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Cat Scratch Fever
Cat scratch fever or cat scratch disease is an infection caused by the bacteria Bartonella henselae. You usually get this disease when an infected cat licks an open wound on your skin or bites or scratches you. Kids and teens are more likely to be infected than healthy adults, but adults with weakened immune systems are at risk, as well.
One way to help prevent cat scratch fever is to keep your cat's claws trimmed. (Photo Credit: iStock/Getty Images)
The most common symptoms of cat scratch fever are swollen, tender lymph nodes, a low-grade fever, and a skin rash. Most cases get better on their own, but you can help ease some of your symptoms with ibuprofen or naproxen.
Kids younger than 5 and immunocompromised adults are at increased risk for complications, which include the infection reaching other organs, such as your liver, spleen, and heart valves. People at risk should take extra steps to avoid getting infected.
Read on to learn more about the causes, symptoms, and prevention strategies for cat scratch fever.
About 30%-40% of cats and kittens carry the bacterium Bartonella henselae in their mouths, under their claws, or on their fur. They get infected by scratching or biting at infected fleas. They can spread it to their paws and fur when they lick themselves. Also, flea poop (also called flea dirt) contains the bacteria, as well. You may get it on your hands if you pet a cat with an active flea infestation.
Cats most likely to be infected are those younger than 1 year old and feral or stray cats. Infected cats generally don't show any signs of infection. Rarely, a cat may have a serious infection. These cats may have fever, vomiting, decreased appetite, lethargy (sleepiness or inactivity), red eyes, and swollen lymph nodes.
How do you get cat scratch fever?
If a cat infected with Bartonella henselae bites or scratches you hard enough to break your skin, then the bacteria can get into your body. You may also get infected if an infected cat licks a sore, wound, or scab that you have. In some cases, you may get infected by rubbing your eyes after petting an infected cat's fur.
Kids are more at risk for cat scratch fever than adults; a little over half of people who get it are younger than 18 years. In the U.S., you're more likely to get it in fall and winter because a little over half of cases happen in September through January.
In most cases, symptoms start about 3-10 days after contact with an infected cat. Symptoms are generally mild and include:
The swollen lymph nodes usually develop within one to three weeks after you're scratched or bitten and appear near the area where you were infected. For instance, if an infected cat bites your arm, the glands in your armpit or near your elbow may swell and become tender. The skin over your swollen glands will likely be discolored due to increased blood flow in the area. Depending on your typical skin tone, your skin may look pink, red, ashen gray, purple, or dark brown. Your glands may stay swollen for one to four months.
Cat scratch disease (Bartonellosis) is an infection with Bartonella hensalae bacteria. Most cases come from a scratch by an infected cat. (Photo Credit: ISM / CID / Medical Images)
Rarely, you may develop disseminated disease, which is when the infection spreads to your eyes, liver, spleen, brain, bones, joints, or heart valves. Kids younger than 5, adults older than 65, and people with a weakened immune system are the most likely to develop disseminated disease.
If your liver and spleen are affected, you may also develop weight loss and belly pain. You may also show abnormal liver enzyme levels on a blood test. If you develop inflammation in your heart (endocarditis), you may also develop:
If your brain is affected, you may also develop the following symptoms:
Your doctor will usually start by asking about your symptoms and doing a physical exam. Your doctor will examine you to:
In some cases, your doctor may be able to diagnose you without any testing. But if not, they may order a blood test to look for Bartonella henselae bacteria. Rarely, your doctor may take a sample of fluid from one of your lymph nodes to look for the bacteria.
Most people won't need treatment because the infection will clear on its own. You can help ease your symptoms by taking an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin, Nuprin) or naproxen (Aleve, Anaprox, Naprosyn). Applying a hot compress to your swollen lymph nodes may help reduce the swelling. If your lymph nodes are so swollen that they hurt, your doctor may be able to drain them with a syringe to help relieve your pain.
If you have disseminated disease affecting your organs, a weakened immune system, or symptoms that haven't gone away in two months, your doctor will likely prescribe antibiotics, usually azithromycin (Zithromax). You may need to take this for several months to clear the infection.
If you're regularly around cats, you can take a few precautions to help avoid getting cat scratch fever, including:
It's rare, but if you were infected through your eyes, you may develop the following conditions:
Neuroretinitis. This is a rare condition that causes inflammation of your optic nerve and the area of the retina around your optic nerve. The main symptom is central vision loss in your affected eye. But your doctor will likely be able to use a special tool (an ophthalmoscope) to see swelling at the back of your eye where your optic nerve enters your eye (the optic disk) and a characteristic pattern of deposits in the center of your retina (also called the macula). Infection with Bartonella henselae causes almost 70% of neuroretinitis cases.
Papillitis. This is another rare condition. It's caused by inflammation and deterioration of your optic disk. The main symptoms are pain and vision loss in the affected eye that can range from slight to complete loss of light perception. You may lose your sight within a few hours of becoming aware of decreased vision in the affected eye. You may also have a decreased ability to perceive colors.
Optic neuritis. This is inflammation and deterioration of the myelin sheath (fatty insulation) around your optic nerve. It causes eye pain, loss of clearness or sharpness in your vision, central vision loss, and reduced color perception — especially for the color red.
Parinaud's oculoglandular syndrome. This is swelling in the lining of your eye caused by an infection. It looks a little like pink eye; it causes red, irritated eyes and eye pain. You may also get growths called conjunctival nodules on the inside of your eyelid or on the whites of your eye. Cat scratch fever is one of the most common causes.
You may be more likely to develop complications if you:
Cat scratch fever is an infection caused by the bacteria Bartonella henselae. Most people get infected when they're scratched or bitten by an infected cat. Stray kittens and cats are more likely than pet cats to be infected with Bartonella henselae because they get it from fleas. Symptoms are generally a low-grade fever, swollen lymph nodes, and a rash. Most people get better without needing special treatment. You can help prevent it by keeping your pet cats indoors, treating your cats for fleas, and avoiding contact with stray or feral cats.
Can you die from cat scratch fever?
It's extremely rare, but people with weakened immune systems may develop disseminated disease without treatment. Disseminated disease is when the infection spreads to the internal organs. People with weakened immune systems who get cat scratch fever may die if they don't get treatment with antibiotics.
Can an infected person spread cat scratch fever to another person?
No, an infected person can't spread cat scratch fever to another person.
Soft-Tissue Infection With Abscesses Following A Cat Bite On The Forearm
A 67-year-old female patient was seen with increasing lightheadedness and painful reddening and swelling of the right arm and chest wall. Laboratory analysis revealed significantly increased markers of infection. An initial CT scan showed a marked phlegmonous tissue reaction with lymphadenitis in the proximal ulnar forearm, running via the axilla to the right chest. Blood cultures tested positive for Pasteurella multocida, a pathognomonic bacterium that can cause infection following a cat bite. The patient's medical history was taken anew, and she reported that she had been bitten by her cat on the right ulnar forearm 3 weeks earlier and had had slight local suppuration at the site. Despite treatment according to antibiogram with piperacillin/tazobactam, escalated to imipenem to treat any secondary pathogens, multiple abscesses developed, requiring several surgeries. Culturing revealed Pasteurella multocida in the abscesses as well. The patient required several weeks of inpatient treatment. This case illustrates the need for interdisciplinary treatment that includes broad-spectrum antibiotic treatment and prompt surgical action in cases of soft tissue infections with abscesses.
Figure
The phlegmons span from the right ulnar forearm via the axilla to the lateral chest wall
Dr. Med. Univ. Florian Offensperger, Laura Vogelbacher, Prof. Dr. Med. Robert Thimme, Universitätsklinikum Freiburg, Klinik für Innere Medizin II florian.Offensperger@uniklinik-freiburg.De
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Offensperger F, Vogelbacher L, Thimme R: Soft-tissue infection with abscesses following a cat bite on the forearm. Dtsch Arztebl Int 2021; 118: 816a. DOI: 10.3238/arztebl.M2021.0142.
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