The cruciality of increasing index of suspicion for atypical Bartonella henselae in pediatric patients: A case series

Bartonella henselae, a gram-negative rod, is the etiologic agent of cat scratch disease, which may manifest as a self-limiting local infection or as an atypical, invasive disease. Establishing B. henselae as the causative organism can be challenging as it is a fastidious organism that does not grow on traditional media. Diagnosis is generally performed with serology, which has variable turnaround times, or microbial cell-free DNA (mcfDNA) sequencing, which has a high cost. Therefore, a high index of suspicion is necessary for timely diagnosis and management of these invasive infections. We depict a case series of nine atypical Bartonella infections in children. By highlighting these presentations, their diagnostic testing, and treatment, we emphasize the significance of an elevated index of suspicion of atypical bartonellosis for accurate diagnosis and timely antibiotic management. Our invasive Bartonella cases entail culture-negative subacute endocarditis, osteomyelitis, neuroretinitis, encephalitis, hepatosplenic disease, and lymphadenopathy with splenic involvement.