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Cat-scratch disease management based on paucity of data

AAP 2011 National Conference

BOSTON — About 40% of cats will carry the bacterium that causes cat-scratch disease, and infection with Bartonella henselae is one of the most common causes of chronic lymphadenopathy among children. However, treatment of this illness remains based on little data, according to a presentation here at the American Academy of Pediatrics 2011 National Conference and Exhibition.

Dwight Powell, MD, of Nationwide Children’s Hospital in Columbus, Ohio, said the diagnosis of cat-scratch disease (CSD) is made largely through positive immunoglobulin M or IgG tests.

Powell said these tests are not FDA-cleared, so clinicians need to verify that the laboratory performing the assay has done quality-control testing to assure accurate results. Also, the sensitivity and specificity on these tests are highly variable.

“We don’t have a great technology that 100% confirms this diagnosis,” he said. He reviewed data indicating sensitivity was as low as 2% in one study and as high as 100% in another. “Just because you have a negative serologic response does not exclude this person from having infection with B. henselae.”

Powell also said there was a “paucity of randomized prospective case control data” on therapies for B. henselae, as well. For most forms of CSD, Powell said, assessing the efficacy of various antibiotics is difficult because symptoms are generally self-limiting over time, even in the absence of specific therapy. However, some limited trials suggest that azithromycin for 5 days may hasten adenopathy resolution. For patients with more severe disease, other antibiotic regimens have been successful, including rifampin combined with azithromycin or gentamicin. For children aged older than 8 years who have neuroretinitis, rifampin plus doxycycline is recommended.

Disclosure: Dr. Powell reports no relevant financial disclosures.

For more information:

• Powell D. #F3137. Presented at: AAP 2011 National Conference and Exhibition; Oct. 15-18; Boston.

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