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Fever of Unknown Origin in Patients with Cat Scratch Disease

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Fever of Unknown Origin in Patients with Cat Scratch Disease Fever of unknown origin in patients with cat scratch disease Landes M1, Maor Y2, Bilavsky E3, Chazan B4, Cohen R5, Glikman D6, Strahilevitz J7, Katzir M8, Litachevsky V9, Melamed R10, Habot-Wilner Z1, Paul M11, Zimhony O12, Srugo I13, Rahav G9, Bishara J14, Rasis M1, Ben-Ami R1, Ephros M15, Giladi M1. 1 Tel Aviv Sourasky Medical Center, 2 Wolfson Medical Center, 3 Schneider Children’s Medical Center of Israel, 4 Ha'Emek Medical Center, 5 Laniado Medical Center, 6 Galilee Medical Center, 7 Hadassah-Hebrew University Medical Centers, 8 Meir Medical Center,9 Sheba Medical Center, 10 Soroka Medical Center,11 Rambam Health Care Campus, 12 Kaplan Medical Center,13 Bnai Zion Medical Center,14 Rabin Medical Center,15 Carmel Medical Center, Israel. BACKGROUND RESULTS A B Fever of unknown origin (FUO) is a rare Table: Data on 32 CSD-FUO patients was identified in 2012-16. manifestation of cat scratch disease (CSD). Patients characteristics n/N* (%)/ Median (range) Familiarity with this syndrome is important, Male 19/32 (59%) however, data are limited. We aimed to Age 41 (5-78) identify patients with CSD-FUO and Immunocompetent 32/32 (100%) characterize disease manifestations and Cat contact 28/32 (88%) long-term clinical outcome. Clinical manifestations Hospitalization 31/32 (97%) A. CT: multiple hypoechoic splenic lesions. Fever pattern: B. PET FDG: left axillary lymphadenopathy not palpable METHODS Relapsing 15/30 (50%) on physical examination Continuous 15/30 (50%) Duration of fever (weeks) 3 (2-9) § This is a part of an ongoing CSD surveillance study Night sweats 15/29 (52%) in Israel, where all CSD diagnostic assays are Weight loss 13/29 (45%) performed in a central national laboratory. >5% body weight 8/29 (28%) § Case definition: a patient with clinical Palpable lymphadenopathy 4/32 (13%) Ocular findings (neuroretinitis, 7/16 (44%) manifestations consistent with CSD AND ≥1 inflammatory disc edema, retinitis, confirmatory laboratory test/s (positive EIA vascular occlusion CONCLUSIONS serology or PCR for Bartonella henselae) AND no Visual impairment 3/32 (9%) alternative diagnosis. Splenic/liver involvement (multiple 14/27 (52%) § Patients with B. henselae endocarditis were hypoechoic lesions) § CSD-FUO may be severe and debilitating and often excluded. Identified by US 8/15 (53%) resembles a malignancy. § FUO was defined as fever of ≥2 weeks without an Identified by CT 11/19 (58%) § Hepatosplenic involvement is common. Follow up and outcome identifiable cause. § Ocular findings, often asymptomatic, are clues to diagnosis. Follow up duration (months)** 7.3 (1-44) § Patients diagnosed in 2012-16 were included. Data § With the exception of eye manifestations, prognosis is Clinical cure 26/29 (90%) good. were obtained from patients’ interviews as well as Permanent visual impairment 3/29 (10%) hospital and outpatients medical records. § Heightened awareness and timely diagnosis are important *n= number of observations; N= number of patients for whom data were in avoiding unnecessary invasive diagnostic procedures and § Follow-up included outpatient clinic visits and available. telephone surveys. ** 29 pts were available for follow up diminishing patient concern. .
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