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Cat-scratch disease

CSD; Cat-scratch fever; Bartonellosis

 

Cat-scratch disease is an infection with bartonella bacteria that is believed to be transmitted by cat scratches, cat bites, or flea bites.

Causes

 

Cat-scratch disease is caused by the bacteria Bartonella henselae . The disease is spread through contact with an infected cat (a bite or scratch) or exposure to cat fleas. It also can be spread through contact with cat saliva on broken skin or mucosal surfaces like those in the nose, mouth, and eyes.

 

Symptoms

 

A person who has had contact with an infected cat may show common symptoms, including:

  • Bump ( papule ) or blister ( pustule ) at site of injury (usually the first sign)
  • Fatigue
  • Fever (in some people)
  • Headache
  • Lymph node swelling ( lymphadenopathy ) near the site of the scratch or bite
  • Overall discomfort ( malaise )

Less common symptoms may include:

  • Loss of appetite
  • Sore throat
  • Weight loss

 

Exams and Tests

 

If you have swollen lymph nodes and a scratch or bite from a cat, your health care provider may suspect cat-scratch disease.

A physical examination may also reveal an enlarged spleen .

Sometimes, an infected lymph node may form a tunnel ( fistula ) through the skin and drain (leak fluid).

This disease is often not found because it is hard to diagnose. The Bartonella henselae immunofluorescence assay (IFA) blood test is an accurate way to detect the infection caused by these bacteria. The results of this test must be considered along with other information from your medical history, lab tests, or biopsy.

A lymph node biopsy may also be done to look for other causes of swollen glands.

 

Treatment

 

Generally, cat-scratch disease is not serious. Medical treatment may not be needed. In some cases, treatment with antibiotics such as azithromycin can be helpful. Other antibiotics may be used, including clarithromycin, rifampin, trimethoprim-sulfamethoxazole, or ciprofloxacin.

In people with HIV/AIDS and others, who have a weakened immune system, cat-scratch disease is more serious. Treatment with antibiotics is recommended.

 

Outlook (Prognosis)

 

People who have a healthy immune system should recover fully without treatment. In people with a weakened immune system, treatment with antibiotics usually leads to recovery.

 

Possible Complications

 

People whose immune systems are weakened may develop complications such as:

  • Encephalopathy
  • Neuroretinitis
  • Osteomyelitis
  • Parinaud syndrome (granulomatous conjunctivitis with adenopathy)

 

When to Contact a Medical Professional

 

Call your provider if you have enlarged lymph nodes and you have been exposed to a cat.

 

Prevention

 

To prevent cat-scratch disease:

  • Wash your hands thoroughly with soap and water after playing with your cat. Especially wash any bites or scratches.
  • Play gently with cats so they don't scratch and bite.
  • Don't allow a cat to lick your skin, eyes, mouth, or open wounds or scratches.
  • Use flea control measures to lower the risk your cat develops the disease.
  • Don't touch feral cats.

 

 

References

Gandhi TN, Slater LN, Welch DF, Koehler JE. Bartonella , including cat-scratch disease. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 236.

Wiener AH, Selkin BA, Murakawa GJ. Cat scratch disease. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 37.

 
  • Cat scratch disease - illustration

    Cat scratch disease is an infectious illness associated with cat scratches, bites, or exposure to cat saliva, causing chronic swelling of the lymph nodes. Cat scratch disease is possibly the most common cause of chronic lymph node swelling in children.

    Cat scratch disease

    illustration

  • Antibodies - illustration

    Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

    Antibodies

    illustration

    • Cat scratch disease - illustration

      Cat scratch disease is an infectious illness associated with cat scratches, bites, or exposure to cat saliva, causing chronic swelling of the lymph nodes. Cat scratch disease is possibly the most common cause of chronic lymph node swelling in children.

      Cat scratch disease

      illustration

    • Antibodies - illustration

      Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

      Antibodies

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Cat-scratch disease

           

           

          Review Date: 9/10/2015

          Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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