Cat scratch disease: U.S. clinicians' experience and knowledge

Abstract

Cat scratch disease (CSD) is a zoonotic infection caused primarily by the bacterium Bartonella henselae. An estimated 12,000 outpatients and 500 inpatients are diagnosed with CSD annually, yet little is known regarding clinician experience with and treatment of CSD in the United States. Questions assessing clinical burden, treatment and prevention of CSD were posed to 3,011 primary care providers (family practitioners, internists, paediatricians and nurse practitioners) during 2014-2015 as part of the annual nationwide DocStyles survey. Among the clinicians surveyed, 37.2% indicated that they had diagnosed at least one patient with CSD in the prior year. Clinicians in the Pacific and Southern regions were more likely to have diagnosed CSD, as were clinicians who saw paediatric patients, regardless of specialty. When presented with a question regarding treatment of uncomplicated CSD, only 12.5% of clinicians chose the recommended treatment option of analgesics and monitoring, while 71.4% selected antibiotics and 13.4% selected lymph node aspiration. In a scenario concerning CSD prevention in immunosuppressed patients, 80.6% of clinicians chose some form of precaution, but less than one-third chose the recommended option of counseling patients to treat their cats for fleas and avoid rough play with their cats. Results from this study indicate that a substantial proportion of U.S. clinicians have diagnosed CSD within the past year. Although published guidelines exist for treatment and prevention of CSD, these findings suggest that knowledge gaps remain. Therefore, targeted educational efforts about CSD may benefit primary care providers.

Atypical Manifestations of Cat-Scratch Disease, United States, 2005–2014

“…Similar to findings from 3 previous studies that reported the highest incidences of cat-scratch disease in the southern United States (13,14,30), in our study, most typical (53.0%) and atypical (57.6%) cat-scratch disease cases occurred in patients residing in this region. In addition, a national survey of US healthcare providers found that those in the Pacific and southern regions of the United States were more likely to have been given a diagnosis of cat-scratch disease than in other regions (32). These findings are further supported by studies that have found higher average B. henselae seroprevalences and active bacteremia in pet cats from warmer, more humid climates, including the southern United States (33,34).…”

Case Reports of Cat Scratch Disease in Patient With Unjustified Surgical Intervention

“…CSD is usually suspected clinically and by culturing of the pathogen, but detection of organisms in lymph nodes by immunofluorescence, molecular techniques including PCR amplification of Bartonella spp. genes have advantages in unclear case [ 13 ].…”

Hepatosplenic abscesses in an immunocompetent child with cat-scratch disease from Peru

“…Cat-scratch disease (CSD) is an infectious zoonotic disease, usually benign, caused by Bartonella henselae and B. clarridgeiae [1]. The causative agents are gram-negative coccobacilli whose biological cycles involve an intermediate host (often fleas), that maintain transmission between cats [2]. The infected saliva and nails of cats are the main routes of transmission to the human.…”