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Cat Scratch Disease
(Bartonella henselae Infection)
Introduction
Cat scratch disease (CSD) is a bacterial disease caused by Bartonella henselae. It typically causes swelling of the lymph nodes. It usually results from the scratch, lick, or bite of a cat — more than 90% of people with the illness have had some kind of contact with cats, often with kittens.
Bartonella henselae is found in all parts of the world. Cat scratch disease occurs more often in the fall and winter. In the United States, about 22,000 cases are diagnosed annually, most of them in people under the age of 21. This may be because children are more likely to play with cats and be bitten or scratched.
Fleas spread the bacteria between cats, although currently there is no evidence that fleas can transmit the disease to humans. Once a cat is infected, the bacteria live in the animal's saliva. Bartonella henselae does not make a cat sick, and kittens or cats may carry the bacteria for months. Experts believe that almost half of all cats have a Bartonella henselae infection at some time in their lives, and cats less than 1 year old are more likely to be infected.
What is cat scratch disease?
Most people with CSD have been bitten or scratched by a cat and developed a mild infection at the point of injury. Lymph nodes, especially those around the head, neck, and upper limbs, become swollen. In most children and adolescents, swollen lymph nodes are the main symptom of the disease, and the illness often is mild. About one third of people with cat scratch disease have other general symptoms. These include fever (usually less than 101° Fahrenheit or 38.3° Celsius), fatigue, loss of appetite, headache, rash, sore throat, and an overall ill feeling.
Rare complications of B. henselae infection are bacillary angiomatosis and Parinaud's oculolandular syndrome.
Can my cat transmit Bartonella henselae to me?
Sometimes cats can spread B. henselae to people. Most people get CSD from cat bites and scratches. Kittens are more likely to be infected and to pass the bacterium to people. About 40% of cats carry B. henselae at some time in their lives. Cats that carry B. henselae do not show any signs of illness; therefore, you cannot tell which cats can spread the disease to you. People with immunocompromised conditions, such as those undergoing immunosuppressive treatments for cancer, organ transplant patients, and people with HIV/AIDS, are more likely than others to have complications of CSD. Although B. henselae has been found in fleas, so far there is no evidence that a bite from an infected flea can give you CSD.
Cat scratch disease is not contagious from person to person.
Treatment
• Professional Treatment
Doctors usually diagnose cat scratch disease based on a child's history of exposure to a cat or kitten and a physical examination. During the exam, a doctor will look for signs of a cat scratch or bite and swollen lymph nodes. In some cases, doctors use laboratory tests to help make the diagnosis, including:
• skin tests, blood tests, and cultures to rule out other causes of swollen lymph nodes
• a blood test that is positive for cat scratch disease
• a microscopic examination of a removed lymph node that shows signs of cat scratch disease
Most cases of cat scratch disease resolve without any treatment at all. Rarely, a swollen lymph node becomes so large and painful that the doctor may recommend removing fluid from the node with a needle and syringe. Antibiotics can be used to treat the disease. If your child's doctor has prescribed antibiotics, give the medication to your child on schedule for as many days as the doctor has advised.
• Home Treatment
A child who has cat scratch disease does not need to be isolated from other family members. Bed rest is not necessary, but it may help if your child tires easily. If your child feels like playing, encourage quiet play while being careful to avoid injuring swollen lymph nodes. To ease the soreness of these nodes, try warm, moist compresses or give your child nonprescription medicines like acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin).
How can I reduce my risk of getting cat scratch disease from my cat?
• Avoid "rough play" with cats, especially kittens. This includes any activity that may lead to cat scratches and bites.
• Wash cat bites and scratches immediately and thoroughly with running water and soap.
• Do not allow cats to lick open wounds that you may have.
• Control fleas.
• If you develop an infection (with pus and pronounced swelling) where you were scratched or bitten by a cat or develop symptoms, including fever, headache, swollen lymph nodes, and fatigue, contact your physician.
