Rampon Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review Case Reports in Pediatrics |
| title | Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review |
| title_full | Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review |
| title_fullStr | Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review |
| title_full_unstemmed | Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review |
| title_short | Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review |
| title_sort | osteomyelitis in cat scratch disease a never ending dilemma a case report and literature review |
| url | http://dx.doi.org/10.1155/2018/1679306 |
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