Bartonella henselae is the causative agent of cat scratch disease (CSD). In this study, we aimed to investigate the clinical data of patients with suspicion of CSD and delineate current epidemiological features.
A total of 785 patients with suspected CSD were included in the study. B. henselae IgM antibody was determined by indirect fluorescent antibody (IFA) test using a commercial kit (Euroimmun, Germany). Sex, age, clinical pre-diagnosis and animal contact information of the patients were obtained from hospital electronic database records.
Seventy-eight (9.9%) of 785 samples were seropositive. Out of 78 patients, 46 with animal contact data were further analyzed. Of these patients, 56% were male, and 41% were under 18 years of age. Seropositivity was more commonly observed in fall and winter. The most common finding was lymphadenitis (63%). Thirty-five patients (76%) had a previous history of animal contact (cat/dog). Of the 46 seropositive patients, 78.3, 15.2, 4.4, and 2.1% had titers of 1:80, 1:160, 1:320, and 1:640, respectively.
Our study confirms that CSD is not rare in Turkey. Thus, it should always be considered in the differential diagnosis of patients presenting with lymphadenopathy in all age groups, particularly children. Questioning of cat exposure should never be neglected, especially in areas with intense population of stray cats, such as Istanbul.
Anderson BE, Neuman MA. Bartonella spp. as emerging human pathogens. Clin Microbiol Rev 1997; 10: 203–19.
Sander A, Posselt M, Oberle K, Bredt W. Seroprevalence of antibodies to Bartonella henselae in patients with cat scratch disease and in healthy controls: evaluation and comparison of two commercial serological tests. Clin Diagn Lab Immunol 1998; 5: 486.
Chaudhry R, Kokkayil P, Ghosh A, Bahadur T, Kant K, Sagar T, et al.. Bartonella henselae infection in diverse clinical conditions in tertiary care hospital in north India. Indian J Med Res 2018; 147: 189–94.
Murakami K, Tsukahara M, Tsuneoka H, Iino H, Ishida C, Tsujino K, et al.. Cat scratch disease: analysis of 130 seropositive cases. J Infect Chemother 2002; 8: 349–52.
Zangwill KM, Hamilton DH, Perkins BA, Regnery RL, Plikaytis BD, Hadler JL, et al.. Cat Scratch Disease in Connecticut: epidemiology, risk factors, and evaluation of a new diagnostic test. N Engl J Med 1993; 329: 81.
Lamas C, Curi A, Bóia MN, Lemos ERS. Human bartonellosis: seroepidemiological and clinical features with an emphasis on data from Brazil – a review. Mem Inst Oswaldo Cruz 2008; 103: 221–35.
Tsuneoka H, Tsukahara M. Analysis of data in 30 patients with cat scratch disease without lymphadenopathy. J Infect Chemother 2006; 12: 224–6.
Asano T, Ichiki K, Koizumi S, Kaizu K, Hatori T, Fujino O. High prevalence of antibodies against Bartonella henselae with cervical lymphadenopathy in children. Pediatr Int 2010; 52: 533–5.
Aydin N, Bülbül R, Tellı M, Gültekın B. Seroprevalence of Bartonella henselae and Bartonella quintana in blood donors in Aydin province, Turkey. Mikrobiyoloji Bulteni 2014; 48: 477–83.
Ulug M. Evaluation of cat scratch disease cases reported from Turkey between 1996 and 2013 and review of the literature. Cent Eur J Public Health 2015; 23: 170–5.
Atıcı S, Kadayıfcı EK, Karaaslan A, Toper MH, Celikel CA, Soysal A, et al.. Atypical presentation of cat-scratch disease in an immunocompetent child with serological and pathological evidence. Case Rep Pediatr 2014: 397437.
Sahin O. Cat-scratch disease: unusual perivascular chorioretinal lesions. Med Hypothesis Discov Innov Ophthalmol 2014: 3(4).
Ulug M, Aslan V, Arik D, Yilmaz N, Üstün M. Two cases of cat scratch disease: a rare zoonotic infectious disease. KLIMIK J 2014; 27: 78–81.
Ak R, Doganay F, Akoglu EU, Ozturk TC. A challenging differential diagnosis of optic neuropathy in ED: CSD. BMJ Case Rep 2015; bcr-2015-210252.
Oray M, Önal S, Koç Akbay A, Tuğal Tutkun İ. Diverse clinical signs of ocular involvement in cat scratch disease. Turk J Ophthalmol 2017; 47: 9–17.
Türker K, Çelebi B, Andaç Ş, Bulut P, Yalçın Ş, Dolhan S. A neglected bacteria with a case: Bartonella henselae. Mikrobiyol Bul 2017; 51: 286–92.
Celiker H, Kazokoglu H, Eraslan M, Cerman E, Karabas L. Bartonella henselae neuroretinitis in patients without cat scratch. Jpn J Infect Dis 2018; 71: 397–401.
Tsukahara M. Cat scratch disease in Japan. J Infect Chemother 2002; 8: 321–25.
Sun J, Fu G, Lin J, Song X, Lu L, Liu Q. Seroprevalence of Bartonella in Eastern China and analysis of risk factors. BMC Infect Dis 2010; 10: 121.
Vilibic-Cavlek T, Karlovic-Martinkovic D, Ljubin-Sternak S, Tabain I, Persic Z, Mlinaric-Galinovic G. High prevalence of Bartonella henselae and Bartonella quintana antibodies in Croatian patients presenting with lymphadenopathy. Pol J Microbiol 2012; 61: 315–17.
Brunetti E, Fabbi M, Ferraioli G, Prati P, Filice C, Sassera D, et al.. Cat-scratch disease in Northern Italy: atypical clinical manifestations in humans and prevalence of Bartonella infection in cats. Eur J Clin Microbiol Infect Dis 2013; 32: 531–4.
Celebi B. Bartonella henselae and its infections. Mikrobiyol Bul 2008; 42: 163–75.
Im JH, Kwon HY, Baek J, Durey A, Lee SM, Park YK, et al.. Serologic study of Bartonella henselae in patients with acute undifferentiated febrile illness in Korea. Vector Borne Zoonotic Dis 2018; 18: 291–6.
Chomel BB, Kasten RW. Bartonellosis, an increasingly recognized zoonosis. J Appl Microbiol 2010; 109: 743–50.
Diren Sığırcı B, Ilgaz A. Detection of the presence of Bartonella henselae in cats in Istanbul. J Fac Vet Med Istanbul Univ 2013; 39: 209–17.
Fiecek B, Chmielewski T, Lewandowska G, Tylewska-Wierzbanowska S. Characteristics of Bartonella spp. infections in Poland in the years 2009–2012 identified in the laboratory of National institute of public Health-National Institute of Hygiene. Przegl Epidemiol 2013; 67: 637–40.
Windsor J. Cat-scratch disease: epidemiology, etiology and treatment. Br J Biomed Sci 2001; 58: 101–10.
Cunningham ET, Koehler JE. Ocular bartonellosis. Am J Ophthalmol 2000; 130: 340–9.
Vermeulen MJ, Herremans M, Verbakel H, Bergmans AM, Roord JJ, van Dijken PJ, et al.. Serological testing for Bartonella henselae infections in the Netherlands: clinical evaluation of immunofluorescence assay and ELISA. Clin Microbiol Infect 2007; 13: 627–34.
Herremans M, Vermeulen MJ, Van de Kassteele J, Bakker J, Schellekens JF, Koopmans MP. The use of Bartonella henselae-specific age dependent IgG and IgM in diagnostic models to discriminate diseased from non-diseased in cat scratch disease serology. J Microbiol Methods 2007; 71: 107–13.