Cat-Scratch Disease: Acute Encephalopathy and Other Neurologic Manifestations

doi:10.1001/archpedi.1991.02160010104026

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Vol. 145 No. 1, January 1991

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Cat-Scratch Disease

Acute Encephalopathy and Other Neurologic Manifestations

Hugh A. Carithers, MD; A. M. Margileth, MD

Am J Dis Child. 1991;145(1):98-101.

Abstract

• Seventy-six patients with neurologic complications ofcat-scratch disease are discussed. Encephalopathy occurred in61, while 15 had either cranial or peripheral nerve involvement.The average age of the patients with encephalopathy was 10.6years (range, 1 to 66 years), and almost twice as many malesas females were affected in contrast to patients with uncomplicatedcat-scratch disease, in which the ratio was almost equal. Feverwas not documented in 50% of patients with encephalopathy andonly 26% had temperatures higher than 39°C. Convulsionsoccurred in 46% and combative behavior in 40%. Lethargy withor without coma was accompanied by variable neurologic signs.Results of laboratory studies, including imaging of the centralnervous system, were inconsistent and nondiagnostic. Biopsytissue from 14 patients showed histopathologic findings compatiblewith cat-scratch disease. The "English-Wear bacillus" was demonstratedby the Warthin-Starry stain in 10 of 14 skin or lymph node specimens.Of the 15 patients without encephalopathy, two children withfacial nerve paresis displayed cranial nerve symptoms and/orsigns, 10 patients had cat-scratch disease neuroretinitis, andthree women had peripheral neuritis. All 76 patients recoveredwithin 12 months; 78% recovered within 1 to 12 weeks. Therewere no neurologic sequelae. Treatment consisted of controlof convulsions and supportive measures. Commonly used antibioticsadministered to more than half of the patients were apparentlyineffective.

(AJDC. 1991;145:98-101)

Author Affiliations

From the Jacksonville Health Education Program, University of Florida (Dr Carithers), and Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Margileth).

Footnotes

Accepted for publication June 27,1990.

Reprint requests to 2121 Park St, Jacksonville, FL 32204 (DrCarithers).

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