{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T04:34:31Z","timestamp":1792730071043,"version":"4.5.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>\n                                 <jats:italic toggle=\"yes\">Bartonella henselae<\/jats:italic> serology is commonly used to diagnose cat-scratch disease (CSD). Titers above a threshold for positivity suggest either a recent or remote infection. Recent infection can be confirmed by a 4-fold rise in the convalescent titer in some cases. Many atypical presentations attributed to CSD utilize a low threshold for positivity without supportive evidence from convalescent sera or supplemental testing, raising a concern for the overdiagnosis of CSD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We conducted a retrospective chart review of immunocompetent pediatric patients at the Hospital for Sick Children, Toronto, spanning an 11-year period. A total of 154 cases were included with serologic titers \u22651:128. These were divided into 3 groups: group 1 = 1:128, group 2 = 1:256, and group 3 \u2265 1:512. Cases within groups were evaluated with respect to cat contact, clinical presentation, further testing, and final diagnosis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>One-third of patients with a titer of 1:128 had an alternative diagnosis. Most cases with a titer of 1:128 or 1:256 did not have convalescent serologic testing performed. Within these 2 groups, only 1 case had a 4-fold rise in the convalescent titer. A trend of decreasing number of cases with alternative diagnoses (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.03) and increasing number of cases presenting with regional lymphadenopathy (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.07) was associated with higher titers in group 3 compared with group 1.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>Concerns about the serologic diagnosis of CSD include the use of low titers for positivity, incomplete diagnostic evaluation, and the lack of convalescent serologic testing. We propose a clinical guide to assist in managing suspected cases of CSD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/inf.0000000000002852","type":"journal-article","created":{"date-parts":[[2020,8,21]],"date-time":"2020-08-21T22:03:51Z","timestamp":1598047431000},"page":"984-989","source":"Crossref","is-referenced-by-count":10,"title":["Pediatric Bartonella henselae Infection"],"prefix":"10.1097","volume":"39","author":[{"given":"Nadia H.","family":"Alattas","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir N.","family":"Patel","sequence":"additional","affiliation":[{"name":"Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan E.","family":"Richardson","sequence":"additional","affiliation":[{"name":"Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Akseer","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health, Johns Hopkins University, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun K.","family":"Morris","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,8,22]]},"reference":[{"key":"R1-20230912","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1111\/j.1651-2227.1954.tb04042.x","article-title":"La maladie des griffes du chat (Cat Scratch Fever).","volume":"43","author":"Debr\u00e9","year":"1954","journal-title":"Acta P\u00e6diatrica"},{"key":"R2-20230912","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1056\/NEJM199012063232301","article-title":"The agent of bacillary angiomatosis. 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