Cats are a common source of minor infections

Cat Scratch Disease (CSD) seems fairly self-explanatory. A cat scratches you and

you get a disease. Maybe this is why dogs are Man’s best friend: except for the

occasional “mad dog” episode they don’t have many infectious agents that are passed

readily to humans.

Cats, on the other hand, won’t come when you call them, disappear for days at a

time, leave toxoplasmosis parasites in their litter boxes, and will scratch your hand raw

whenever the mood strikes them. (Despite the aforementioned, I like cats.)

This infection was first described in the 19th century and cats were fingered as the

source of the infection in 1931. By 1985, the agent of CSD was identified as a bacterium

called, Bartonella henselae.

Many cats are carriers of B. henselae, but show no signs of illness. Kittens also

seem to be a frequent source CSD, perhaps because they are overly “playful” or nervous

scratchers when being handled. More than ninety percent of typical CSD patients report

prior contact with a cat or kitten. Fortunately for most of us, CSD is a mild, self-limiting

infection that many people might not even be aware of having contracted.

Bartonella causes a mild infection at the site of the wound. A pustule may form at

the site and persist for some weeks. Swollen lymph nodes in the neck or upper body are

the most common symptoms of CSD. Some people also may experience fever, headache

and fatigue. The infection usually resolves without treatment over the course of several

weeks.

That may not be true for HIV patients and others with underlying illnesses or

immunodeficiencies. Among such patients, more serious infections may occur (e.g.,

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bacillary angiomatosis), and prolonged antibiotic therapy may be necessary to prevent a

life-threatening infection and related complications. Common antibiotics for treating

CSD include erythromycin, doxycycline and azithromycin.

Patients with HIV or other immune disorders should avoid close contact with cats

and their fleas.

The February issue of Lancet Infectious Diseases described an unusual case of a

12-year-old boy whose lip had been scratched by a kitten. Swelling, fever and pain

persisted for three weeks and the boy was given separate 10-day and 5-day courses of

antibiotics. Later, he was hospitalized and the wound on his lip was surgically drained.

He received additional antibiotics (clindamycin and then rifampicin) for related lesions

on his liver and spleen, and recovered fully after one month.

Fleas appear to play an important role in maintaining Bartonella infections within

cat populations. The prevalence of Bartonella infection in cats also seems to vary with

climate. Northern countries have few infected cats; warmer, humid climates where fleas

are more active tend to have more infected cats. It’s unclear how important the flea is in

directly transmitting CSD to people through bites, but a flea collar (for the cat) probably

would reduce the chances of a cat acquiring or re-acquiring CSD from fleas, and then

passing it to people.

DNA from B. henselae also has been found in ticks in the U.S. and in parts of

Europe. It’s not clear, however, that ticks are able to transmit CSD directly to people.

Until more research is done, it appears that CSD is an infection transmitted only by cats

and their fleas.

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 Finally, big predator cats also are known to carry B. henselae. A recent study

found that 17% of tested lions and tigers were positive for antibodies to Bartonella.

Eighteen percent of tested cheetahs also were positive. Free-ranging California bobcats

and Florida panthers were 53% and 18% positive, respectively.

Of course, if you get scratched by one of these cats, CSD will be the least of your

worries.

For more information about CSD visit the Kids Health website,

www.kidshealth.org/parent/infections/bacterial_viral/cat_scratch.html