Cat-scratch disease is a zoonotic Bartonella henselae infection, usually acquired after cat exposure and classically presenting with regional lymphadenopathy and febrile illness. Atypical disease can involve the spleen, liver, eye, bone, or nervous system.
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name: Cat-scratch Disease
creation_date: "2026-05-06T23:27:35Z"
updated_date: "2026-05-07T00:20:00Z"
category: Infectious
description: >-
Cat-scratch disease is a zoonotic Bartonella henselae infection, usually
acquired after cat exposure and classically presenting with regional
lymphadenopathy and febrile illness. Atypical disease can involve the spleen,
liver, eye, bone, or nervous system.
disease_term:
preferred_term: cat-scratch disease
term:
id: MONDO:0005692
label: cat-scratch disease
parents:
- bartonellosis
- lymphadenitis
synonyms:
- Cat-scratch fever
- cat scratch disease
- benign lymphoreticulosis
classifications:
harrisons_chapter:
- classification_value: infectious disease
evidence:
- reference: PMID:41641055
reference_title: "Clinical and epidemiological characteristics of cat scratch disease in children from southwestern China: a retrospective analysis of mNGS-confirmed cases."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Cat scratch disease (CSD) is a zoonotic infection predominantly caused by
Bartonella henselae, typically featured by regional lymphadenopathy and
febrile illness.
explanation: Establishes cat-scratch disease as a zoonotic infectious disease.
- classification_value: bacterial infectious disease
evidence:
- reference: PMID:37772236
reference_title: "Cat Scratch Disease: An Unusual Case of Right Inguinal Lymphadenitis Due to Bartonella henselae."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Cat scratch disease (CSD) is caused by a bacterial infection due to
Bartonella henselae and is associated with young cats and kittens.
explanation: Establishes B. henselae as the bacterial cause of CSD.
definitions:
- name: Zoonotic regional lymphadenopathy syndrome
definition_type: CASE_DEFINITION
description: >-
Cat-scratch disease is defined clinically by compatible cat exposure,
regional lymphadenopathy, and laboratory or pathologic evidence of B.
henselae infection.
scope: Human clinical CSD diagnosis
evidence:
- reference: PMID:36072697
reference_title: "Cat Scratch Disease: 9 Years of Experience at a Pediatric Center."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Distinguishing clinical features of CSD included subacute regional
lymphadenopathy in school-aged children in the late summer, almost all of
whom had cat exposure.
explanation: Supports the core clinical syndrome of subacute lymphadenopathy after cat exposure.
- reference: PMID:36072697
reference_title: "Cat Scratch Disease: 9 Years of Experience at a Pediatric Center."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
We conducted a retrospective analysis of children presenting to a tertiary
pediatric hospital system in Atlanta, Georgia between January 1, 2010 and
December 31, 2018 who had serology, polymerase chain reaction, and/or
cytopathological results consistent with a Bartonella henselae infection.
explanation: Defines the laboratory/pathology evidence framework used to identify CSD cases.
infectious_agent:
- name: Bartonella henselae
description: Principal bacterial cause of cat-scratch disease.
infectious_agent_term:
preferred_term: Bartonella henselae
term:
id: NCBITaxon:38323
label: Bartonella henselae
evidence:
- reference: PMID:37772236
reference_title: "Cat Scratch Disease: An Unusual Case of Right Inguinal Lymphadenitis Due to Bartonella henselae."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Cat scratch disease (CSD) is caused by a bacterial infection due to
Bartonella henselae and is associated with young cats and kittens.
explanation: Directly identifies B. henselae as the etiologic agent of CSD.
- reference: PMID:39611834
reference_title: Differential vasoproliferative traits of Bartonella henselae strains associated with autotransporter BafA variants.
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
Bartonella henselae, a Gram-negative facultative intracellular bacterium, is
the etiological agent of cat-scratch disease and also causes bacillary
angiomatosis in immunocompromised individuals.
explanation: Confirms B. henselae as a facultative intracellular Gram-negative etiologic agent.
transmission:
- name: Cat-associated scratch or bite transmission
description: >-
Human infection usually follows inoculation of B. henselae from infected cats
through scratches or bites.
evidence:
- reference: PMID:37772236
reference_title: "Cat Scratch Disease: An Unusual Case of Right Inguinal Lymphadenitis Due to Bartonella henselae."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
B. henselae is transmitted from cats to humans through scratching or biting
when located on the cat's claws or oral cavity.
explanation: Directly supports scratch/bite transmission from cats.
- name: Feline exposure risk
description: >-
Cat exposure is documented in most pediatric CSD cases, while non-cat animal
exposures can also be reported in a minority.
evidence:
- reference: PMID:36072697
reference_title: "Cat Scratch Disease: 9 Years of Experience at a Pediatric Center."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
242 of 262 (92.4%) reported feline exposure; and 55 of 250 (22%) reported
canine exposure of those with exposure histories documented in the medical
record.
explanation: Quantifies the strong association between CSD and feline exposure in a pediatric cohort.
progression:
- phase: Cat-associated inoculation
notes: >-
B. henselae is introduced into skin or soft tissue after scratch or bite
exposure, initiating local infection.
evidence:
- reference: PMID:37772236
reference_title: "Cat Scratch Disease: An Unusual Case of Right Inguinal Lymphadenitis Due to Bartonella henselae."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
B. henselae is transmitted from cats to humans through scratching or biting
when located on the cat's claws or oral cavity.
explanation: Supports the exposure/inoculation phase of CSD.
- phase: Subacute regional lymphadenopathy
notes: >-
Regional lymphadenopathy is the typical post-inoculation syndrome in
immunocompetent children and young adults.
evidence:
- reference: PMID:36072697
reference_title: "Cat Scratch Disease: 9 Years of Experience at a Pediatric Center."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Distinguishing clinical features of CSD included subacute regional
lymphadenopathy in school-aged children in the late summer, almost all of
whom had cat exposure.
explanation: Supports the subacute lymphadenopathy phase.
- phase: Atypical or disseminated disease
notes: >-
A clinically important subset lacks typical lymphadenopathy and may show
hepatosplenic, ocular, bone, or neurologic involvement.
evidence:
- reference: PMID:36072697
reference_title: "Cat Scratch Disease: 9 Years of Experience at a Pediatric Center."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Although lymphadenopathy was present on physical examination in the majority
of cases (78.8%), atypical presentations lacking lymphadenopathy were also
common (63 of 304, 20.7%).
explanation: Supports an atypical clinical phase or presentation pattern.
- reference: PMID:37772236
reference_title: "Cat Scratch Disease: An Unusual Case of Right Inguinal Lymphadenitis Due to Bartonella henselae."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The prognosis for immunocompetent patients is favorable with complete
recovery, however, immunocompromised adults can progress to
life-threatening complications such as neuroretinitis, osteomyelitis, and
bacillary angiomatosis.
explanation: Supports severe disseminated complications, especially in immunocompromised hosts.
pathophysiology:
- name: Cat-associated Bartonella inoculation
description: >-
Scratching or biting by a colonized cat inoculates B. henselae into local
tissue, setting up the first infectious trigger for CSD.
biological_processes:
- preferred_term: response to bacterium
term:
id: GO:0009617
label: response to bacterium
evidence:
- reference: PMID:37772236
reference_title: "Cat Scratch Disease: An Unusual Case of Right Inguinal Lymphadenitis Due to Bartonella henselae."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
B. henselae is transmitted from cats to humans through scratching or biting
when located on the cat's claws or oral cavity.
explanation: Supports skin/soft-tissue inoculation as the initiating event.
downstream:
- target: Regional lymph node inflammation
description: Inoculation leads to draining regional lymphadenitis.
evidence:
- reference: PMID:37772236
reference_title: "Cat Scratch Disease: An Unusual Case of Right Inguinal Lymphadenitis Due to Bartonella henselae."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
CSD commonly occurs as regional lymphadenitis in the setting of subacute
regional lymphadenopathy predominantly in children and young adults.
explanation: Supports the transition from infection to regional lymphadenitis.
- name: Regional lymph node inflammation
description: >-
Draining lymph nodes enlarge and inflame, producing the classic regional
lymphadenopathy syndrome.
locations:
- preferred_term: lymph node
term:
id: UBERON:0000029
label: lymph node
biological_processes:
- preferred_term: inflammatory response
modifier: INCREASED
term:
id: GO:0006954
label: inflammatory response
cell_types:
- preferred_term: neutrophil
term:
id: CL:0000775
label: neutrophil
evidence:
- reference: PMID:36072697
reference_title: "Cat Scratch Disease: 9 Years of Experience at a Pediatric Center."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Although lymphadenopathy was present on physical examination in the majority
of cases (78.8%), atypical presentations lacking lymphadenopathy were also
common (63 of 304, 20.7%).
explanation: Supports regional lymphadenopathy as the dominant clinical mechanism.
downstream:
- target: Atypical hepatosplenic dissemination
description: Some patients develop systemic organ involvement rather than isolated nodal disease.
evidence:
- reference: PMID:36072697
reference_title: "Cat Scratch Disease: 9 Years of Experience at a Pediatric Center."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Among children with radiographic imaging, 20 of 55 (36.4%) had
splenomegaly and 21 of 55 (38.1%) had splenic and/or hepatic
microabscesses.
explanation: Supports hepatosplenic involvement among imaged children.
- name: Intracellular Bartonella survival
description: >-
Bartonella species persist by surviving within host-cell intracellular
compartments.
biological_processes:
- preferred_term: innate immune response
modifier: DYSREGULATED
term:
id: GO:0045087
label: innate immune response
evidence:
- reference: PMID:38443331
reference_title: "Sneaky tactics: Ingenious immune evasion mechanisms of Bartonella."
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Gram-negative Bartonella species are facultative intracellular bacteria
that can survive in the harsh intracellular milieu of host cells.
explanation: Supports intracellular survival as a Bartonella persistence mechanism.
- name: Antigenic variation-mediated immune recognition evasion
description: >-
Bartonella alters exposed immunogenic surface proteins after infection,
helping evade host immune recognition.
biological_processes:
- preferred_term: immune response
modifier: DECREASED
term:
id: GO:0006955
label: immune response
evidence:
- reference: PMID:38443331
reference_title: "Sneaky tactics: Ingenious immune evasion mechanisms of Bartonella."
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Following infection, Bartonella alters the initial immunogenic
surface-exposed proteins to evade immune recognition via antigen or phase
variation.
explanation: Supports antigenic or phase variation as an immune-recognition evasion mechanism.
- name: Erythrocyte-associated immune clearance evasion
description: >-
Mature erythrocyte survival and resistance to lysosomal fusion can protect
Bartonella from rapid immune clearance.
cell_types:
- preferred_term: erythrocyte
term:
id: CL:0000232
label: erythrocyte
biological_processes:
- preferred_term: immune response
modifier: DECREASED
term:
id: GO:0006955
label: immune response
evidence:
- reference: PMID:38443331
reference_title: "Sneaky tactics: Ingenious immune evasion mechanisms of Bartonella."
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Additionally, the survival of mature erythrocytes and their resistance to
lysosomal fusion further complicate the immune clearance of this species.
explanation: Supports erythrocyte-associated evasion of immune clearance.
- name: Biofilm-associated immune evasion
description: Bartonella biofilm production contributes to immune attack evasion.
biological_processes:
- preferred_term: immune response
modifier: DECREASED
term:
id: GO:0006955
label: immune response
evidence:
- reference: PMID:38443331
reference_title: "Sneaky tactics: Ingenious immune evasion mechanisms of Bartonella."
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Certain Bartonella species also evade immune attacks by producing biofilms
and anti-inflammatory cytokines and decreasing endothelial cell apoptosis.
explanation: Supports biofilm production as one Bartonella immune-evasion mechanism.
- name: Anti-inflammatory cytokine-associated immune evasion
description: >-
Bartonella immune evasion includes production of anti-inflammatory cytokines.
biological_processes:
- preferred_term: regulation of cytokine production
modifier: DYSREGULATED
term:
id: GO:0001817
label: regulation of cytokine production
evidence:
- reference: PMID:38443331
reference_title: "Sneaky tactics: Ingenious immune evasion mechanisms of Bartonella."
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Certain Bartonella species also evade immune attacks by producing biofilms
and anti-inflammatory cytokines and decreasing endothelial cell apoptosis.
explanation: Supports anti-inflammatory cytokine production as one Bartonella immune-evasion mechanism.
- name: Reduced endothelial cell apoptosis
description: Bartonella immune evasion can include decreased endothelial cell apoptosis.
cell_types:
- preferred_term: endothelial cell
term:
id: CL:0000115
label: endothelial cell
biological_processes:
- preferred_term: apoptotic process
modifier: DECREASED
term:
id: GO:0006915
label: apoptotic process
evidence:
- reference: PMID:38443331
reference_title: "Sneaky tactics: Ingenious immune evasion mechanisms of Bartonella."
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Certain Bartonella species also evade immune attacks by producing biofilms
and anti-inflammatory cytokines and decreasing endothelial cell apoptosis.
explanation: Supports reduced endothelial cell apoptosis as one immune-evasion mechanism.
- name: BafA/BadA-associated endothelial proliferation
description: >-
B. henselae autotransporters BafA and BadA are implicated in endothelial
cell proliferation and vasoproliferative lesions, helping explain vascular
manifestations such as bacillary angiomatosis in immunocompromised disease.
locations:
- preferred_term: blood vessel
term:
id: UBERON:0001981
label: blood vessel
cell_types:
- preferred_term: endothelial cell
term:
id: CL:0000115
label: endothelial cell
biological_processes:
- preferred_term: angiogenesis
modifier: INCREASED
term:
id: GO:0001525
label: angiogenesis
evidence:
- reference: PMID:39611834
reference_title: Differential vasoproliferative traits of Bartonella henselae strains associated with autotransporter BafA variants.
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
Bartonella angiogenic factor A (BafA) and Bartonella adhesin A (BadA) have
been identified as autotransporters of B. henselae that are involved in
endothelial cell proliferation.
explanation: Supports BafA/BadA-mediated endothelial proliferation.
- reference: PMID:39611834
reference_title: Differential vasoproliferative traits of Bartonella henselae strains associated with autotransporter BafA variants.
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
B. henselae strains exhibited variable proliferation-promoting ability and
cytotoxicity in vascular endothelial cells, which corresponded to the bafA
gene variants possessed by the strains.
explanation: Supports strain-dependent endothelial proliferation and cytotoxicity.
- name: Atypical hepatosplenic dissemination
description: >-
In a subset of patients, CSD disseminates beyond regional lymph nodes,
producing splenomegaly and hepatic or splenic microabscesses on imaging.
locations:
- preferred_term: spleen
term:
id: UBERON:0002106
label: spleen
- preferred_term: liver
term:
id: UBERON:0002107
label: liver
biological_processes:
- preferred_term: positive regulation of inflammatory response
modifier: INCREASED
term:
id: GO:0050729
label: positive regulation of inflammatory response
evidence:
- reference: PMID:36072697
reference_title: "Cat Scratch Disease: 9 Years of Experience at a Pediatric Center."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Among children with radiographic imaging, 20 of 55 (36.4%) had
splenomegaly and 21 of 55 (38.1%) had splenic and/or hepatic
microabscesses.
explanation: Supports hepatosplenic involvement in imaged CSD cases.
phenotypes:
- name: Inflammatory skin inoculation site
category: Dermatologic
description: Cat-associated scratches or bites can create the initial skin inoculation site.
phenotype_term:
preferred_term: Inflammatory abnormality of the skin
term:
id: HP:0011123
label: Inflammatory abnormality of the skin
evidence:
- reference: DOI:10.5455/ovj.2025.v15.i5.5
reference_title: Uncovering the truth about cat-scratch disease
supports: SUPPORT
evidence_source: OTHER
snippet: >-
The pathogenesis of CSD starts when a tiny wound from an infected cat's
bite or scratch allows the bacteria B. henselae to enter the human body.
explanation: Supports a skin inoculation site after cat bite or scratch exposure.
- name: Regional Lymphadenopathy
category: Immune
frequency: FREQUENT
description: Subacute regional lymph node enlargement is the dominant typical presentation.
phenotype_term:
preferred_term: Regional lymphadenopathy
term:
id: HP:0002716
label: Lymphadenopathy
evidence:
- reference: PMID:36072697
reference_title: "Cat Scratch Disease: 9 Years of Experience at a Pediatric Center."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Although lymphadenopathy was present on physical examination in the majority
of cases (78.8%), atypical presentations lacking lymphadenopathy were also
common (63 of 304, 20.7%).
explanation: Quantifies lymphadenopathy frequency as 78.8%, consistent with FREQUENT.
- name: Fever
category: Constitutional
frequency: FREQUENT
description: Fever is a common systemic feature accompanying CSD.
phenotype_term:
preferred_term: Fever
term:
id: HP:0001945
label: Fever
evidence:
- reference: PMID:41641055
reference_title: "Clinical and epidemiological characteristics of cat scratch disease in children from southwestern China: a retrospective analysis of mNGS-confirmed cases."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Fever and lymphadenopathy were the primary reasons for hospitalization.
explanation: Supports fever as a major clinical reason for hospitalization in pediatric CSD.
- name: Splenomegaly
category: Abdominal
description: Splenic enlargement can occur in atypical hepatosplenic CSD.
phenotype_term:
preferred_term: Splenomegaly
term:
id: HP:0001744
label: Splenomegaly
evidence:
- reference: PMID:36072697
reference_title: "Cat Scratch Disease: 9 Years of Experience at a Pediatric Center."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Among children with radiographic imaging, 20 of 55 (36.4%) had
splenomegaly and 21 of 55 (38.1%) had splenic and/or hepatic
microabscesses.
explanation: Supports splenomegaly as an atypical hepatosplenic manifestation.
- name: Osteomyelitis
category: Musculoskeletal
description: Osteomyelitis is a recognized severe complication, especially in complicated disease.
phenotype_term:
preferred_term: Osteomyelitis
term:
id: HP:0002754
label: Osteomyelitis
evidence:
- reference: PMID:37772236
reference_title: "Cat Scratch Disease: An Unusual Case of Right Inguinal Lymphadenitis Due to Bartonella henselae."
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: >-
The prognosis for immunocompetent patients is favorable with complete
recovery, however, immunocompromised adults can progress to
life-threatening complications such as neuroretinitis, osteomyelitis, and
bacillary angiomatosis.
explanation: Supports osteomyelitis as a possible severe complication, not a typical presentation.
- name: Neuroretinitis
category: Ophthalmologic
description: Ocular CSD may involve the optic nerve and retina as neuroretinitis.
phenotype_term:
preferred_term: Neuroretinitis
evidence:
- reference: PMID:37602640
reference_title: "A Case Series of Cat-Scratch Disease with Ocular Manifestations: Clinical Findings and Treatment Approach."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Posterior segment findings included neuroretinitis in 14 (61%), superficial
retinal infiltrate(s) in 8 (35%), papillitis in 3 (13%), branch retinal
artery occlusion in 2 (8%), and cilioretinal artery occlusion in 1 (4%) of
the eyes.
explanation: Supports neuroretinitis and related posterior segment abnormalities in ocular CSD.
- name: Infectious encephalitis
category: Neurologic
description: Neurologic Bartonella involvement can include encephalitis or encephalopathy.
phenotype_term:
preferred_term: Infectious encephalitis
term:
id: HP:0002383
label: Infectious encephalitis
evidence:
- reference: DOI:10.1186/s13071-024-06491-3
reference_title: "Neurobartonelloses: emerging from obscurity!"
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Encephalitis and encephalopathy, also most often associated with B.
henselae, have been reported with B. quintana, B. washoensis (ground
squirrels) and B. vinsonii subsp. vinsonii (voles) infections.
explanation: Supports encephalitis as a neurologic Bartonella manifestation.
diagnosis:
- name: Serology, PCR, or cytopathology-supported diagnosis
presence: Positive
notes: >-
Diagnosis is commonly supported by Bartonella serology, PCR, cytopathology,
and compatible exposure and clinical findings.
evidence:
- reference: PMID:36072697
reference_title: "Cat Scratch Disease: 9 Years of Experience at a Pediatric Center."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
We conducted a retrospective analysis of children presenting to a tertiary
pediatric hospital system in Atlanta, Georgia between January 1, 2010 and
December 31, 2018 who had serology, polymerase chain reaction, and/or
cytopathological results consistent with a Bartonella henselae infection.
explanation: Supports serology, PCR, and cytopathology as diagnostic evidence streams.
- name: Metagenomic next-generation sequencing
presence: Positive
notes: mNGS can identify B. henselae in atypical or difficult-to-confirm cases.
evidence:
- reference: PMID:41641055
reference_title: "Clinical and epidemiological characteristics of cat scratch disease in children from southwestern China: a retrospective analysis of mNGS-confirmed cases."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Definitive B. henselae identification was achieved through metagenomic next-generation sequencing (mNGS).
explanation: Supports mNGS as a definitive microbiologic diagnostic method in the pediatric series.
- reference: PMID:38637335
reference_title: "Application of metagenomic next-generation sequencing in the diagnosis of Bartonella neuroretinitis: a case report and literature review."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
To identify the possible causative pathogen of the disease, mNGS of aqueous
humour sample was performed and 521 reads of B. henselae were identified.
explanation: Supports mNGS for ocular CSD pathogen detection.
- name: Histopathologic evaluation of skin lesions and lymph nodes
presence: Positive
notes: Histopathology can support CSD evaluation in selected skin or lymph node lesions.
evidence:
- reference: DOI:10.5455/ovj.2025.v15.i5.5
reference_title: Uncovering the truth about cat-scratch disease
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Histological investigation of skin lesions and lymph nodes in
immunocompetent people early in the clinical phase of CSD reveals lymphoid
hyperplasia and arteriolar proliferation.
explanation: Supports histopathologic evaluation of skin and lymph node lesions in CSD.
treatments:
- name: Azithromycin for typical cat-scratch disease
description: >-
A 5-day oral azithromycin course can accelerate early reduction of lymph node
volume in typical CSD.
treatment_term:
preferred_term: pharmacotherapy
term:
id: MAXO:0000058
label: pharmacotherapy
therapeutic_agent:
- preferred_term: azithromycin
term:
id: CHEBI:2955
label: azithromycin
evidence:
- reference: PMID:9655532
reference_title: Prospective randomized double blind placebo-controlled evaluation of azithromycin for treatment of cat-scratch disease.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Treatment of patients with typical cat-scratch disease with oral
azithromycin for five days affords significant clinical benefit as measured
by total decrease in lymph node volume within the first month of treatment.
explanation: Randomized placebo-controlled trial supports azithromycin benefit for typical CSD lymphadenopathy.
- name: Doxycycline and rifampicin-containing therapy for complicated presentations
description: >-
Doxycycline and rifampicin are used in selected complicated or atypical
presentations as part of antimicrobial management.
treatment_term:
preferred_term: pharmacotherapy
term:
id: MAXO:0000058
label: pharmacotherapy
therapeutic_agent:
- preferred_term: doxycycline
term:
id: CHEBI:50845
label: doxycycline
- preferred_term: rifampicin
term:
id: CHEBI:28077
label: rifampicin
evidence:
- reference: PMID:37772236
reference_title: "Cat Scratch Disease: An Unusual Case of Right Inguinal Lymphadenitis Due to Bartonella henselae."
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: He was treated with a short course of oral doxycycline for CSD and opioids for pain management.
explanation: Case-level evidence supports doxycycline use in a painful atypical lymphadenitis presentation.
- reference: PMID:41641055
reference_title: "Clinical and epidemiological characteristics of cat scratch disease in children from southwestern China: a retrospective analysis of mNGS-confirmed cases."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Antimicrobial agents, including azithromycin, doxycycline, and rifampin, achieved satisfactory therapeutic outcomes.
explanation: Retrospective pediatric mNGS-confirmed series supports antimicrobial therapy for hospitalized CSD cases.
references:
- reference: DOI:10.1038/s42003-025-07535-9
title: Comparison of transcriptomic profiles between intracellular and extracellular Bartonella henselae
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.1080/21505594.2024.2322961
title: "Sneaky tactics: Ingenious immune evasion mechanisms of Bartonella"
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.1093/ofid/ofac426
title: "Cat Scratch Disease: 9 Years of Experience at a Pediatric Center"
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.1128/aac.48.6.1921-1933.2004
title: Recommendations for Treatment of Human Infections Caused by Bartonella Species
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.1128/spectrum.01925-24
title: Differential vasoproliferative traits of Bartonella henselae strains associated with autotransporter BafA variants
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.1186/s12348-024-00387-0
title: "Application of metagenomic next-generation sequencing in the diagnosis of Bartonella neuroretinitis: a case report and literature review"
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.1186/s12886-023-03063-4
title: "Cat-scratch disease manifesting as uveitis and binocular fundus nodular lesions: a case report"
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.1186/s13071-024-06491-3
title: "Neurobartonelloses: emerging from obscurity!"
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.3389/fpubh.2025.1743423
title: "Clinical and epidemiological characteristics of cat scratch disease in children from southwestern China: a retrospective analysis of mNGS-confirmed cases"
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.4274/tjo.galenos.2022.44692
title: "A Case Series of Cat-Scratch Disease with Ocular Manifestations: Clinical Findings and Treatment Approach"
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.5455/ovj.2025.v15.i5.5
title: Uncovering the truth about cat-scratch disease
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.7759/cureus.44280
title: "Cat Scratch Disease: An Unusual Case of Right Inguinal Lymphadenitis Due to Bartonella henselae"
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.7759/cureus.45866
title: Neuroretinitis as a Complication of Cat Scratch Disease
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.7759/cureus.66134
title: Three-Month History of Lymphadenopathy Caused by Bartonella henselae in a 13-Year-Old Following a Dog Scratch
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
- reference: DOI:10.7759/cureus.66840
title: "Cat-Scratch Disease Mimicking Neoplastic Etiology in a Complex Clinical Presentation: A Case Report"
found_in:
- Cat-Scratch_Disease-deep-research-falcon.md
findings: []
Question: You are an expert researcher providing comprehensive, well-cited information.
Provide detailed information focusing on: 1. Key concepts and definitions with current understanding 2. Recent developments and latest research (prioritize 2023-2024 sources) 3. Current applications and real-world implementations 4. Expert opinions and analysis from authoritative sources 5. Relevant statistics and data from recent studies
Format as a comprehensive research report with proper citations. Include URLs and publication dates where available. Always prioritize recent, authoritative sources and provide specific citations for all major claims.
Please provide a comprehensive research report on Cat-scratch Disease covering all of the disease characteristics listed below. This report will be used to populate a disease knowledge base entry. Be thorough and cite primary literature (PMID preferred) for all claims.
For each section, suggested databases/resources are listed. These are the first places you should search for information on each topic.
Search first: OMIM, Orphanet, ICD-10/ICD-11, MeSH, PubMed
Search first: PubMed, Cochrane Library, UpToDate, clinical guidelines, ClinVar, ClinGen, GWAS Catalog, PheGenI, CTD, CDC, WHO, epidemiological databases
Search first: PubMed, Cochrane Library, clinical trial databases, GWAS Catalog, gnomAD, WHO, CDC, nutrition databases
Search first: CTD, PubMed, PheGenI, GxE databases
Search first: HPO (Human Phenotype Ontology), OMIM, Orphanet, PubMed, clinicaltrials.gov, MedDRA, SNOMED CT, DECIPHER, LOINC
For each phenotype, provide: - Phenotype type: symptoms, clinical signs, physical manifestations, behavioral changes, or laboratory abnormalities
For symptoms/signs: HPO, OMIM, Orphanet, PubMed For behavioral changes: HPO, DSM, RDoC (Research Domain Criteria), PubMed For laboratory abnormalities: LOINC, SNOMED CT, LabTests Online, PubMed - Phenotype characteristics: Search first: OMIM, Orphanet, HPO, PubMed - Age of symptom onset (neonatal, childhood, adult-onset, late-onset) - Symptom severity (mild, moderate, severe, variable) - Symptom progression (stable, progressive, episodic, fluctuating) - Frequency among affected individuals (percentage or qualitative) - Quality of life impact: Effects on daily functioning and well-being (per-phenotype when possible) Search first: EQ-5D database, SF-36, WHO QOL databases, PubMed - Suggest HPO (Human Phenotype Ontology) terms for each phenotype
Search first: OMIM, ClinVar, HGMD, Ensembl, NCBI Gene
Search first: ENCODE, Roadmap Epigenomics, MethBase, DiseaseMeth
Search first: DECIPHER, ClinVar, ECARUCA, UCSC Genome Browser
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Search first: CDC databases, WHO, PubMed, NHANES
Search first: NCBI Taxonomy, ViPR, BV-BRC, MicrobeDB, GIDEON
Search first: KEGG, Reactome, WikiPathways, PathBank, BioCyc
Search first: Gene Ontology (GO), Reactome, KEGG, PubMed
Search first: UniProt, PDB (Protein Data Bank), InterPro, Pfam, AlphaFold
Search first: KEGG, BioCyc, HMDB (Human Metabolome Database), BRENDA
Search first: ImmPort, Immunome Database, IEDB, Gene Ontology
Search first: PubMed, Gene Ontology, Reactome
Search first: BRENDA, UniProt, KEGG, OMIM, PubMed
Search first: ENCODE, Roadmap Epigenomics, MethBase, DiseaseMeth
For each mechanism, describe: - The causal chain from initial trigger to clinical manifestation - Which mechanisms are upstream vs downstream - What cell types and biological processes are involved - Suggest GO terms for biological processes and CL terms for cell types
Search first: Uberon, FMA (Foundational Model of Anatomy), OMIM, HPO, ICD-11, MeSH, SNOMED CT
Search first: Uberon, Human Protein Atlas, Cell Ontology, Human Cell Atlas, CellMarker, PanglaoDB
Search first: Gene Ontology (Cellular Component), UniProt, Human Protein Atlas
Search first: OMIM, Orphanet, HPO, PubMed
Search first: Disease registries, longitudinal cohort databases, natural history studies, PubMed, Orphanet, OMIM
Search first: Orphanet, CDC, WHO, GBD (Global Burden of Disease), national registries, SEER, disease registries
Search first: GTR (Genetic Testing Registry), GeneReviews, ClinGen
For each treatment, suggest MAXO (Medical Action Ontology) terms where applicable.
Search first: CDC vaccine schedules, WHO immunization, FDA vaccine database
Search first: CDC, WHO, behavioral intervention databases, Cochrane Library
Search first: NSGC resources, ACMG guidelines, GeneReviews
Search first: Clinical guidelines, FDA approvals, PubMed
Search first: NCBI Taxonomy
Search first: VBO (Vertebrate Breed Ontology)
Search first: NCBI Gene
Structure your response as a comprehensive narrative organized by the sections above. For each section, provide: - Factual content with specific details (numbers, percentages, gene names, variant nomenclature) - Ontology term suggestions (HPO, GO, CL, UBERON, CHEBI, MAXO, MONDO) where applicable - Evidence citations with PMIDs - Direct quotes from abstracts to support key claims - Clear indication when information is not available or not applicable for this disease
This report will be used to populate a disease knowledge base entry with: - Pathophysiology descriptions with causal chains - Gene/protein annotations (HGNC, GO terms) - Phenotype associations (HP terms) with frequencies - Cell type involvement (CL terms) - Anatomical locations (UBERON terms) - Chemical entities (CHEBI terms) - Treatment annotations (MAXO terms) - Evidence items with PMIDs and exact abstract quotes - Epidemiology, prognosis, diagnostic, and prevention information - Animal model descriptions with phenotype recapitulation details
Target disease: Cat-scratch disease (CSD)
Causal agent (primary): Bartonella henselae (facultative intracellular Gram-negative bacillus) (puspitasari2025uncoveringthetruth pages 1-2, smith2024catscratchdiseasemimicking pages 3-5)
Last updated: 2026-05-06
Cat-scratch disease is a zoonotic infection most commonly acquired after contact with cats (often kittens), classically presenting as subacute regional lymphadenopathy, sometimes preceded by an inoculation papule/pustule; a clinically important minority develop atypical/disseminated disease (e.g., hepatosplenic microabscesses, osteomyelitis, ocular disease, neurologic syndromes). Key diagnostic modalities in real-world practice are serology (IFA/ELISA), histopathology of lymph node tissue in selected cases, and nucleic-acid detection (PCR or increasingly metagenomic next-generation sequencing [mNGS] for atypical disease). Treatment is often supportive/observational for uncomplicated disease, with azithromycin commonly used to shorten symptom course; complicated ocular/CNS disease is often treated with doxycycline plus rifampin based on expert recommendations and case-based evidence. (amin2022catscratchdisease pages 1-2, amin2022catscratchdisease pages 2-3, sulaiman2023catscratchdisease pages 4-7, rolain2004recommendationsfortreatment pages 6-7)
CSD is an infectious zoonosis “caused by Bartonella henselae infection” and typically presents with “regional lymphadenopathy following a cat scratch or bite.” (smith2024catscratchdiseasemimicking pages 3-5) A recent review similarly defines CSD as a systemic infection due to the intracellular Gram-negative zoonotic bacillus B. henselae. (puspitasari2025uncoveringthetruth pages 1-2)
Direct abstract-supporting quote(s) - “Cat-scratch disease (CSD) is caused by a bacterial infection due to Bartonella henselae…” (Sulaiman et al., 2023-08, Cureus) (sulaiman2023catscratchdisease pages 4-7) - “Cat-scratch disease (CSD) is caused by Bartonella henselae infection.” (Li et al., 2024-04, J Ophthalmic Inflamm Infect) (lai2026clinicalandepidemiological pages 1-2)
Not fully retrievable from the currently retrieved full-text corpus. The evidence set did not directly include MONDO, MeSH, or ICD code strings for CSD. (No in-corpus evidence)
What is available from retrieved clinical literature: the disease entity is consistently referenced as “cat-scratch disease,” “cat scratch disease,” and “Bartonella henselae infection,” and is discussed in the context of lymphadenitis/lymphadenopathy differentials. (sulaiman2023catscratchdisease pages 4-7, amin2022catscratchdisease pages 2-3, smith2024catscratchdiseasemimicking pages 3-5)
Animal/vector exposure (dominant risk factor class): - High association with cat exposure in pediatric series: 92.4% feline exposure (242/262) in the Atlanta pediatric cohort. (amin2022catscratchdisease pages 1-2) - Review-level risk factors include kittens, fleas, stray/shelter cats, multicat households, outdoor cats, and hot/humid environments. (puspitasari2025uncoveringthetruth pages 5-6)
Host factors: - Immunocompromised status is associated with more severe complications (e.g., bacillary angiomatosis, severe systemic disease); case reports emphasize broadened differential in people living with HIV. (smith2024catscratchdiseasemimicking pages 3-5, puspitasari2025uncoveringthetruth pages 5-6)
Direct abstract-supporting quote(s) - “B. henselae is transmitted from cats to humans through scratching or biting…” (Sulaiman et al., 2023-08, Cureus) (sulaiman2023catscratchdisease pages 4-7)
No specific genetic protective variants or environmental protective factors were identified in the retrieved evidence. Primary preventive measures are behavioral and veterinary (flea control, avoiding bites/scratches). (puspitasari2025uncoveringthetruth pages 6-7, puspitasari2025uncoveringthetruth pages 5-6)
No human host GxE interactions were identified in the retrieved evidence corpus. (No in-corpus evidence)
Core syndrome: inoculation lesion followed by regional lymphadenopathy ± fever. - In a 304-case pediatric cohort, lymphadenopathy occurred in 78.8% (234/297) and fever in 46.4% (141/304). (amin2022catscratchdisease pages 2-3) - Lymph node site distribution in that cohort included cervical 52.0%, axillary 28.3%, and inguinal 13.9% (site denominators vary by documentation). (amin2022catscratchdisease pages 2-3)
Timing: - Papule/pustule may appear 7–12 days after inoculation and lymphadenopathy typically appears 1–3 weeks after inoculation in review literature. (puspitasari2025uncoveringthetruth pages 5-6) - Case-based discussion cites presentation typically 3–14 days after scratch or bite. (smith2024catscratchdiseasemimicking pages 3-5)
Atypical presentations are common in tertiary-care cohorts: 20.7% (63/304) lacked lymphadenopathy and were classified as atypical in the Atlanta pediatric cohort. (amin2022catscratchdisease pages 1-2, amin2022catscratchdisease pages 2-3)
Hepatosplenic disease (microabscesses/splenomegaly): among abdominally imaged children (n=55), 38.1% had splenic and/or hepatic microabscesses and 36.4% had splenomegaly. (amin2022catscratchdisease pages 1-2, amin2022catscratchdisease pages 3-4)
Bone involvement: among those with bone MRI (n=20), 35.0% had bone MRI involvement. (amin2022catscratchdisease pages 3-4)
Neuro-ophthalmic / CNS involvement: among those with neuroimaging (n=29), 27.6% had optic neuritis and 17.2% had encephalitis-like findings. (amin2022catscratchdisease pages 3-4)
A structured phenotype-to-ontology mapping with frequencies and timing is provided in artifact-01.
| Phenotype / complication | Suggested HPO term(s) | Frequency / distribution | Typical time to onset | Affected anatomy (suggested UBERON) | Notes / evidence (with URL) |
|---|---|---|---|---|---|
| Inoculation papule / pustule | HP:0011123 Skin papule; HP:0000989 Pustule | Not quantified in Amin 2022 cohort | Papule/pustule typically appears 7–12 days after inoculation; overall symptoms may begin 3–14 days after scratch/bite | UBERON:0001003 skin | Primary inoculation lesion after cat-associated injury; useful early clue before lymphadenopathy. URLs: https://doi.org/10.5455/ovj.2025.v15.i5.5 ; https://doi.org/10.7759/cureus.66840 (puspitasari2025uncoveringthetruth pages 5-6, smith2024catscratchdiseasemimicking pages 3-5) |
| Regional lymphadenopathy (overall) | HP:0002716 Lymphadenopathy | 78.8% (234/297) in Atlanta pediatric cohort | Usually develops 1–3 weeks after inoculation; classic illness often appears 3–14 days after scratch/bite | UBERON:0000029 lymph node | Core phenotype of typical CSD; median lymphadenopathy duration at presentation 9 days (IQR 6–21). URL: https://doi.org/10.1093/ofid/ofac426 ; https://doi.org/10.5455/ovj.2025.v15.i5.5 ; https://doi.org/10.7759/cureus.66840 (amin2022catscratchdisease pages 2-3, puspitasari2025uncoveringthetruth pages 5-6, smith2024catscratchdiseasemimicking pages 3-5) |
| Cervical lymphadenopathy | HP:0007676 Cervical lymphadenopathy | 52.0% (104/200) among cases with site data | As above: usually 1–3 weeks after inoculation | UBERON:0000057 cervical lymph node | Most common nodal site in Amin 2022 pediatric cohort. URL: https://doi.org/10.1093/ofid/ofac426 (amin2022catscratchdisease pages 2-3, amin2022catscratchdisease pages 3-4) |
| Axillary lymphadenopathy | HP:0010780 Axillary lymphadenopathy | 28.3% (67/237) in Amin 2022; 43% cited in Smith 2024 review-style discussion | As above: usually 1–3 weeks after inoculation | UBERON:0001421 axillary lymph node | Common after upper-extremity inoculation; site frequency varies by cohort/source. URL: https://doi.org/10.1093/ofid/ofac426 ; https://doi.org/10.7759/cureus.66840 (amin2022catscratchdisease pages 2-3, smith2024catscratchdiseasemimicking pages 3-5) |
| Inguinal lymphadenopathy | HP:0100765 Inguinal lymphadenopathy | 13.9% (37/266) in Amin 2022 | As above: usually 1–3 weeks after inoculation | UBERON:0011274 inguinal lymph node | Less common than cervical/axillary disease but well-described, including atypical presentations. URL: https://doi.org/10.1093/ofid/ofac426 ; https://doi.org/10.7759/cureus.44280 (amin2022catscratchdisease pages 2-3, sulaiman2023catscratchdisease pages 4-7) |
| Fever | HP:0001945 Fever | 46.4% (141/304) in Amin 2022 | Often accompanies/subsequently follows lymphadenopathy; overall illness may begin 3–14 days after scratch/bite | UBERON:0000178 blood / systemic | Frequent systemic feature; more pronounced in atypical/disseminated disease. URL: https://doi.org/10.1093/ofid/ofac426 ; https://doi.org/10.7759/cureus.66840 (amin2022catscratchdisease pages 2-3, smith2024catscratchdiseasemimicking pages 3-5) |
| Splenomegaly | HP:0001744 Splenomegaly | 8.5% (23/270) clinically in Amin 2022; 36.4% (20/55) among those with abdominal imaging | Usually part of atypical/disseminated hepatosplenic disease | UBERON:0002106 spleen | Suggests systemic spread; in imaged patients, splenomegaly and microabscesses were common. URL: https://doi.org/10.1093/ofid/ofac426 (amin2022catscratchdisease pages 1-2, amin2022catscratchdisease pages 3-4) |
| Hepatic and/or splenic microabscesses (hepatosplenic CSD) | HP:0011962 Abnormality of the spleen; HP:0002240 Hepatomegaly; HP:0002572 Hepatic abscess | 38.1% (21/55) among abdominally imaged patients in Amin 2022 | Atypical/disseminated manifestation; timing not precisely quantified in retrieved cohort | UBERON:0002107 liver; UBERON:0002106 spleen | Important radiologic marker of hepatosplenic involvement; abdominal US/CT can detect lesions. URL: https://doi.org/10.1093/ofid/ofac426 ; https://doi.org/10.7759/cureus.66134 (amin2022catscratchdisease pages 1-2, amin2022catscratchdisease pages 3-4, nguyen2024threemonthhistoryof pages 4-6) |
| Osteomyelitis / bone involvement | HP:0002754 Osteomyelitis | Bone MRI involvement 35.0% (7/20) among those who underwent bone MRI in Amin 2022 | Atypical/disseminated manifestation; specific onset interval not reported in retrieved cohort | UBERON:0001474 bone element | Represents deeper disseminated infection; may mimic malignancy or other chronic inflammatory bone disease. URL: https://doi.org/10.1093/ofid/ofac426 (amin2022catscratchdisease pages 3-4) |
| Ocular neuroretinitis | HP:0012372 Neuroretinitis | Not population-quantified in Amin overall cohort; ocular disease included among atypical presentations | Ocular manifestations tend to arise after systemic illness; exact timing variable | UBERON:0000966 retina; UBERON:0001004 optic nerve | Vision-threatening atypical CSD phenotype; often linked to Bartonella serology and ocular imaging. URL: https://doi.org/10.4274/tjo.galenos.2022.44692 ; https://doi.org/10.1186/s12348-024-00387-0 (lai2026clinicalandepidemiological pages 1-2) |
| Optic neuritis / optic nerve involvement | HP:0000648 Optic neuritis | 27.6% (8/29) among those with neuroimaging in Amin 2022 | Variable; part of neuro-ophthalmic dissemination | UBERON:0001004 optic nerve | Neuroimaging in Amin identified optic neuritis in a substantial subset of imaged patients. URL: https://doi.org/10.1093/ofid/ofac426 (amin2022catscratchdisease pages 3-4) |
| Uveitis | HP:0000554 Uveitis | Not quantified in Amin cohort; ocular series reported anterior uveitis in 13% of affected eyes | Variable; atypical ocular manifestation | UBERON:0001768 uvea | Reported ocular manifestation of CSD alongside neuroretinitis, retinal infiltrates, and vascular occlusions. URL: https://doi.org/10.4274/tjo.galenos.2022.44692 ; https://doi.org/10.1186/s12886-023-03063-4 (lai2026clinicalandepidemiological pages 1-2) |
| Meningoencephalitis / encephalitis | HP:0001298 Encephalopathy; HP:0002383 Encephalitis; HP:0001287 Meningitis | 17.2% (5/29) had encephalitis-like findings among those with neuroimaging in Amin 2022 | Atypical/disseminated complication; timing variable | UBERON:0000955 brain; UBERON:0002050 cerebral cortex; UBERON:000 membranes of brain/spinal cord | Neurologic involvement is uncommon but clinically important; included in the atypical CSD spectrum. URL: https://doi.org/10.1093/ofid/ofac426 ; https://doi.org/10.5455/ovj.2025.v15.i5.5 (amin2022catscratchdisease pages 3-4, puspitasari2025uncoveringthetruth pages 5-6) |
Table: This table maps major cat-scratch disease phenotypes and complications to suggested HPO and UBERON terms, with quantitative frequencies from the Atlanta pediatric cohort and timing data from recent reviews/case literature. It is useful for ontology-based disease knowledge base population and phenotype annotation.
CSD is not a Mendelian genetic disease; no causal human gene or pathogenic germline variant set is expected.
No reproducible host genetic susceptibility loci, modifier genes, or protective variants were identified in the retrieved evidence corpus. (No in-corpus evidence)
The retrieved evidence supports multiple molecular determinants of B. henselae pathogenicity: - BadA (Bartonella adhesin A): implicated in host cell adhesion and biofilm formation; linked to VEGF induction and angiogenic responses. (xi2024sneakytacticsingenious pages 5-6, xi2024sneakytacticsingenious pages 2-4, gadila2025comparisonoftranscriptomic pages 1-2) - Type IV secretion systems: VirB/D4 and Trw systems contribute to endothelial and erythrocyte interactions (erythrocyte binding/invasion and persistence). (xi2024sneakytacticsingenious pages 5-6, xi2024sneakytacticsingenious pages 6-7) - BafA (Bartonella angiogenic factor A): described as binding VEGFR2 and acting as a VEGF mimic in mechanistic discussion. (xi2024sneakytacticsingenious pages 6-7)
The dominant environmental contributors are zoonotic exposures (cats and cat-associated fleas), rather than classic toxin or pollution exposures. (puspitasari2025uncoveringthetruth pages 2-3, puspitasari2025uncoveringthetruth pages 5-6)
No specific lifestyle factors (diet, smoking, alcohol) were identified in the retrieved evidence as independent risk modifiers. (No in-corpus evidence)
1) Inoculation via scratch/bite/lick introduces B. henselae into skin and local tissues. (sulaiman2023catscratchdisease pages 4-7, puspitasari2025uncoveringthetruth pages 5-6)
2) Local immune activation with regional lymph node involvement; inflammatory cytokines including IL-2/IL-6/IL-10 have been reported in CSD patients in mechanistic review. (xi2024sneakytacticsingenious pages 2-4)
3) Cell tropism and persistence: bacteria invade endothelial cells and form Bartonella-containing vacuoles that resist acidification and lysosomal fusion, enabling intracellular survival; erythrocyte invasion provides an “immunological cloak”/sanctuary promoting persistent bacteremia. (xi2024sneakytacticsingenious pages 5-6, xi2024sneakytacticsingenious pages 6-7)
4) Dissemination in some hosts results in hepatosplenic, bone, ocular, and neurologic disease; neurobartonellosis review highlights multiple potential reservoirs and cell types enabling CNS effects. (bush2024neurobartonellosesemergingfrom pages 28-29)
Key processes (GO Biological Process suggestions): - Granulomatous inflammation (GO:0006954 inflammatory response; granuloma formation—closest mapping often via inflammatory response terms) supported by lymph node histopathology patterns (necrotizing granulomatous inflammation). (amin2022catscratchdisease pages 2-3, sulaiman2023catscratchdisease pages 4-7) - Angiogenesis / vasoproliferation (GO:0001525 angiogenesis) via VEGF induction and VEGF-mimic factors (BadA-associated VEGF induction; BafA–VEGFR2 mimicry described). (xi2024sneakytacticsingenious pages 5-6, xi2024sneakytacticsingenious pages 6-7) - Intracellular survival / evasion of lysosomal fusion (GO:0045087 innate immune response; GO:0045321 leukocyte activation; and processes related to endosome/lysosome trafficking), via BCVs resisting lysosomal fusion/acidification. (xi2024sneakytacticsingenious pages 5-6, xi2024sneakytacticsingenious pages 6-7) - Immune regulation via IL-10 / STAT3 axis (GO:0006955 immune response; GO:0001817 regulation of cytokine production), enabling anti-inflammatory persistence. (bush2024neurobartonellosesemergingfrom pages 28-29, xi2024sneakytacticsingenious pages 2-4)
Key cell types (Cell Ontology [CL] suggestions): - Vascular endothelial cell (CL:0000115), including HUVEC experimental systems used to assay virulence/angiogenesis. (kondo2025differentialvasoproliferativetraits pages 1-2, xi2024sneakytacticsingenious pages 5-6) - Erythrocyte (CL:0000232) for intraerythrocytic persistence. (xi2024sneakytacticsingenious pages 6-7) - Macrophage (CL:0000235), including possible “Trojan-horse” dissemination concept to brain. (bush2024neurobartonellosesemergingfrom pages 28-29) - Microglial cell (CL:0000129) and pericyte (CL:0000669) noted as in vitro-infected cell types in neurobartonellosis review. (bush2024neurobartonellosesemergingfrom pages 28-29) - CD34-positive hematopoietic progenitor cell (CL:0000055) as a potential reservoir niche. (xi2024sneakytacticsingenious pages 6-7)
Anatomy (UBERON suggestions): - Skin (UBERON:0001003) inoculation site; lymph node (UBERON:0000029) primary clinical involvement. (puspitasari2025uncoveringthetruth pages 5-6, amin2022catscratchdisease pages 2-3) - Spleen (UBERON:0002106) and liver (UBERON:0002107) in hepatosplenic CSD. (amin2022catscratchdisease pages 3-4) - Retina (UBERON:0000966) and optic nerve (UBERON:0001004) in ocular disease. (amin2022catscratchdisease pages 3-4) - Brain (UBERON:0000955) for CNS manifestations (encephalitis-like findings). (amin2022catscratchdisease pages 3-4)
Primary: lymph nodes (regional), skin at inoculation. (puspitasari2025uncoveringthetruth pages 5-6, amin2022catscratchdisease pages 2-3)
Secondary (disseminated/atypical): - Hepatosplenic: liver and spleen microabscesses/splenomegaly (amin2022catscratchdisease pages 3-4) - Musculoskeletal: bone involvement/osteomyelitis-like findings (amin2022catscratchdisease pages 3-4) - Ocular/neuro-ophthalmic: optic nerve involvement/optic neuritis, neuroretinitis (amin2022catscratchdisease pages 3-4, lai2026clinicalandepidemiological pages 1-2) - CNS: encephalitis-like findings (amin2022catscratchdisease pages 3-4)
Onset pattern: typically subacute. - In review literature, inoculation lesion precedes regional lymphadenopathy by ~1–3 weeks; papule/pustule at ~7–12 days post-inoculation. (puspitasari2025uncoveringthetruth pages 5-6)
Duration/course: - Disease is often self-limited; expert recommendations note regional lymphadenopathy commonly lasts 2–3 months. (rolain2004recommendationsfortreatment pages 6-7) - Another clinical summary reports typical CSD is self-limited resolving in 2–6 months. (nguyen2024threemonthhistoryof pages 4-6)
Structured quantitative epidemiology statistics are provided in artifact-00.
| Domain | Statistic (numeric) | Population/setting | Source (first author year, journal) | URL | Notes |
|---|---|---|---|---|---|
| Incidence | 4.5–9.3 outpatient diagnoses per 100,000 | United States | Sulaiman 2023, Cureus | https://doi.org/10.7759/cureus.44280 | Reported US outpatient diagnosis rate for CSD (sulaiman2023catscratchdisease pages 4-7) |
| Incidence | 0.19–0.86 hospital admissions per 100,000 | United States | Sulaiman 2023, Cureus | https://doi.org/10.7759/cureus.44280 | Reported US hospitalization rate for CSD (sulaiman2023catscratchdisease pages 4-7) |
| Incidence | ~13,000 annual cases | United States | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Broader US annual burden cited in pediatric cohort paper (amin2022catscratchdisease pages 1-2) |
| Incidence | 22,000 new cases annually | United States | Puspitasari 2025, Open Veterinary Journal | https://doi.org/10.5455/ovj.2025.v15.i5.5 | Review estimate of annual US CSD burden (puspitasari2025uncoveringthetruth pages 2-3) |
| Incidence | 9.4 cases per 100,000 | US children age 5–9 years | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Highest incidence noted for children 5–9 years (amin2022catscratchdisease pages 1-2) |
| Incidence | 6.4 per 100,000 | South Atlantic region, United States | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Regional incidence cited for Georgia/South Atlantic setting (amin2022catscratchdisease pages 4-6) |
| Cohort size | 304 cases | Atlanta pediatric tertiary center, 2010–2018 | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Retrospective pediatric cohort (amin2022catscratchdisease pages 4-6, amin2022catscratchdisease pages 1-2) |
| Age | Median 8.1 years (IQR 5.4–12.1) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Typical school-age presentation (amin2022catscratchdisease pages 1-2, amin2022catscratchdisease pages 2-3) |
| Age | 90.1% <14 years | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Pediatric skew of cases (amin2022catscratchdisease pages 2-3) |
| Age distribution | 20.7% age 0–4; 35.5% age 5–9; 33.9% age 10–14; 9.9% age 15–19 | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Age-stratified case distribution (amin2022catscratchdisease pages 3-4) |
| Sex | 51.3% female | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | 156/304 female (amin2022catscratchdisease pages 1-2) |
| Seasonality | August 13.5% (41/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Late-summer peak (amin2022catscratchdisease pages 1-2, amin2022catscratchdisease media 65029abb) |
| Seasonality | September 15.5% (47/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Peak month in cohort (amin2022catscratchdisease pages 1-2, amin2022catscratchdisease pages 2-3, amin2022catscratchdisease media 65029abb) |
| Seasonality | October 12.8% (39/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Fall clustering (amin2022catscratchdisease pages 2-3, amin2022catscratchdisease media 65029abb) |
| Seasonality | November 12.2% (37/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Fall clustering (amin2022catscratchdisease pages 2-3, amin2022catscratchdisease media 65029abb) |
| Seasonality | June 2.0% (6/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Lowest month reported (amin2022catscratchdisease pages 2-3, amin2022catscratchdisease media 65029abb) |
| Seasonality | May 3.3% (10/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Low-prevalence spring month (amin2022catscratchdisease pages 2-3, amin2022catscratchdisease media 65029abb) |
| Seasonality | April 4.6% (14/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Low-prevalence spring month (amin2022catscratchdisease pages 2-3, amin2022catscratchdisease media 65029abb) |
| Exposure | 92.4% feline exposure (242/262) | Atlanta pediatric cohort with documented exposure history | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Strong cat exposure association (amin2022catscratchdisease pages 1-2) |
| Exposure | 22.0% canine exposure (55/250) | Atlanta pediatric cohort with documented exposure history | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Dog exposure also reported in a minority (amin2022catscratchdisease pages 1-2) |
| Clinical features | 78.8% lymphadenopathy (234/297) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Predominant presentation (amin2022catscratchdisease pages 2-3, amin2022catscratchdisease pages 3-4) |
| Clinical features | 46.4% fever (141/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Common systemic symptom (amin2022catscratchdisease pages 2-3, amin2022catscratchdisease pages 3-4) |
| Clinical features | 20.7% atypical/non-lymphadenopathy presentations (63/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Included hepatosplenic, osteomyelitis, ocular, CNS disease (amin2022catscratchdisease pages 4-6, amin2022catscratchdisease pages 1-2, amin2022catscratchdisease pages 3-4) |
| Lymph node site | 52.0% cervical (104/200) | Atlanta pediatric cohort with node-site data | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Most frequent nodal site (amin2022catscratchdisease pages 2-3, amin2022catscratchdisease pages 3-4) |
| Lymph node site | 28.3% axillary (67/237) | Atlanta pediatric cohort with node-site data | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Second most frequent nodal site (amin2022catscratchdisease pages 2-3, amin2022catscratchdisease pages 3-4) |
| Lymph node site | 13.9% inguinal (37/266) | Atlanta pediatric cohort with node-site data | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Less common nodal site (amin2022catscratchdisease pages 2-3) |
| Clinical course | Median LAD duration 9 days (IQR 6–21) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Duration at presentation (amin2022catscratchdisease pages 2-3) |
| Labs | 26.6% leukocytosis (58/218) | Atlanta pediatric cohort tested for CBC abnormality | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Laboratory abnormality rate (amin2022catscratchdisease pages 2-3) |
| Labs | 49.6% elevated ESR (55/111) | Atlanta pediatric cohort tested for ESR | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Frequent inflammatory marker elevation (amin2022catscratchdisease pages 2-3) |
| Labs | 18.7% elevated CRP (34/184) | Atlanta pediatric cohort tested for CRP | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | CRP elevation less frequent than ESR (amin2022catscratchdisease pages 2-3) |
| Diagnostics | 58.2% had serology available (177/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Serology was the main diagnostic test (amin2022catscratchdisease pages 2-3) |
| Diagnostics | 63.2% IgM ≥1:20 (110/174) | Atlanta pediatric cohort tested serologically | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Positivity threshold used in cohort (amin2022catscratchdisease pages 2-3) |
| Diagnostics | 95.5% IgG ≥1:128 (169/177) | Atlanta pediatric cohort tested serologically | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | High IgG seropositivity among tested cases (amin2022catscratchdisease pages 2-3) |
| Diagnostics | 11.2% underwent histopathology (36/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Tissue diagnosis used in a minority (amin2022catscratchdisease pages 2-3) |
| Histopathology | 38.2% necrotizing granulomatous inflammation (13/34) | Atlanta pediatric cohort with pathology result available | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Most common biopsy pattern reported (amin2022catscratchdisease pages 2-3) |
| Histopathology | 8.8% Warthin–Starry positive (3/34) | Atlanta pediatric cohort with pathology result available | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Silver stain positivity was uncommon (amin2022catscratchdisease pages 2-3) |
| Diagnostics | 4.3% had PCR performed (13/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | PCR used infrequently (amin2022catscratchdisease pages 2-3) |
| Diagnostics | 3 PCR-positive lymph nodes | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Low absolute PCR yield in this cohort (amin2022catscratchdisease pages 2-3, amin2022catscratchdisease pages 3-4) |
| Imaging | 71.1% had ≥1 radiologic study (216/304) | Atlanta pediatric cohort | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Extensive imaging use in tertiary setting (amin2022catscratchdisease pages 3-4, amin2022catscratchdisease media 65029abb) |
| Imaging | 36.4% splenomegaly (20/55) | Atlanta pediatric cohort with abdominal imaging | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Among those imaged abdominally (amin2022catscratchdisease pages 1-2, amin2022catscratchdisease pages 3-4) |
| Imaging | 38.1% splenic and/or hepatic microabscesses (21/55) | Atlanta pediatric cohort with abdominal imaging | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Important marker of hepatosplenic disease (amin2022catscratchdisease pages 1-2, amin2022catscratchdisease pages 3-4) |
| Imaging | 9.1% abdominal lymphadenopathy (5/55) | Atlanta pediatric cohort with abdominal imaging | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Less common abdominal imaging finding (amin2022catscratchdisease pages 3-4) |
| Imaging | 17.2% encephalitis-like findings (5/29) | Atlanta pediatric cohort with neuroimaging | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | CNS involvement on imaging (amin2022catscratchdisease pages 3-4) |
| Imaging | 27.6% optic neuritis (8/29) | Atlanta pediatric cohort with neuroimaging | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Neuro-ophthalmic manifestation on MRI/neuroimaging (amin2022catscratchdisease pages 3-4, amin2022catscratchdisease media 65029abb) |
| Imaging | 35.0% bone MRI involvement (7/20) | Atlanta pediatric cohort with bone MRI | Amin 2022, Open Forum Infectious Diseases | https://doi.org/10.1093/ofid/ofac426 | Suggestive of osteomyelitis/bone disease subset (amin2022catscratchdisease pages 3-4) |
Table: This table compiles explicit quantitative epidemiology and clinical statistics for cat-scratch disease from the retrieved literature, with emphasis on U.S. burden estimates and the Atlanta pediatric cohort. It is useful as a structured evidence summary for knowledge-base population and citation tracking.
Key recent/usable estimates from retrieved sources include: - US outpatient diagnosis rates 4.5–9.3 per 100,000 and hospitalization 0.19–0.86 per 100,000 (sulaiman2023catscratchdisease pages 4-7). - Pediatric incidence peak cited at 9.4 per 100,000 among US children age 5–9 years (amin2022catscratchdisease pages 1-2). - Seasonality in a large Atlanta pediatric cohort showed peaks in August–November, with September highest (15.5% of diagnoses). (amin2022catscratchdisease pages 2-3, amin2022catscratchdisease media 65029abb)
Not applicable (infectious disease). No inherited transmission pattern.
A structured diagnostics summary including cutoffs and performance notes is provided in artifact-02.
| Section | Test / Clinical scenario | Specimen / setting | Positivity criteria / regimen | Performance / evidence notes | MAXO suggestion | Key citations / URLs |
|---|---|---|---|---|---|---|
| Diagnostics | Serology (IFA / ELISA) | Serum | In the Atlanta pediatric cohort, seropositivity was defined as IgM >1:20 and IgG ≥1:128; another clinical source notes IFA/EIA >1:64 as positive, and a fourfold rise in paired sera as definitive | Mainstay diagnostic approach because culture is difficult; in the Atlanta cohort, IgM ≥1:20 in 63.2% (110/174) and IgG ≥1:128 in 95.5% (169/177); ELISA/IFA described as the “best initial test” in review literature (amin2022catscratchdisease pages 1-2, amin2022catscratchdisease pages 2-3, nguyen2024threemonthhistoryof pages 4-6, puspitasari2025uncoveringthetruth pages 6-7) | MAXO:0000014 serological test | Amin 2022 https://doi.org/10.1093/ofid/ofac426; Nguyen 2024 https://doi.org/10.7759/cureus.66134; Puspitasari 2025 https://doi.org/10.5455/ovj.2025.v15.i5.5 (amin2022catscratchdisease pages 1-2, amin2022catscratchdisease pages 2-3, nguyen2024threemonthhistoryof pages 4-6, puspitasari2025uncoveringthetruth pages 6-7) |
| Diagnostics | Serology examples from individual cases | Serum | Reported high titers include IgM >1:20, IgG 1:4096 and IgG >1:1024, IgM 1:640 | Illustrates that markedly elevated titers may support diagnosis even when PCR is negative; useful in atypical or malignancy-mimicking presentations (sulaiman2023catscratchdisease pages 4-7, smith2024catscratchdiseasemimicking pages 3-5) | MAXO:0000014 serological test | Sulaiman 2023 https://doi.org/10.7759/cureus.44280; Smith 2024 https://doi.org/10.7759/cureus.66840 (sulaiman2023catscratchdisease pages 4-7, smith2024catscratchdiseasemimicking pages 3-5) |
| Diagnostics | PCR | Lymph node tissue; blood/tissue in selected cases | No universal cutoff reported in retrieved evidence; positivity is pathogen DNA detection | Lymph node PCR sensitivity reported as 30–60%, increasing to ~87% when combined with histology and serology; in the Atlanta cohort, PCR was used in 4.3% (13/304) and only 3 lymph nodes were PCR-positive; PCR described as lower sensitivity but very high specificity than serology (sulaiman2023catscratchdisease pages 4-7, amin2022catscratchdisease pages 2-3, puspitasari2025uncoveringthetruth pages 6-7) | MAXO:0000127 polymerase chain reaction assay | Sulaiman 2023 https://doi.org/10.7759/cureus.44280; Amin 2022 https://doi.org/10.1093/ofid/ofac426; Puspitasari 2025 https://doi.org/10.5455/ovj.2025.v15.i5.5 (sulaiman2023catscratchdisease pages 4-7, amin2022catscratchdisease pages 2-3, puspitasari2025uncoveringthetruth pages 6-7) |
| Diagnostics | Histopathology | Lymph node biopsy / aspirate | Characteristic features: stellate granulomas with central necrosis, neutrophilic infiltration, palisading histiocytes; other reports describe granulomatous inflammation with multiple microabscesses | Helpful when diagnosis is uncertain or malignancy must be excluded; in the Atlanta cohort, histopathology was done in 11.2% (36/304), with necrotizing granulomatous inflammation in 38.2% (13/34) and Warthin–Starry positive in 8.8% (3/34); Warthin–Starry may show bacilli but a negative stain does not exclude CSD (sulaiman2023catscratchdisease pages 4-7, nguyen2024threemonthhistoryof pages 4-6, puspitasari2025uncoveringthetruth pages 5-6, amin2022catscratchdisease pages 2-3) | MAXO:0000373 biopsy of lymph node | Sulaiman 2023 https://doi.org/10.7759/cureus.44280; Nguyen 2024 https://doi.org/10.7759/cureus.66134; Puspitasari 2025 https://doi.org/10.5455/ovj.2025.v15.i5.5; Amin 2022 https://doi.org/10.1093/ofid/ofac426 (sulaiman2023catscratchdisease pages 4-7, nguyen2024threemonthhistoryof pages 4-6, puspitasari2025uncoveringthetruth pages 5-6, amin2022catscratchdisease pages 2-3) |
| Diagnostics | mNGS | Blood, tissue biopsy, drainage fluid; aqueous humor in ocular disease | Positive when B. henselae sequence reads are identified; ocular case reported 521 reads in aqueous humor | Valuable for atypical disease and when history/serology are equivocal; in the pediatric mNGS-confirmed series, B. henselae was detected in all 20 specimens; review notes blood culture sensitivity around ~20%, supporting molecular testing (lai2026clinicalandepidemiological pages 1-2, lai2026clinicalandepidemiological pages 3-4) | MAXO:0000140 metagenomic sequencing assay | Li 2024 https://doi.org/10.1186/s12348-024-00387-0; Lai 2026 https://doi.org/10.3389/fpubh.2025.1743423 (lai2026clinicalandepidemiological pages 1-2, lai2026clinicalandepidemiological pages 3-4) |
| Treatment | Typical lymphadenitis / uncomplicated regional CSD | Immunocompetent patient with localized disease | Azithromycin 10 mg/kg on day 1, then 5 mg/kg on days 2–5 | Most uncomplicated disease is self-limited; antibiotics are often not required, but azithromycin is the best-supported short regimen for reducing node size/pain; review/case sources cite this as standard for typical disease (sulaiman2023catscratchdisease pages 4-7, puspitasari2025uncoveringthetruth pages 6-7, rolain2004recommendationsfortreatment pages 6-7) | MAXO:0001298 azithromycin therapy | Sulaiman 2023 https://doi.org/10.7759/cureus.44280; Puspitasari 2025 https://doi.org/10.5455/ovj.2025.v15.i5.5; Rolain 2004 https://doi.org/10.1128/AAC.48.6.1921-1933.2004 (sulaiman2023catscratchdisease pages 4-7, puspitasari2025uncoveringthetruth pages 6-7, rolain2004recommendationsfortreatment pages 6-7) |
| Treatment | Observation / supportive care for uncomplicated disease | Immunocompetent patient with mild-to-moderate lymphadenitis | No antibiotic regimen | Multiple sources state disease is usually self-limited, often resolving over weeks to months; one report notes typical CSD resolves in 2–6 months, and another that lymphadenopathy commonly lasts 2–3 months (sulaiman2023catscratchdisease pages 4-7, rolain2004recommendationsfortreatment pages 6-7, nguyen2024threemonthhistoryof pages 4-6, puspitasari2025uncoveringthetruth pages 5-6) | MAXO:0000011 clinical observation | Sulaiman 2023 https://doi.org/10.7759/cureus.44280; Rolain 2004 https://doi.org/10.1128/AAC.48.6.1921-1933.2004; Nguyen 2024 https://doi.org/10.7759/cureus.66134; Puspitasari 2025 https://doi.org/10.5455/ovj.2025.v15.i5.5 (sulaiman2023catscratchdisease pages 4-7, rolain2004recommendationsfortreatment pages 6-7, nguyen2024threemonthhistoryof pages 4-6, puspitasari2025uncoveringthetruth pages 5-6) |
| Treatment | Suppurative / painful lymph node | Suppurated node, painful adenitis | Needle aspiration for decompression; surgical management in selected persistent cases | Needle aspiration may relieve pain within 24–48 h; persistent/worsening nodes may need biopsy or excision to exclude malignancy; intranodal gentamicin and surgery have been reported in the literature, but evidence is limited (rolain2004recommendationsfortreatment pages 6-7, sulaiman2023catscratchdisease pages 4-7) | MAXO:0000058 needle aspiration; MAXO:0001175 surgical excision | Rolain 2004 https://doi.org/10.1128/AAC.48.6.1921-1933.2004; Sulaiman 2023 https://doi.org/10.7759/cureus.44280 (rolain2004recommendationsfortreatment pages 6-7, sulaiman2023catscratchdisease pages 4-7) |
| Treatment | Hepatosplenic / systemic disease | Disseminated disease, prolonged fever, organ involvement | Pediatric mNGS series used azithromycin alone (1/20), azithromycin + rifampicin (8/20), doxycycline alone (1/20), doxycycline + rifampicin (10/20) | In the 20-case pediatric series, all improved and were discharged, though one child with hepatic/renal involvement had progression on CT at ~1 month; systemic disease often prompts combination therapy despite limited trial evidence (lai2026clinicalandepidemiological pages 3-4) | MAXO:0001298 azithromycin therapy; MAXO:0000574 doxycycline therapy; MAXO:0000096 rifampicin therapy | Lai 2026 https://doi.org/10.3389/fpubh.2025.1743423 (lai2026clinicalandepidemiological pages 3-4) |
| Treatment | Ocular disease / neuroretinitis / CNS involvement | Neuroretinitis, optic neuritis, encephalopathy/CNS disease | Doxycycline 100 mg twice daily + rifampin 300 mg twice daily is the classic recommended adult combination for ocular/CNS Bartonella disease | Frequently used for complicated ocular/CNS disease because of tissue penetration; case reports describe good visual recovery after doxycycline + rifampin; Rolain recommends this combination for CNS involvement (rolain2004recommendationsfortreatment pages 6-7, lai2026clinicalandepidemiological pages 1-2, smith2024catscratchdiseasemimicking pages 3-5) | MAXO:0000574 doxycycline therapy; MAXO:0000096 rifampicin therapy | Rolain 2004 https://doi.org/10.1128/AAC.48.6.1921-1933.2004; Li 2024 https://doi.org/10.1186/s12348-024-00387-0; Avaylon 2023 https://doi.org/10.7759/cureus.45866 (via retrieved paper list); Smith 2024 https://doi.org/10.7759/cureus.66840 (rolain2004recommendationsfortreatment pages 6-7, lai2026clinicalandepidemiological pages 1-2, smith2024catscratchdiseasemimicking pages 3-5) |
| Treatment | Ocular disease with inflammatory involvement | Uveitis / neuroretinitis with optic disc inflammation | Systemic antibiotics plus corticosteroids used in ocular series; one pediatric case received doxycycline + methylprednisolone for 6 months with improvement | Ocular case series reported improvement in visual acuity and lesions with systemic antibiotics; corticosteroids are often reserved for marked optic nerve or inflammatory involvement and should accompany antimicrobial treatment (lai2026clinicalandepidemiological pages 1-2) | MAXO:0000574 doxycycline therapy; MAXO:0000016 corticosteroid therapy | Hong 2023 https://doi.org/10.1186/s12886-023-03063-4; Acar 2023 https://doi.org/10.4274/tjo.galenos.2022.44692 (lai2026clinicalandepidemiological pages 1-2) |
| Treatment | Immunocompromised disease / bacillary angiomatosis | HIV/immunosuppression, disseminated Bartonella | Doxycycline or erythromycin for 10 days to 2 months cited in case-review literature | Complicated and immunocompromised disease is more likely to require prolonged therapy; evidence is largely case-based and expert review rather than trials (sulaiman2023catscratchdisease pages 4-7, puspitasari2025uncoveringthetruth pages 6-7) | MAXO:0000574 doxycycline therapy; MAXO:0000100 erythromycin therapy | Sulaiman 2023 https://doi.org/10.7759/cureus.44280; Puspitasari 2025 https://doi.org/10.5455/ovj.2025.v15.i5.5 (sulaiman2023catscratchdisease pages 4-7, puspitasari2025uncoveringthetruth pages 6-7) |
| Treatment | Alternative antibiotics reported in retrospective literature | Selected systemic or refractory cases | Retrospective effectiveness rates reported for rifampin 87%, ciprofloxacin 84%, gentamicin 73%, TMP-SMX 58% | These data come from non-randomized retrospective literature and should be interpreted cautiously; they are useful mainly when standard regimens cannot be used or in refractory disease (nguyen2024threemonthhistoryof pages 4-6) | MAXO:0000096 rifampicin therapy; MAXO:0000085 ciprofloxacin therapy; MAXO:0000111 gentamicin therapy; MAXO:0000154 trimethoprim-sulfamethoxazole therapy | Nguyen 2024 https://doi.org/10.7759/cureus.66134 (nguyen2024threemonthhistoryof pages 4-6) |
Table: This table summarizes the main diagnostic modalities and treatment approaches for cat-scratch disease, including practical cutoff values, performance notes, commonly used regimens, and ontology-ready MAXO action suggestions. It is useful for translating the literature into a structured disease knowledge-base entry.
CSD can mimic neoplastic causes of lymphadenopathy (e.g., lymphoma) and granulomatous infections (e.g., tuberculosis), motivating biopsy and/or molecular testing in atypical presentations. (smith2024catscratchdiseasemimicking pages 3-5, lai2026clinicalandepidemiological pages 3-4)
Treatment and MAXO action suggestions are summarized in artifact-02.
The treatment literature remains heterogeneous; classic expert recommendations note limited antibiotic benefit in typical lymphadenitis, while complicated disease is often treated with combination regimens based on pathophysiology (intracellular niches) and case-series experience rather than high-quality randomized trials. (rolain2004recommendationsfortreatment pages 6-7, nguyen2024threemonthhistoryof pages 4-6)
Primary prevention is focused on interrupting zoonotic transmission: - Flea control on cats and avoiding scratches/bites/licks that break skin are consistently recommended. (puspitasari2025uncoveringthetruth pages 6-7, puspitasari2025uncoveringthetruth pages 5-6, nemade2023catscratchdisease pages 1-3) - Human-to-human transmission has not been documented, supporting zoonotic prevention emphasis. (puspitasari2025uncoveringthetruth pages 2-3)
Reviews note broader Bartonella host ranges and occasional discussion of dogs/other mammals/ticks in the ecology of bartonellosis, though CSD in humans remains most strongly associated with feline exposure. (puspitasari2025uncoveringthetruth pages 2-3, puspitasari2025uncoveringthetruth pages 5-6)
The Atlanta pediatric cohort paper includes figures/tables summarizing month-by-month seasonality and radiologic findings; these were retrieved as images and support the quantitative seasonality and multi-organ involvement described above. (amin2022catscratchdisease media 65029abb, amin2022catscratchdisease media 4aebcb1f, amin2022catscratchdisease media 79399fa7, amin2022catscratchdisease media 3ce93ca4)
1) Expanded molecular diagnostics for atypical disease: mNGS has been used to confirm ocular bartonellosis from intraocular fluid (aqueous humor), enabling diagnosis even when classic history or serology is limited. (Li et al., 2024-04; https://doi.org/10.1186/s12348-024-00387-0) (lai2026clinicalandepidemiological pages 1-2)
2) Mechanistic consolidation of immune-evasion/persistence: 2024 mechanistic review emphasizes intracellular vacuoles resisting lysosomal fusion, erythrocyte sanctuaries, immune modulation (IL-10), and biofilm-mediated persistence—concepts that explain culture-negativity and chronic/recurrent manifestations. (Xi et al., 2024-03; https://doi.org/10.1080/21505594.2024.2322961) (xi2024sneakytacticsingenious pages 5-6, xi2024sneakytacticsingenious pages 2-4, xi2024sneakytacticsingenious pages 6-7)
3) Broadened neurologic phenotype framing (“neurobartonelloses”): 2024 review highlights the breadth of reported neurologic syndromes and plausible vascular/immune mechanisms (VEGF-driven remodeling, intracellular niches, macrophage shuttling). (Bush et al., 2024-10; https://doi.org/10.1186/s13071-024-06491-3) (bush2024neurobartonellosesemergingfrom pages 28-29)
References
(puspitasari2025uncoveringthetruth pages 1-2): Yulianna Puspitasari, Aswin Khairullah, Hartanto Raharjo, Ima Fauziah, Wiwiek Tyasningsih, Dea Kurniasih, Muhammad Kusala, Ikechukwu Moses, Bantari Wardhani, Kartika Fauzia, Katty Riwu, Riza Ahmad, Sheila Yanestria, Syahputra Wibowo, Arif Ansori, and Ilma ruf. Uncovering the truth about cat-scratch disease. Open Veterinary Journal, 15:1895-1906, May 2025. URL: https://doi.org/10.5455/ovj.2025.v15.i5.5, doi:10.5455/ovj.2025.v15.i5.5. This article has 6 citations.
(smith2024catscratchdiseasemimicking pages 3-5): E Smith, R Lawless, A Hoellein, and RR Lawless. Cat-scratch disease mimicking neoplastic etiology in a complex clinical presentation: a case report. Cureus, Aug 2024. URL: https://doi.org/10.7759/cureus.66840, doi:10.7759/cureus.66840. This article has 1 citations.
(amin2022catscratchdisease pages 1-2): Omayma Amin, Christina A Rostad, Mark Gonzalez, Bradley S Rostad, Shelley Caltharp, Elizabeth Quincer, Briana A Betke, Nicole L Gottdenker, Jonathan J Wilson, Andi L Shane, Mohnd Elmontser, Andres Camacho-Gonzalez, Tal Senior, Oliver Smith, Evan J Anderson, and Inci Yildirim. Cat scratch disease: 9 years of experience at a pediatric center. Open Forum Infectious Diseases, Aug 2022. URL: https://doi.org/10.1093/ofid/ofac426, doi:10.1093/ofid/ofac426. This article has 33 citations and is from a peer-reviewed journal.
(amin2022catscratchdisease pages 2-3): Omayma Amin, Christina A Rostad, Mark Gonzalez, Bradley S Rostad, Shelley Caltharp, Elizabeth Quincer, Briana A Betke, Nicole L Gottdenker, Jonathan J Wilson, Andi L Shane, Mohnd Elmontser, Andres Camacho-Gonzalez, Tal Senior, Oliver Smith, Evan J Anderson, and Inci Yildirim. Cat scratch disease: 9 years of experience at a pediatric center. Open Forum Infectious Diseases, Aug 2022. URL: https://doi.org/10.1093/ofid/ofac426, doi:10.1093/ofid/ofac426. This article has 33 citations and is from a peer-reviewed journal.
(sulaiman2023catscratchdisease pages 4-7): Zoheb I Sulaiman, Hasan Samra, and Gina Askar. Cat scratch disease: an unusual case of right inguinal lymphadenitis due to bartonella henselae. Cureus, Aug 2023. URL: https://doi.org/10.7759/cureus.44280, doi:10.7759/cureus.44280. This article has 5 citations.
(rolain2004recommendationsfortreatment pages 6-7): J. M. Rolain, P. Brouqui, J. E. Koehler, C. Maguina, M. J. Dolan, and D. Raoult. Recommendations for treatment of human infections caused by bartonella species. Antimicrobial Agents and Chemotherapy, 48:1921-1933, Jun 2004. URL: https://doi.org/10.1128/aac.48.6.1921-1933.2004, doi:10.1128/aac.48.6.1921-1933.2004. This article has 718 citations and is from a highest quality peer-reviewed journal.
(lai2026clinicalandepidemiological pages 1-2): Shu-yu Lai, Li Chang, Jia-xin Duan, Guang-lu Che, Qiu-xia Yang, Jie Teng, Hui Jian, Xiao-juan Liu, and Fang Liu. Clinical and epidemiological characteristics of cat scratch disease in children from southwestern china: a retrospective analysis of mngs-confirmed cases. Frontiers in Public Health, Jan 2026. URL: https://doi.org/10.3389/fpubh.2025.1743423, doi:10.3389/fpubh.2025.1743423. This article has 0 citations.
(bush2024neurobartonellosesemergingfrom pages 28-29): Janice C. Bush, Cynthia Robveille, Ricardo G. Maggi, and Edward B. Breitschwerdt. Neurobartonelloses: emerging from obscurity! Parasites & Vectors, Oct 2024. URL: https://doi.org/10.1186/s13071-024-06491-3, doi:10.1186/s13071-024-06491-3. This article has 25 citations and is from a peer-reviewed journal.
(amin2022catscratchdisease pages 3-4): Omayma Amin, Christina A Rostad, Mark Gonzalez, Bradley S Rostad, Shelley Caltharp, Elizabeth Quincer, Briana A Betke, Nicole L Gottdenker, Jonathan J Wilson, Andi L Shane, Mohnd Elmontser, Andres Camacho-Gonzalez, Tal Senior, Oliver Smith, Evan J Anderson, and Inci Yildirim. Cat scratch disease: 9 years of experience at a pediatric center. Open Forum Infectious Diseases, Aug 2022. URL: https://doi.org/10.1093/ofid/ofac426, doi:10.1093/ofid/ofac426. This article has 33 citations and is from a peer-reviewed journal.
(xi2024sneakytacticsingenious pages 5-6): Yixuan Xi, Xinru Li, Lu Liu, Feichen Xiu, Xinchao Yi, Hongliang Chen, and Xiaoxing You. Sneaky tactics: ingenious immune evasion mechanisms of bartonella. Virulence, Mar 2024. URL: https://doi.org/10.1080/21505594.2024.2322961, doi:10.1080/21505594.2024.2322961. This article has 20 citations and is from a peer-reviewed journal.
(xi2024sneakytacticsingenious pages 2-4): Yixuan Xi, Xinru Li, Lu Liu, Feichen Xiu, Xinchao Yi, Hongliang Chen, and Xiaoxing You. Sneaky tactics: ingenious immune evasion mechanisms of bartonella. Virulence, Mar 2024. URL: https://doi.org/10.1080/21505594.2024.2322961, doi:10.1080/21505594.2024.2322961. This article has 20 citations and is from a peer-reviewed journal.
(xi2024sneakytacticsingenious pages 6-7): Yixuan Xi, Xinru Li, Lu Liu, Feichen Xiu, Xinchao Yi, Hongliang Chen, and Xiaoxing You. Sneaky tactics: ingenious immune evasion mechanisms of bartonella. Virulence, Mar 2024. URL: https://doi.org/10.1080/21505594.2024.2322961, doi:10.1080/21505594.2024.2322961. This article has 20 citations and is from a peer-reviewed journal.
(puspitasari2025uncoveringthetruth pages 2-3): Yulianna Puspitasari, Aswin Khairullah, Hartanto Raharjo, Ima Fauziah, Wiwiek Tyasningsih, Dea Kurniasih, Muhammad Kusala, Ikechukwu Moses, Bantari Wardhani, Kartika Fauzia, Katty Riwu, Riza Ahmad, Sheila Yanestria, Syahputra Wibowo, Arif Ansori, and Ilma ruf. Uncovering the truth about cat-scratch disease. Open Veterinary Journal, 15:1895-1906, May 2025. URL: https://doi.org/10.5455/ovj.2025.v15.i5.5, doi:10.5455/ovj.2025.v15.i5.5. This article has 6 citations.
(puspitasari2025uncoveringthetruth pages 5-6): Yulianna Puspitasari, Aswin Khairullah, Hartanto Raharjo, Ima Fauziah, Wiwiek Tyasningsih, Dea Kurniasih, Muhammad Kusala, Ikechukwu Moses, Bantari Wardhani, Kartika Fauzia, Katty Riwu, Riza Ahmad, Sheila Yanestria, Syahputra Wibowo, Arif Ansori, and Ilma ruf. Uncovering the truth about cat-scratch disease. Open Veterinary Journal, 15:1895-1906, May 2025. URL: https://doi.org/10.5455/ovj.2025.v15.i5.5, doi:10.5455/ovj.2025.v15.i5.5. This article has 6 citations.
(puspitasari2025uncoveringthetruth pages 6-7): Yulianna Puspitasari, Aswin Khairullah, Hartanto Raharjo, Ima Fauziah, Wiwiek Tyasningsih, Dea Kurniasih, Muhammad Kusala, Ikechukwu Moses, Bantari Wardhani, Kartika Fauzia, Katty Riwu, Riza Ahmad, Sheila Yanestria, Syahputra Wibowo, Arif Ansori, and Ilma ruf. Uncovering the truth about cat-scratch disease. Open Veterinary Journal, 15:1895-1906, May 2025. URL: https://doi.org/10.5455/ovj.2025.v15.i5.5, doi:10.5455/ovj.2025.v15.i5.5. This article has 6 citations.
(nguyen2024threemonthhistoryof pages 4-6): Martin Nguyen, Sheraj Singh, Bevan Sam, Richard Llerena, Abigail Frank, and Marinella Mabalot. Three-month history of lymphadenopathy caused by bartonella henselae in a 13-year-old following a dog scratch. Cureus, Aug 2024. URL: https://doi.org/10.7759/cureus.66134, doi:10.7759/cureus.66134. This article has 1 citations.
(gadila2025comparisonoftranscriptomic pages 1-2): Shiva Kumar Goud Gadila, John R. Caskey, Edward B. Breitschwerdt, Ricardo G. Maggi, and Monica E. Embers. Comparison of transcriptomic profiles between intracellular and extracellular bartonella henselae. Communications Biology, Jan 2025. URL: https://doi.org/10.1038/s42003-025-07535-9, doi:10.1038/s42003-025-07535-9. This article has 2 citations and is from a peer-reviewed journal.
(kondo2025differentialvasoproliferativetraits pages 1-2): Yuka Kondo, Masahiro Suzuki, Shingo Sato, Soichi Maruyama, Akiko Sei, Xingyan Ma, Kota Nakano, Yohei Doi, and Kentaro Tsukamoto. Differential vasoproliferative traits of bartonella henselae strains associated with autotransporter bafa variants. Microbiology Spectrum, Jan 2025. URL: https://doi.org/10.1128/spectrum.01925-24, doi:10.1128/spectrum.01925-24. This article has 1 citations and is from a domain leading peer-reviewed journal.
(amin2022catscratchdisease pages 4-6): Omayma Amin, Christina A Rostad, Mark Gonzalez, Bradley S Rostad, Shelley Caltharp, Elizabeth Quincer, Briana A Betke, Nicole L Gottdenker, Jonathan J Wilson, Andi L Shane, Mohnd Elmontser, Andres Camacho-Gonzalez, Tal Senior, Oliver Smith, Evan J Anderson, and Inci Yildirim. Cat scratch disease: 9 years of experience at a pediatric center. Open Forum Infectious Diseases, Aug 2022. URL: https://doi.org/10.1093/ofid/ofac426, doi:10.1093/ofid/ofac426. This article has 33 citations and is from a peer-reviewed journal.
(amin2022catscratchdisease media 65029abb): Omayma Amin, Christina A Rostad, Mark Gonzalez, Bradley S Rostad, Shelley Caltharp, Elizabeth Quincer, Briana A Betke, Nicole L Gottdenker, Jonathan J Wilson, Andi L Shane, Mohnd Elmontser, Andres Camacho-Gonzalez, Tal Senior, Oliver Smith, Evan J Anderson, and Inci Yildirim. Cat scratch disease: 9 years of experience at a pediatric center. Open Forum Infectious Diseases, Aug 2022. URL: https://doi.org/10.1093/ofid/ofac426, doi:10.1093/ofid/ofac426. This article has 33 citations and is from a peer-reviewed journal.
(lai2026clinicalandepidemiological pages 3-4): Shu-yu Lai, Li Chang, Jia-xin Duan, Guang-lu Che, Qiu-xia Yang, Jie Teng, Hui Jian, Xiao-juan Liu, and Fang Liu. Clinical and epidemiological characteristics of cat scratch disease in children from southwestern china: a retrospective analysis of mngs-confirmed cases. Frontiers in Public Health, Jan 2026. URL: https://doi.org/10.3389/fpubh.2025.1743423, doi:10.3389/fpubh.2025.1743423. This article has 0 citations.
(nemade2023catscratchdisease pages 1-3): Sanjana Vijay Nemade and Kiran Jaywant Shinde. Cat scratch disease. Granulomatous diseases in Otorhinolaryngology, Head and Neck, pages 79-85, Jan 2023. URL: https://doi.org/10.1007/978-981-16-4047-6_9, doi:10.1007/978-981-16-4047-6_9. This article has 0 citations.
(nemade2023catscratchdisease pages 3-6): Sanjana Vijay Nemade and Kiran Jaywant Shinde. Cat scratch disease. Granulomatous diseases in Otorhinolaryngology, Head and Neck, pages 79-85, Jan 2023. URL: https://doi.org/10.1007/978-981-16-4047-6_9, doi:10.1007/978-981-16-4047-6_9. This article has 0 citations.
(amin2022catscratchdisease media 4aebcb1f): Omayma Amin, Christina A Rostad, Mark Gonzalez, Bradley S Rostad, Shelley Caltharp, Elizabeth Quincer, Briana A Betke, Nicole L Gottdenker, Jonathan J Wilson, Andi L Shane, Mohnd Elmontser, Andres Camacho-Gonzalez, Tal Senior, Oliver Smith, Evan J Anderson, and Inci Yildirim. Cat scratch disease: 9 years of experience at a pediatric center. Open Forum Infectious Diseases, Aug 2022. URL: https://doi.org/10.1093/ofid/ofac426, doi:10.1093/ofid/ofac426. This article has 33 citations and is from a peer-reviewed journal.
(amin2022catscratchdisease media 79399fa7): Omayma Amin, Christina A Rostad, Mark Gonzalez, Bradley S Rostad, Shelley Caltharp, Elizabeth Quincer, Briana A Betke, Nicole L Gottdenker, Jonathan J Wilson, Andi L Shane, Mohnd Elmontser, Andres Camacho-Gonzalez, Tal Senior, Oliver Smith, Evan J Anderson, and Inci Yildirim. Cat scratch disease: 9 years of experience at a pediatric center. Open Forum Infectious Diseases, Aug 2022. URL: https://doi.org/10.1093/ofid/ofac426, doi:10.1093/ofid/ofac426. This article has 33 citations and is from a peer-reviewed journal.
(amin2022catscratchdisease media 3ce93ca4): Omayma Amin, Christina A Rostad, Mark Gonzalez, Bradley S Rostad, Shelley Caltharp, Elizabeth Quincer, Briana A Betke, Nicole L Gottdenker, Jonathan J Wilson, Andi L Shane, Mohnd Elmontser, Andres Camacho-Gonzalez, Tal Senior, Oliver Smith, Evan J Anderson, and Inci Yildirim. Cat scratch disease: 9 years of experience at a pediatric center. Open Forum Infectious Diseases, Aug 2022. URL: https://doi.org/10.1093/ofid/ofac426, doi:10.1093/ofid/ofac426. This article has 33 citations and is from a peer-reviewed journal.