Musculoskeletal manifestations of cat scratch disease
Musculoskeletal manifestations of cat scratch disease
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DOI：
10.1086/523587
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发表时间：
2007-12-15
影响因子：
11.8
通讯作者：
Giladi, Michael
中科院分区：
文献类型：
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作者：
Maman, Eran;Bickels, Jacob;Giladi, Michael
背景在猫抓病（CSD）中，肌肉骨骼表现（musculoskeleton inhibitors，EMT）被认为是罕见的，并且没有很好的表征。目的：研究CSD的生物学特性。一项进行了11年的监测研究根据相容的临床表现和汉赛巴尔通体的确证性血清学试验或PCR结果确定了CSD患者。患有CSD的患者有腹泻（即，肌痛、关节炎、关节痛、肌腱炎、骨髓炎和神经痛）与无关节炎的CSD患者（对照组）进行比较。913例CSD患者中，96例（10.5%）有颈动脉狭窄。肌痛（53例患者[5.8%]）通常为重度，中位持续时间为4周（范围：1-26周）。关节病（关节痛和/或关节炎; 50例患者[5.5%]）主要发生在中型和大型关节，26例患者被归类为中度或重度，中位持续时间为5.5周（范围，1-240周）。在7名患者中，症状持续≥ 1年; 5名发展为慢性疾病。肌腱炎、神经痛和骨髓炎分别发生7例、4例和2例。与对照组患者相比，老年痴呆症患者的年龄明显更大（中位年龄分别为31.5岁和15.0岁;）。在多变量分析中，年龄> 20岁与任何MM（相对风险[RR]，4.96; 95%置信区间[CI]，2.79-8.8）、肌痛（RR，4.69; 95% CI，2.22-9.88）和关节病（RR，11.0; 95% CI，4.3-28.2）相关。关节病还与女性（RR，1.89; 95%CI，1.01-3.52）和结节性红斑（RR，4.07; 95%CI，1.38-12.02）相关。CSD的复发比以前认为的更常见，并且影响十分之一的CSD患者。年龄> 20岁的患者多发生脑卒中，可能严重且持续时间长。骨髓炎，最有名的MM的CSD，其实是最罕见的。
Background. Musculoskeletal manifestations (MMs) are considered to be rare in cat scratch disease (CSD) and are not well characterized. We aimed to study MMs of CSD.Methods. A surveillance study performed over 11 years identified patients with CSD on the basis of compatible clinical presentation and confirmatory serological test or PCR results for Bartonella henselae. Patients with CSD who had MMs (i.e., myalgia, arthritis, arthralgia, tendinitis, osteomyelitis, and neuralgia) were compared with patients with CSD who did not have MMs (control subjects).Results. Of 913 patients with CSD, 96 (10.5%) had MMs. Myalgia (in 53 patients [5.8%]) was often severe, with a median duration of 4 weeks (range, 1-26 weeks). Arthropathy (arthralgia and/or arthritis; in 50 patients [5.5%]) occurred mainly in the medium and large joints and was classified as moderate or severe in 26 patients, with a median duration of 5.5 weeks (range, 1-240 weeks). In 7 patients, symptoms persisted for >= 1 year; 5 developed chronic disease. Tendinitis, neuralgia, and osteomyelitis occurred in 7, 4, and 2 patients, respectively. Patients with MMs were significantly older than patients in the control group (median age, 31.5 years vs. 15.0 years;). In multivariate analysis, age > 20 years was associated with having any MM (relative risk [RR], 4.96; 95% confidence interval [CI], 2.79-8.8), myalgia (RR, 4.69; 95% CI, 2.22-9.88), and arthropathy (RR, 11.0; 95% CI, 4.3-28.2). Arthropathy was also associated with female sex (RR, 1.89; 95% CI, 1.01-3.52) and erythema nodosum (RR, 4.07; 95% CI, 1.38-12.02).Conclusions. MMs of CSD are more common than previously thought and affect one-tenth of patients with CSD. MMs occur mostly in patients aged > 20 years and may be severe and prolonged. Osteomyelitis, the most well known MM of CSD is, in fact, the rarest.