Cat Scratch Disease in Connecticut -- Epidemiology, Risk Factors, and Evaluation of a New Diagnostic Test
Kenneth M. Zangwill, Douglas H. Hamilton, Bradley A. Perkins, Russell L. Regnery, Brian D. Plikaytis, James L. Hadler, Matthew L. Cartter, and Jay D. Wenger
Background Although cat scratch disease is commonly diagnosedin patients who have unexplained regional lymphadenopathy afterencounters with cats, its epidemiology and the risk factorsfor disease are not clearly defined, and there is no generallyaccepted diagnostic test.
Methods We conducted a physician survey to identify cases ofcat scratch disease occurring over a 13-month period in catowners in Connecticut. We interviewed both the patients (ortheir parents) and controls matched for age who owned cats.Serum from the patients was tested for antibodies to Rochalimaeahenselae with a new, indirect fluorescent-antibody test.
Results We identified 60 patients with cat scratch disease and56 age-matched, cat-owning control subjects. Patients were morelikely than controls to have at least one pet kitten 12 monthsold or younger (odds ratio, 15), to have been scratched or bittenby a kitten (odds ratio, 27), and to have had at least one kittenwith fleas (odds ratio, 29). A conditional logistic-regressionanalysis found that in kitten-owning households, patients weremore likely than controls to have been scratched or bitten bya cat or kitten (odds ratio, 12.4; 95 percent confidence interval,1.0 to 150).
Of 45 patients, 38 had serum samples with titers of 1:64 orhigher for antibody to R. henselae, as compared with 4 of 112samples from controls (P<0.001). The positive predictivevalue of the serologic test was 91 percent. Of 48 serum samplesfrom patients' cats, 39 were positive for antibodies to R. henselae,as compared with positive samples from 11 of 29 control cats(P<0.001).
Conclusions Cat scratch disease is strongly associated withowning a kitten, and fleas may be involved in its transmission.The serologic test for rochalimaea may be useful diagnostically,and our results suggest an etiologic role for this genus.
Source Information
From the Meningitis and Special Pathogens Branch (K.M.Z., B.A.P., J.D.W.) and the Biostatistics and Information Management Branch (B.D.P.), Division of Bacterial and Mycotic Diseases, and the Viral and Rickettsial Zoonoses Branch, Division of Viral and Rickettsial Diseases (R.L.R.), National Center for Infectious Diseases, and the Epidemic Intelligence Service (K.M.Z.), Centers for Disease Control and Prevention, Atlanta; the Division of Field Services, Epidemiology Program Office, and the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Hartford, Conn. (D.H.H.); and the Connecticut Department of Health Services, Bureau of Health Promotion, Epidemiology Section, Hartford (J.L.H., M.L.C.). Presented in part at the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Anaheim, Calif., October 11-14, 1992.
Address reprint requests to Dr. Zangwill at the Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Mailstop C-09, 1600 Clifton Rd., Atlanta, GA 30333.
Cat Scratch Disease
Colford J. M., Newman T. B., Perkins B. A., Wenger J. D.
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N Engl J Med 1994;
330:370-371, Feb 3, 1994.
Correspondence
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