Infecties met Bartonella henselae; de vele gezichten van kattenkrabziekte

The clinical spectrum of cat scratch disease caused by Bartonella henselae is much wider than initially recognised. Three patients are described. A 5 year old girl with axillar lymphadenopathy and negative serology, had a positive polymerase chain reaction (PCR) for Bartonella henselae. An 11 year old girl presenting with convulsions and coma, had Bartonella henselae encephalitis. A 7 year old girl with fever of unknown origin, turned out to have systemic cat scratch disease with liver and spleen abcesses. Bartonella henselae infections should be suspected in patients with an unclear infectious presentation. In case of negative serological results and persistent suspicion of a Bartonella henselae infection, one should obtain a PCR from relevant tissue. Antibiotic treatment is usually not necessary. In severe atypical infections, as in immuno-compromised hosts, macrolides are the drug of choice.