Cat-Scratch Disease

Definition
Cat-scratch disease is an uncommon infection that typically results from a cat’s scratch or bite. Most sufferers experience only moderate discomfort and find that their symptoms clear up without any lasting harm after a few weeks or months. Professional medical treatment is rarely needed.

Description
Cat-scratch disease (also called cat-scratch fever) is caused by the Bartonella henselae bacterium, which is found in cats around the world and is transmitted from cat to cat by fleas. Researchers have discovered that large numbers of North American cats carry antibodies for the disease (meaning that the cats have been infected at some point in their lives).
Some parts of North America have much higher rates of cat infection than others, however. Bartonella henselae is uncommon or absent in cold climates, which fleas have difficulty tolerating, but prevalent in warm, humid places such as Memphis, Tennessee, where antibodies were found in 71% of the cats tested. The bacterium, which remains in a cat’s bloodstream for several months after infection, seems to be harmless to most cats, and normally an infected cat will not display any symptoms. Kittens (cats less than one year old) aremore likely than adult cats to be carrying the infection Bartonella henselae can infect people who are scratched or (more rarely) bitten or licked by a cat. It cannot be passed from person to person. Although cats are popular pets found in about 30% of American households, human infection appears to be rare. One study estimated that for every 100,000 Americans there are only 2.5 cases of cat-scratch disease each year (2.5/100,000). It is also unusual for more than one family member to become ill; a Florida investigation discovered multiple cases in only 3.5% of the families studied. Children and teenagers appear to be the most likely victims of catscratch disease, although the possibility exists that the disease may be more common among adults than previously thought.

Symptoms
A sore or blister may develop where a cat has bitten or scratched you. It may take 3 to 10 days for the sore or blister to appear after the bite or scratch. The sore or blister may take a long time to heal. An infection of the lymph nodes (also called lymph glands) also develops, most often in the glands that are near the place where you got the cat scratch or cat bite. For example, if the infection is from a cat scratch on your arm, the glands in your armpit may become tender and swollen. The lymph nodes may swell to an inch or more in size. You may also run a low-grade fever (up to 102°F).

A person who has had contact with a cat may show common symptoms, including:
    * Bump (papule) or blister (pustule) at site of injury (usually the first sign)
    * Fatigue
    * Fever (in some patients)
    * Headache
    * Lymph node swelling near the scratch or bite
    * Overall discomfort (malaise)

Less common symptoms may include:

    * Draining lymph nodes'
    * Enlarged spleen
    * Loss of appetite
    * Sore throat
    * Weight loss

Diagnosed
If you remember that you were bitten or scratched by a cat, your doctor will probably be able to diagnose the illness based on the fact that you were bitten or scratched and then developed painful, swollen lymph nodes. When the diagnosis is not clear, a blood test may help your doctor make the diagnosis.

Treatment
In most people, cat-scratch disease clears up without treatment. Often, taking an over-the-counter pain reliever such as aspirin, ibuprofen (some brands: Motrin, Advil) and naproxen (one brand: Aleve) and applying heat compresses to the affected area can help relieve pain and discomfort. However, antibiotics (medicines that kill bacteria) may be needed when infected lymph nodes stay painful and swollen for more than 2 or 3 months. Antibiotics may also help if you have a fever for a long time or if the infection is in your bones, liver or another organ.

If a lymph node is very large or painful, your doctor may drain it to help relieve the pain. The lymph node is drained by putting a needle through normal skin off to the side of the node and moving the needle to the swollen node. The needle is then inserted into the node and the fluid in the node is drained out.

Prevention
Avoiding cats is the simplest way to prevent the disease, but it is not usually necessary to get rid of your cat. Try to avoid any situation where you might be bitten or scratched by a cat. Do not tease or provoke a cat. Most scratches and bites come from cats that are provoked. Washing your hands carefully after handling your cat is another way to prevent the infection. Getting rid of fleas on your cat may also keep you and your family members from catching the infection.

Cats only seem to be able to transmit this infection for a few weeks. Young cats seem to be more likely to carry the bacteria than older cats. Households with kittens have higher rates of infection. If the kittens have fleas, the infection rate is even higher.

Cats Treatment
Cats typically don't require treatment. The bacteria usually doesn't cause cats to get sick. They merely carry the bacteria that causes cat-scratch disease in people. If you are worried that your cat may be experiencing symptoms from the Bartonella henselae bacteria, contact your vet.

When to  call your Doctor
Call your family doctor if you notice any of the following problems:
•    A cat scratch or bite that does not heal in the usual length of time.
•    An area of redness around a cat scratch or bite that continues to get bigger for more than 2 days after the injury.
•    Fever that lasts for several days after a cat scratch or bite.
•    Painful and swollen lymph nodes for more than 2 or 3 weeks.
•    Bone or joint pain, abdominal pain (without fever, vomiting or diarrhea) or an unusual degree of tiredness for more than 2 or 3 weeks.

Resources
Smith, David L. ‘‘Cat-Scratch Disease and Related Clinical
Syndromes.’’ American Family Physician
Website
http://www.nlm.nih.gov

http://familydoctor.org