Bartonella henselae is a common cause of adenopathy in children. Treatment is not uniformly required but when treated azithromycin is the drug of choice.
Bartonella henselae
Common cause of regional adenopathy in children typically with exposures to kittens. IgG Titer >1:256 is consistent with current infection while lower titers may reflect previous exposure.
Azithromycin has been shown to speed improvement of lymphadenopathy but is not always necessary in mild cases in immunocompetent hosts. Severe cases and cases in immunocompromised hosts should be treated.
Other manifestations include Oculoglanduar syndrome (conjunctivitis and ipsilateral preauricular lymphadenopathy) as well as painless vision loss from neuroretinitis.
Potential alternative agents include: azithromycin, clarithromycin, ciprofloxacin, doxycycline, trimethoprim-sulfamethoxazole, rifampin, and gentamicin
References:
American Academy of Pediatrics. Bartonella henselae (Cat-Scratch Disease). In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2018;