Cat-scratch disease

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

  • Alternative Names
    • CSD; Cat-scratch fever; Bartonellosis

  • 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:

  • 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
  • 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.