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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:
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Bump (
papule
) or blister (
pustule
) at site of injury (usually the first sign)
Papule
A papule is a solid or cystic raised spot on the skin that is less than 1 centimeter (cm) wide. It is a type of skin lesion.
ImageRead Article Now Book Mark ArticlePustule
Pustules are small, inflamed, pus-filled, blister-like sores (lesions) on the skin surface.
ImageRead Article Now Book Mark Article - Fatigue
- Fever (in some people)
- Headache
-
Lymph node swelling (
lymphadenopathy
) near the site of the scratch or bite
Lymphadenopathy
Lymphofollicular hyperplasia is an increase in the size of the lymph node follicles. These follicles contain normal white blood cells called lymphoc...
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Overall discomfort (
malaise
)
Malaise
Malaise is a general feeling of discomfort, illness, or lack of well-being.
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Less common symptoms may include:
-
Loss of appetite
Loss of appetite
A decreased appetite is when your desire to eat is reduced. The medical term for a loss of appetite is anorexia.
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- 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 .
Enlarged spleen
Splenomegaly is a larger-than-normal spleen. The spleen is an organ in the upper left part of the belly.
Sometimes, an infected lymph node may form a tunnel ( fistula ) through the skin and drain (leak fluid).
Fistula
A fistula is an abnormal connection between 2 body parts, such as an organ or blood vessel and another structure. Fistulas are usually the result of...
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.
Lymph node biopsy
A lymph node biopsy is the removal of lymph node tissue for examination under a microscope. The lymph nodes are small glands that make white blood ce...
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.
HIV/AIDS
Human immunodeficiency virus (HIV) is the virus that causes AIDS. When a person becomes infected with HIV, the virus attacks and weakens the immune ...
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
Neuroretinitis
Neuroretinitis is inflammation of the retina and optic nerve of the eye. The condition can be caused by bacteria, viruses or autoimmune disease. It...
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Osteomyelitis
Osteomyelitis
Osteomyelitis is a bone infection. It is mainly caused by bacteria or other germs.
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Parinaud syndrome
(granulomatous conjunctivitis with adenopathy)
Parinaud syndrome
Parinaud oculoglandular syndrome is an eye problem that is similar to conjunctivitis ("pink eye"). It most often affects only one eye. It occurs wi...
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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.
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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
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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
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.
