{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:17:48Z","timestamp":1760059068185,"version":"build-2065373602"},"reference-count":49,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:00:00Z","timestamp":1747353600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Open Access Publishing Fund of Leipzig  University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>With an incidence of 0.3 per 100,000, spondylodiscitis is a rare condition in children. It is typically bacterial in origin and most commonly caused by Staphylococcus aureus. Bone involvement in cat-scratch disease (CSD) due to Bartonella henselae is exceedingly rare, occurring in only 0.17\u20130.27% of cases. We present the case of a 3-year-old boy with a two-week history of intermittent back pain and a recent onset fever. Initial laboratory findings were unremarkable, and MRI revealed spondylodiscitis at L3\/4 without abscess formation. Empirical antibiotic treatment with ampicillin\/sulbactam showed no clinical response. Serologic testing revealed a positive Bartonella henselae IgM (IgG negative), leading to a change in antibiotic treatment to azithromycin and rifampicin for three weeks, resulting in rapid clinical improvement. Follow-up at nine weeks showed marked clinical and radiologic improvement. Although IgM subsequently turned negative without IgG seroconversion\u2014a pattern previously described in Bartonella infections\u2014this does not exclude the diagnosis. Biopsy or tissue PCR was not performed due to the mild clinical course. A review of the literature identified 28 pediatric cases of Bartonella henselae spondylodiscitis, with significant variation in diagnostic and treatment approaches. This case underscores the importance of considering Bartonella in the differential diagnosis of pediatric vertebral osteomyelitis.<\/jats:p>","DOI":"10.3390\/children12050649","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T04:48:18Z","timestamp":1747716498000},"page":"649","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Presumed Bartonella-Associated Spondylodiscitis in a 3-Year-Old Child: A Case Report and Review of the Literature"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5636-2519","authenticated-orcid":false,"given":"Hadi","family":"El Assaad","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eckehard","family":"Schumann","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Klemann","sequence":"additional","affiliation":[{"name":"Department of Pediatric Immunology, Rheumatology and Infectiology, Hospital for Children and Adolescents, University of Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadine","family":"Dietze-Jergus","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology and Virology, University of Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph-Eckhard","family":"Heyde","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0906-5479","authenticated-orcid":false,"given":"Philipp","family":"Pieroh","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1097\/INF.0000000000003534","article-title":"Spondylodiscitis in Pediatric Age: A Retrospective Cohort Study","volume":"41","author":"Cavalieri","year":"2022","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Principi, N., and Esposito, S. (2016). Infectious Discitis and Spondylodiscitis in Children. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17040539"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1017\/S0950268807008850","article-title":"Epidemiology of vertebral osteomyelitis (VO) in France: Analysis of hospital-discharge data 2002\u20132003","volume":"136","author":"Grammatico","year":"2008","journal-title":"Epidemiol. Infect."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"iii11","DOI":"10.1093\/jac\/dkq303","article-title":"Spondylodiscitis: Update on diagnosis and management","volume":"65","author":"Gouliouris","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_5","first-page":"8","article-title":"Natural History of Bartonella Infections (an Exception to Koch\u2019s Postulate)","volume":"9","author":"Jacomo","year":"2002","journal-title":"Clin. Diagn. Lab. Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ijantimicag.2014.04.006","article-title":"Pathogenicity and treatment of Bartonella infections","volume":"44","author":"Angelakis","year":"2014","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1001\/archpedi.1985.02140130062031","article-title":"Cat-scratch disease. An overview based on a study of 1200 patients","volume":"139","author":"Carithers","year":"1985","journal-title":"Am. J. Dis. Child."},{"key":"ref_8","first-page":"1","article-title":"Cat scratch disease","volume":"8","author":"Margileth","year":"1993","journal-title":"Adv. Pediatr. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.jinf.2006.10.045","article-title":"Bone infection in cat-scratch disease: A review of the literature","volume":"54","author":"Hajjaji","year":"2007","journal-title":"J. Infect."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1097\/01.inf.0000246807.14916.d3","article-title":"Transient paresis associated with cat-scratch disease: Case report and literature review of vertebral osteomyelitis caused by Bartonella henselae","volume":"25","author":"Vermeulen","year":"2006","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_11","first-page":"9562634","article-title":"Multifocal Osteomyelitis in an Adolescent Patient with Cat Scratch Disease","volume":"2024","author":"Suma","year":"2024","journal-title":"Case Rep. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e6117","DOI":"10.1002\/ccr3.6117","article-title":"Bartonella henselae vertebral osteomyelitis in a pediatric patient: A case report","volume":"10","author":"Beltrami","year":"2022","journal-title":"Clin. Case Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"224","DOI":"10.4103\/jcvjs.jcvjs_206_20","article-title":"Atlantoaxial instability secondary to Bartonella henselae osteomyelitis managed surgically by atlantoaxial instrumentation: A case report and systematic review","volume":"13","author":"Mathkour","year":"2022","journal-title":"J. Craniovertebral Junction Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.jpeds.2018.05.033","article-title":"Clinical and Radiologic Manifestations of Bone Infection in Children with Cat Scratch Disease","volume":"201","author":"Erdem","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"189","DOI":"10.3171\/2018.2.PEDS17600","article-title":"Bartonella henselae infection presenting as cervical spine osteomyelitis: Case report","volume":"22","author":"Akbari","year":"2018","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e341","DOI":"10.1097\/INF.0000000000002013","article-title":"An 11-Year-Old Male With Vertebral Osteomyelitis and a Paraspinal Abscess","volume":"37","author":"Kopsidas","year":"2018","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e164","DOI":"10.1097\/PEC.0000000000001330","article-title":"Torticollis and Fever in a Young Boy: A Unique Presentation of Cat-Scratch Disease with Vertebral Osteomyelitis and Epidural Phlegmon","volume":"33","author":"Rafferty","year":"2017","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"713","DOI":"10.3171\/2016.7.PEDS1677","article-title":"Thoracic osteomyelitis and epidural abscess formation due to cat scratch disease: Case report","volume":"18","author":"Dornbos","year":"2016","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.rchipe.2015.08.004","article-title":"Osteomielitis vertebral por Bartonella henselae: A prop\u00f3sito de un caso","volume":"87","author":"Zepeda","year":"2016","journal-title":"Rev. Chil. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1007\/s00247-011-2087-2","article-title":"Thoracic vertebral osteomyelitis with paraspinous mass and intraspinal extension: An atypical presentation of cat-scratch disease","volume":"42","author":"Gray","year":"2012","journal-title":"Pediatr. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1097\/INF.0b013e3181a3242e","article-title":"Cat scratch disease with cervical vertebral osteomyelitis and spinal epidural abscess","volume":"28","author":"Tasher","year":"2009","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1159\/000098395","article-title":"Cat Scratch Disease with Epidural Extension while on Antimicrobial Treatment","volume":"43","author":"Hussain","year":"2007","journal-title":"Pediatr. Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/01202412-200607000-00010","article-title":"Multifocal osteomyelitis in a child: A rare manifestation of cat scratch disease: A case report and systematic review of the literature","volume":"15","author":"Robben","year":"2006","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1097\/01.SMJ.0000163305.50078.63","article-title":"Disseminated Cat Scratch Disease with Vertebral Osteomyelitis and Epidural Abscess","volume":"98","author":"Abuhammour","year":"2005","journal-title":"South. Med. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1177\/000992280204100911","article-title":"Vertebral Osteomyelitis in 2 Children","volume":"41","author":"Malorgiol","year":"2002","journal-title":"Clin. Pediatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/S0213-005X(02)72862-0","article-title":"Osteomielitis vertebral asociada a enfermedad por ara\u00f1azo de gato","volume":"20","author":"Pocheville","year":"2002","journal-title":"Enfermedades Infecc. Microbiol. Clin."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1086\/515102","article-title":"Cat-Scratch Disease with Paravertebral Mass and Osteomyelitis","volume":"28","author":"Robson","year":"1999","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","first-page":"875","article-title":"Spondylodiscitis: Diagnosis and Treatment Options","volume":"114","author":"Herren","year":"2017","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1111\/1469-0691.12653","article-title":"Vertebral osteomyelitis: Clinical features and diagnosis","volume":"20","author":"Baykam","year":"2014","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1093\/infdis\/171.4.916","article-title":"Etiology of Cat Scratch Disease: Comparison of Polymerase Chain Reaction Detection of Bartonella (Formerly Rochalimaea) and Afipia felis DNA with Serology and Skin Tests","volume":"171","author":"Bergmans","year":"1995","journal-title":"J. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1111\/j.1469-0691.2007.01700.x","article-title":"Serological testing for Bartonella henselae infections in The Netherlands: Clinical evaluation of immunofluorescence assay and ELISA","volume":"13","author":"Vermeulen","year":"2007","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1128\/jcm.35.8.1931-1937.1997","article-title":"Pitfalls and fallacies of cat scratch disease serology: Evaluation of Bartonella henselae-based indirect fluorescence assay and enzyme-linked immunoassay","volume":"35","author":"Bergmans","year":"1997","journal-title":"J. Clin. Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1086\/378738","article-title":"Long-term serological analysis and clinical follow-up of patients with cat scratch disease","volume":"37","author":"Kletter","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Bayart, J.-L., Gusbin, C., Lardinois, B., Scohy, A., and Kabamba-Mukadi, B. (2020). Analytical and clinical evaluation of new automated chemiluminescent immunoassays for the detection of IgG and IgM anti-Bartonella henselae antibodies. Diagn. Microbiol. Infect. Dis., 98.","DOI":"10.1016\/j.diagmicrobio.2020.115203"},{"key":"ref_35","first-page":"557","article-title":"Longitudinal Study of Serological Response to Bartonella henselae by Indirect Fluorescence Assay in Cat Scratch Disease","volume":"75","author":"Kusaba","year":"2001","journal-title":"J. Jpn. Assoc. Infect. Dis."},{"key":"ref_36","first-page":"968","article-title":"Cat-scratch disease associated with an osteolytic lesion","volume":"137","author":"Carithers","year":"1983","journal-title":"Am. J. Dis. Child."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1080\/00365549309169684","article-title":"Multiorgan involvement in systemic cat-scratch disease","volume":"25","author":"Fretzayas","year":"1993","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/00006454-199806000-00002","article-title":"Prospective randomized double blind placebo-controlled evaluation of azithromycin for treatment of cat-scratch disease","volume":"17","author":"Bass","year":"1998","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1097\/00006454-199206000-00010","article-title":"Antibiotic therapy for cat-scratch disease: Clinical study of therapeutic outcome in 268 patients and a review of the literature","volume":"11","author":"Margileth","year":"1992","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/00003086-199902000-00026","article-title":"Oral rifampin plus azithromycin or clarithromycin to treat osteomyelitis in rabbits","volume":"359","author":"Shirtliff","year":"1999","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1093\/cid\/civ482","article-title":"2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults","volume":"61","author":"Berbari","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1093\/jpids\/piab027","article-title":"Clinical Practice Guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics","volume":"10","author":"Woods","year":"2021","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_43","first-page":"540","article-title":"Aktuelle Praxis der empirischen Antibiotikatherapie bei Spondylodiszitis [Current practice of empiric antibiotic treatment for spondylodiscitis]","volume":"51","author":"Lang","year":"2022","journal-title":"Orthopadie"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2818","DOI":"10.1093\/cid\/ciz1137","article-title":"Cat Scratch Disease Presenting as Fever of Unknown Origin Is a Unique Clinical Syndrome","volume":"71","author":"Landes","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1136\/bjophthalmol-2019-315239","article-title":"Ocular complications of cat scratch disease","volume":"104","author":"Johnson","year":"2020","journal-title":"Br. J. Ophthalmol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e255928","DOI":"10.1136\/bcr-2023-255928","article-title":"Acute perimyocarditis associated with Bartonella henselae infection","volume":"16","author":"Cucchi","year":"2023","journal-title":"BMJ Case Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1542\/peds.77.5.714","article-title":"Central nervous system involvement in cat scratch disease","volume":"77","author":"Lewis","year":"1986","journal-title":"Pediatrics"},{"key":"ref_48","first-page":"450","article-title":"[Cat scratch disease with hepatosplenic involvement]","volume":"61","author":"Guardado","year":"2004","journal-title":"An. Pediatr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1016\/j.cgh.2016.07.026","article-title":"Atypical Cat Scratch Disease With Hepatosplenic Involvement","volume":"15","author":"Verma","year":"2017","journal-title":"Clin. Gastroenterol. Hepatol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/5\/649\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:34:16Z","timestamp":1760031256000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/5\/649"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,16]]},"references-count":49,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["children12050649"],"URL":"https:\/\/doi.org\/10.3390\/children12050649","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2025,5,16]]}}}