Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review
Autor: | R. Lundin, G. Bordin, Osvalda Rampon, L. Nai Fovino, G. Cabrelle, Elena Mozzo, T. Zangardi, Daniele Donà, Carlo Giaquinto |
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Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
0301 basic medicine
Pediatrics medicine.medical_specialty 030106 microbiology Case Report Disease Serology 03 medical and health sciences 0302 clinical medicine medicine 030212 general & internal medicine Bartonella henselae medicine.diagnostic_test biology business.industry Osteomyelitis lcsh:RJ1-570 Cat-scratch disease lcsh:Pediatrics General Medicine medicine.disease biology.organism_classification Regimen Bone scintigraphy Differential diagnosis business |
Zdroj: | Case Reports in Pediatrics, Vol 2018 (2018) Case Reports in Pediatrics |
ISSN: | 2090-6811 2090-6803 |
Popis: | 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 henselaeshould 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. |
Databáze: | OpenAIRE |
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