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

• Published in: Emerging infectious diseases Vol. 26; no. 7; pp. 1438 - 1446
• Main Authors: Nawrocki, Courtney C, Max, Ryan J, Marzec, Natalie S, Nelson, Christina A
• Format: Journal Article
• Language: English
• Published: United States U.S. National Center for Infectious Diseases 01.07.2020; Centers for Disease Control and Prevention
• Subjects: Age; Analysis; atypical manifestations; Atypical Manifestations of Cat-Scratch Disease, United States, 2005–2014; bacteria; Bartonella henselae; Cat-scratch disease; CME; Codes; Conjunctivitis; Disease; Encephalitis; Endocarditis; Epidemiology; Erythema; Fever; Health insurance; Infections; Insurance claims; meningitis/encephalitis; National health insurance; Nervous system; Older people; Population; retinitis; Trends; Zoonoses; United States > US; cat-scratch disease; osteomyelitis; bacteria; retinitis; United States; atypical manifestations; zoonoses; Bartonella henselae; meningitis/encephalitis
• ISSN: 1080-6040; 1080-6059
• DOI: 10.3201/eid2607.200034

Atypical manifestations that can be severe and difficult to diagnosis develop in 5%-20% of patients with cat-scratch disease. To clarify the epidemiology of atypical cat-scratch disease in the United States, we analyzed data from the 2005-2014 MarketScan national health insurance claims databases by using the International Classification of Diseases, 9th Revision, Clinical Modification, codes for cat-scratch disease and selected atypical manifestations: retinitis/neuroretinitis, conjunctivitis, neuritis, encephalitis, hepatosplenic disease, osteomyelitis, erythema nodosum, and endocarditis. Atypical cat-scratch disease accounted for 1.5% of all cases, resulting in an average annual incidence of 0.7 cases/100,000 population. Atypical cat-scratch disease was associated with increased risk for hospitalization (risk ratios 8.77, 95% CI 6.56-11.72) and occurred most often in female patients 10-14 years of age. Ocular (48.7%), hepatosplenic (24.6%), and neurologic (13.8%) manifestations were most common among patients. A more comprehensive understanding of atypical cat-scratch disease can improve patient diagnosis and potentially elucidate pathophysiology of the disease.