Variantes en la presentación clínica de la enfermedad por arañazo de gato en niños del hospital Garrahan / Variants in the clinical presentation of cat scratch disease in children at Garrahan Hospital

La infección por Bartonella henselae (BH) adopta diversas formas de presentación clínica en pediatría. Según la bibliografía la forma de presentación más frecuente en pacientes inmunocompetentes es la linfadenopatía única asociada a fiebre. En el 85 % de los casos se compromete un solo ganglio siendo los axilares y los epitrocleares los más frecuentemente involucrados. Existen otras formas de presentación menos frecuentes que debemos tener en consideración, para poder realizar un diagnóstico precoz e indicar un tratamiento adecuado si así lo requiere. El diagnóstico requiere de la sospecha clínica del equipo de salud tratante, junto al antecedente epidemiológico, los hallazgos clínicos del examen físico y la realización de serologías que incluyan el dosaje de inmunoglobulina M y G. Los objetivos del presente trabajo fueron reconocer las manifestaciones clínicas típicas y atípicas de la EAG por Bartonella henselae, describir la epidemiología, características clínicas y evolución de esta enfermedad que se presentaron en nuestro hospital. Se estudiaron un total de 187 pacientes. La media de edad fue de 7.6 años (rango 1-14); siendo 53.5% de género masculino. Las formas de presentación más frecuentes en nuestro trabajo fueron la adenitis y la fiebre. La mayoría recibió diversos esquemas de tratamiento antibiótico, secundario al retraso en el diagnóstico. La tasa de hospitalización fue muy baja, remitió con tratamiento ambulatorio con antibióticos o sin ellos (AU)

Bartonella henselae infection has different clinical presentations in pediatrics. According to the literature, the most common form of presentation in immunocompetent patients is single lymphadenopathy associated with fever. In 85 % of the cases a single lymph node is involved, with the axillary and epitrochlear nodes being the most commonly involved. There are other, less frequent, forms of presentation that should be taken into consideration in order to make an early diagnosis and indicate appropriate treatment if required. Diagnosis relies on clinical suspicion by the treating healthcare team, together with the epidemiological history, clinical findings on physical examination, and serology including immunoglobulin M and G dosage. The objectives of this study were to identify both the typical and atypical clinical manifestations of Bartonella henselae cat scratch disease, to describe the epidemiology, clinical characteristics, and outcomes of cases presenting at our hospital. A total of 187 patients were studied. The mean age was 7.6 years (range 1-14); 53.5% were male. The most frequent forms of presentation in our study were adenitis and fever. Most of them received different antibiotic treatment regimens due to delayed diagnosis. The hospitalization rate was very low and the disease typically resolved with outpatient treatment, with or without antibiotics (AU)

Enfermedad por arañazo de gato: experiencia en unhospital pediátrico de tercer nivel / Cat-scratch disease: Experience in a tertiary care children's hospital

Introducción. Bartonella henselae es el agente etiológico de la enfermedad por arañazo de gato. Afecta a niños y a adultos jóvenes. El espectro clínico es amplio; la forma de presentación más frecuente es la linfadenopatía única. El objetivo de este estudio fue analizar epidemiología, características clínicas y evolución de esta enfermedad en un hospital de alta complejidad de Argentina. Población y métodos. Estudio retrospectivo, descriptivo y observacional realizado en un hospital pediátrico de tercer nivel, desde el 01 de enero de 2019 hasta el 30 de junio de 2021. Se incluyeron niños de 0 a 16 años con clínica compatible y serología positiva. Resultados. Se incluyeron 150 niños, con una media de edad de 7,9 años ± 3,68. El 68,7 % refirió tener contacto con gatos. El motivo de consulta más frecuente fueron las adenopatías únicas (84,7 %) localizadas en cabeza y cuello. El síndrome febril sin foco motivó la consulta en el 15,5 % de los casos, con ecografía abdominal patológica en el 85,7 %. Presentó IgM e IgG positivas el 88 %. Con el resultado de la serología positiva, el 44 % recibió tratamiento antibiótico. Las adenopatías prolongadas fueron la principal causa de su instauración; el más utilizado fue la azitromicina (42,4 %). El 14 % (n = 21) requirió internación. Conclusiones. El diagnóstico implica sospecha clínica, nexo epidemiológico y exámenes complementarios. Su forma típica son las adenomegalias únicas localizadas en cabeza y cuello. Debido a la alta frecuencia de compromiso hepatoesplénico, la realización de ecografía abdominal estaría indicada en niños con fiebre.

Introduction. Bartonella henselae is the etiologic agent in cat-scratch disease. It affects children and young adults. The clinical spectrum is wide; the most common clinical presentation is a solitary lymphadenopathy. The objective of this study was to analyze the epidemiology, clinical features, and course of this disease in a tertiary care hospital in Argentina. Population and methods. Retrospective, descriptive, and observational study conducted at a tertiary care pediatric hospital from January 1st, 2019 to June 30 th, 2021. Children aged 0 to 16 years with compatible clinical signs and symptoms and positive serology were included. Results. A total of 150 patients were included; their mean age was 7.9 years ± 3.68. Of them, 68.7% reported having contact with cats. The most common reason for consultation was the presence of solitary lymphadenopathies (84.7%) in the head and neck. Febrile syndrome without source was the reason for consultation in 15.5% of cases, with a pathological abdominal ultrasound scan in 85.7%. IgM and IgG were positive in 88%. With the result of a positive serology test, 44% received antibiotic treatment. Protracted lymphadenopathy was the main reason for antibiotic treatment; the agent most commonly used was azithromycin (42.4%). Fourteen percent (n = 21) required hospitalization. Conclusions. Diagnosis is based on clinical suspicion, epidemiological history, and complementary testing. Its typical presentation is a solitary enlarged lymph node in the head and neck. Due to the high frequency of hepatosplenic involvement, an abdominal ultrasound scan would be indicated in children with fever.

Bartonella henselae en niños con adenitis regional atendidos en un hospital nacional del Perú, 2012 / Bartonella henselae in children with regional adenitis treated in a Peruvian national hospital, 2012

Con el objetivo de determinar la frecuencia de casos seropositivos a Bartonella henselae en niños con adenitis regional atendidos en un hospital nacional del Perú, se realizó un estudio trasversal en 106 niños con adenitis regional mayor de 1 cm de diámetro, de aparición aguda, con tiempo de enfermedad mayor de cinco días, atendidos en el Instituto Nacional de Salud del Niño durante el año 2012. Se definió seropositividad para B. henselae mediante el examen de inmunofluorescencia indirecta, siendo positivos 86 niños (81,1%) con una mediana de edad de 7 años, rango de 5 a 11; en el análisis bivariado se encontraron como factores asociados, edad mayor de 5 años, antecedentes de fiebre, adenopatía mayor de 4 cm y reporte de contacto con gato. En conclusión, los niños con adenitis regional atendidos en este hospital de referencia nacional presentaron una frecuencia alta de serología positiva para B. henselae.

In order to determine the frequency of seropositive cases of Bartonella henselae in children with regional adenitis treated in a national hospital in Peru, a cross-sectional study was conducted in 106 children with regional adenitis greater than 1 cm in diameter. The sample was selected from patients aged 5-11 years seen at the National Institute of Child Health for acute onset of regional adentitis, with more than five days of symptoms. B. henselae seropositivity was defined by indirect immunofluorescence test. We found that 86 children (81.1%) were positive for B.henselae. The median age of the patients was 7 years. In the bivariate analysis, the following associated factors were found: aged 5 years, history of fever, lymphadenopathy greater than 4 cm and reported contact with cat. In conclusion, children with regional adenitis treated in this national referral hospital showed a high frequency of positive serology for B. henselae.

Infecções associadas a felinos domésticos com esporotricose atendidos no IPEC/FIOCRUZ com ênfase na infecção por Bartonella spp / Infections in domestic cats with sporotrichosis with emphasis on infection by Bartonella spp

A doença da arranhadura do gato é uma zoonose causada por bactérias do gênero Bartonella. O gato atua como reservatório de Bartonella henselae e a transmissão ao humano ocorre através da arranhadura ou mordedura. A esporotricose, causada por fungos do complexo Sporothrix, é transmitida aos humanos através da implantação traumática deste microrganismo no tecido subcutâneo. Os gatos com esporotricose apresentam lesões cutâneas ulceradas com elevada carga parasitária e têm importante papel na transmissão. Nos últimos 14 anos foram diagnosticados mais de 3.000 casos de esporotricose felina no IPEC/FIOCRUZ. Com o objetivo de estudar a soroprevalência de infecção por Bartonella spp. em gatos com esporotricose, 112 amostras de soro foram submetidas ao teste de imunofluorescência indireta utilizando o kit B. henselae IFA IgG (Bion®, USA). Além disso, foi realizada a pesquisa de anticorpos anti-vírus da leucemia felina (FeLV) e antígenos do vírus da imunodeficiência felina (FIV) utilizando kit comercial Snap Combo FIV-FeLV (Idexx®, USA). Um grupo composto por 77 amostras de soro de gatos sem lesões cutâneas aparentes também foi incluído no estudo. No grupo de gatos com esporotricose, 93 eram machos, a idade mediana foi 22 meses e oito (7,1 por cento) foram positivos para FIV e 15 (13,4 por cento) para FeLVNo grupo sem lesões cutâneas, 36 eram machos, a idade mediana foi 48 meses, e dez (13,0 por cento) gatos foram positivos para FIV e oito (10,4 por cento) para FeLV. Dos 112 gatos com esporotricose e dos 77 sem leões cutâneas, 72 (64,3 por cento) e 35 (45,5 por cento), respectivamente, foram reativos ao teste de imunofluorescência para Bartonella spp. Não houve associação entre as variáveis faixa etária, sexo, status sorológico para FIV/FeLV e a presença de anticorpos anti-Bartonella spp. Os resultados obtidos sugerem que a população de gatos com esporotricose deste estudo pode ser considerada uma potencial fonte de infecção humana também para Bartonella spp...

Cat scratch disease is a zoonosis caused by species of genus Bartonella. Cats are the mainreservoir of Bartonella henselae. Transmission of these bacteria to humans occurs throughbites or scratches of infected cats. Sporotrichosis, caused by fungus of Sporothrix complex,is transmitted by traumatic inoculation of soil, plants and organic matter contaminated withthe fungus. Cats are important in zoonotic transmission because of the large amount ofyeast cells in the lesions. In the last 14 years were diagnosed more than 3.000 cases offeline sporotrichosis in IPEC/FIOCRUZ. The main objective of this study was toinvestigate the prevalence of infection by Bartonella spp. in cats with sporotrichosis. Serumsamples from 112 domestic cats were analyzed by indirect immunofluorescence test assay(IFA) using the commercial kit B. henselae IFA IgG (Bion®, USA). In addition, it wasdetected the presence of antibodies to feline leukemia vírus (FeLV) and antigens of felineimmunodeficiency virus (FIV) using the commercial kit Snap Combo FIV-FeLV (Idexx®,USA). One group of 77 serum samples from cats with no apparent skin lesions was alsoincluded in the study. In the group of animals with sporotrichosis, 93 were males, medianage was 22 months, and eight (7.1 percent) were positive for FIV, 15 (13.4 percent) were positive forFeLV. In the group of animals without skin lesions 36 were males, median age was 48months, and ten (13.0 percent) were positive for FIV, eight (10.4 percent) were positive for FeLV. Ofthe 112 cats with sporotrichosis and 77 cats without skin lesions, 72 (64.3 percent) e 35 (45.5 percent),respectively, were reactive to IFA. There was no association between age, sex, FIV/FeLVand the presence of antibodies to Bartonella spp. The results suggest that the studypopulation can be considered a potential source of human infection by both zoonosis...

Prevalencia de anticuerpos contra Bartonella henselae en niños, en adolescentes y en una población de riesgo ocupacional en Chile / Prevalence of Bartonella henselae antibodies in Chilean children, adolescents and veterinary workers

Background: Bartonella henselae is the causative agent of cat-scratch disease. Aim: To study the seroepidemiology of Bartonella henselae in healthy Chilean children and in a population with occupational risk. Material and methods: Serum IgG antibodies were determined by indirect fluorescence technique in 181 children and adolescents and in 107 technical and professional workers involved in the care of cats. Samples with titers equal to or greater than 64 were considered positive. Results: Twenty four (13.3%) children and 11 (10.3%) occupational risk subjects were seropositive. No significant differences by age and gender were observed. Conclusions: Assuming that seroprevalence indicates level of exposure to Bartonella henselae, these results suggest that this infection is endemic in Chile and, for this reason, the best antibody titer to diagnose acute cat-scratch disease should be higher than the figure recommended by the Centers for Disease Control in the in United States.

Enfermedad del arañazo de gato en Lima-Perú: primer estudio prospectivo / Illness of the cat scratch in Lima - Peru: first prospective study

Enfermedad del arañazo de gato es descrita como una linfadenitis, que puede progresar a una forma severa o recurrente, y ocasionalmente asociada a morbilidad; cuyas características eran desconocidas en nuestro país. Se incluyeron 43 pacientes, 46.51 por ciento fueron hombres y 53.49 por ciento mujeres. La media de la edad fue 14.09 años, 74.4 por ciento menores de 18 años. Durante el verano 53.33 por ciento fueron captados. Contacto con gatos presentaron el 93.02 por ciento de los pacientes. Las manifestaciones clínicas principales fueron fiebre y malestar general, y el hallazgo de linfoadenonegalia y la lesión de inoculación. Doce pacientes presentaron títulos entre 1/50 a 1/800 para B. henselae y B.Clarridgeae utilizando IFI. Tres muestras anatomopatológicos fueron características, otras seis fueron sugerentes. No se logró preservar colonias en los cultivos microbiológicos. El presente trabajo es el primer estudio prospectivo nacional de enfermedad del arañazo de gato, logrando identificar B. henselae y B. clarridgeae, principalmente en pacientes de edad pediátrica.