貓抓病確診個案的臨床特徵及預測因子

Clinical Characteristics and Predictive Factors of Cat Scratch Disease

貓抓病（Cat scratch disease）大多在被貓抓或咬後，出現倦怠、淋巴腺炎及發燒等症狀，多是感染Bartonella henselae所造成，臨床上容易與造成局部性淋巴腺病變之疾病混淆。本研究探討台灣之貓抓病的臨床表徵之特色，並分析通報貓抓病個案中確診陽性的預測因子。資料收集自1991年至2010年6月，南台灣某醫療體系通報共69例貓抓病個案，其中12例為確診個案，年齡分佈為9～51歲。75%的病人有發燒表徵，皆具有淋巴結腫大，有7例個案（58.3%）在淋巴結附近可見皮膚傷口，實驗室血液白血球平均計數為11,219 4,601/µL，C-反應蛋白平均值55.5 37.8 mg/L，確診個案中11例（91.7%）曾接觸貓，1例（8.3%）曾接觸狗。經由貓抓傷後的感染率為83%。利用單變相分析顯示貓抓病陽性與血液白血球計數大於10,000/µL、動物接觸史、動物抓傷、淋巴結腫大、淋巴結附近有皮膚傷口以及淋巴結炎在腋下或前臂的部位等因素為貓抓病患者之特徵，以多變項分析顯示動物抓傷（odds ratio=31.23, P=0.005）為通報貓抓病個案中確診陽性之顯著偵測因子。本文報告本土貓抓病之臨床表現，希望有助於醫療人員對此疾病之診斷與治療有所助益。

Cat scratch disease (CSD) is usually is caused by Bartonella henselae and manifests as fatigue, lymphadenitis, and fever after a scratch or bite by a cat. The clinical symptoms and signs were similar to those of diseases with lymph node enlargement. We aimed to investigate the clinical manifestations of CSD in Taiwan and identify the predictive factors for CSD among suspected CSD cases in two Taiwan hospitals from 1991 to June 2010. A total of 69 suspected CSD cases were included. Among them, 12 were confirmed cases. The patients with CSD aged from 9 to 51 years. Fever was present in 75% cases, and all CSD patients had lymphadenopathy. Seven patients (58.3%) had skin lesions located close to the enlarged lymph nodes. Their mean (±standard deviation) white blood cell (WBC) count and CRP level were 11,219±4,601/µL and 55.5±37.8 mg/L, respectively. Eleven patients (91/7%) had a history of contact with cats, and one case was caused by contact with a dog. Among all patients with a history of scratches or bites by cats, CSD was confirmed in 83%. A WBC count > 10,000/µL, animal exposure, animal scratch, lymph node enlargement, skin lesions close to enlarged lymph node, and axillary and forearm lymph nodes were associated with CSD. Multivariate analysis showed that an animal scratch was a significant factor (odds ratio = 31.23, P = 0.005) predicting CSD. A better understanding of the clinical manifestations of local CSD cases may help clinicians to diagnose and treat CSD.