Clinical and epidemiological characteristics of cat scratch disease in children from southwestern China: a retrospective analysis of mNGS-confirmed cases

Background and aim Cat scratch disease (CSD) is a zoonotic infection predominantly caused by Bartonella henselae , typically featured by regional lymphadenopathy and febrile illness. Although these classic features characterize most cases, the clinical spectrum extends to severe systemic manifestations including meningitis and neuroretinitis, leading to poor prognosis. Given this potential for diverse clinical presentations, prompt microbiological confirmation becomes essential for accurate diagnosis and appropriate management of CSD. The present study aimed to provide a comprehensive analysis of epidemiological patterns, clinical characteristics, diagnostic findings, and therapeutic outcomes in pediatric CSD cases, with the ultimate goal of optimizing early detection and enhancing the clinical understanding of this disease. Methods This single-center retrospective study analyzed 20 pediatric cases diagnosed with CSD at West China Second University Hospital in southwestern China between September 2021 and July 2025. All diagnoses were established based on comprehensive clinical evaluation including medical history, characteristic symptoms, and imaging findings. Definitive B. henselae identification was achieved through metagenomic next-generation sequencing (mNGS). These diagnostic characteristics were systematically evaluated and discussed in detail. Results Among the 20 patients with CSD included in the study, 18 (90.00%) reported a history of cat contact. Ten patients were male (50.00%). School-aged children (6–14 years) accounted for the majority of patients. Eleven cases (55.00%) occurred in autumn. Fever and lymphadenopathy were the primary reasons for hospitalization. B. henselae was detected in all cases using mNGS. Nine patients were diagnosed with atypical CSD, seven of whom were female. Atypical CSD was associated with higher body temperature and longer hospitalization stay. Antimicrobial agents, including azithromycin, doxycycline, and rifampin, achieved satisfactory therapeutic outcomes. Conclusion This study elucidates the epidemiological, clinical, and laboratory characteristics of CSD in children. mNGS may serve as a powerful tool to facilitate the diagnosis of CSD, including its atypical manifestations.