Cat Scratch Fever

Cat Scratch FeverCasey Coon FNP-SSeptember 11th, 2013

DefinitionCat scratch fever (Cat Scratch disease,CSD) is a bacterial disease caused by Bartonella henselae. Caused when a person is scratched or bitten by an infected cat and developed an infection at the site of injury.Can also be caused when an infected cats saliva comes into contact with broken skin or the white of the eye (US National Library of Medicine, 2012).

PathophysiologyUsually children are diagnosed, but adults may contract the disease as wellCommon symptoms:Papule or pustule at site of infectionFatigue and fever (can be cause of FUO)HeadacheLymphadenopathy (unilateral) on affected side nearest exposureOverall malaise (US National Library of Medicine, 2012).

Figure 1. Cat Scratch Disease. (nlm.nih.gov, 2013). EtiologyCaused by an infected cat or kitten (kittens are more likely to be infected and more likely to spread infection)Cats are infected with the Bartonella henselae bacteria which is gram negative.Can be spread between cats by fleasApproximately 50 percent of cats harbor B. henselae and are entirely asymptomatic

(Klotz, Ianas, & Elliott, 2011).

IncidenceHas been described in all areas of North America and world-wideIn northern temperate zones, occurs more often August-October in warm, humid zones.There is estimated 22,000 new cases diagnosed each year in the U.S.

(Klotz, Ianas, & Elliott, 2011).

Screening/Risk FactorsAny person who owns cats is at riskPeople with kittens (especially if they have fleas) are at increased risk

Figure 2. Lymphadenopathy. (Lieberman, 2009).Clinical FindingsTender regional adenopathy (with hx of exposure to cats)- symptom in 85-90% of PTVesicle at inoculation siteAching, malaise, anorexiaFEVERMyalgia, arthralgia and arthritisHepatosplenomegaly

(US National Library of Medicine, 2012).

Differential Diagnosis Cytomegalovirus lymphadenopathyEpstein-Barr virus lymphadenopathyGroup A streptococcal adenitisHIV lymphadenopathyNontuberculous mycobacterial lymphadenitisStaphylococcus aureus adenitisToxoplasmosis lymphadenopathyMalignancy- lymphoma, leukemia

(Klotz, Ianas, & Elliott, 2011).

Social/Environmental ConsiderationsCannot be spread person to personCan be spread from cat to cat through fleasIs usually spread in the autumn and winter, when there is more time for contact with catsHas been found world-wide, including U.S.

(University of Rochester Medical Center, 2013).

Laboratory TestsCBC, Sedimentation rate, Bartonella antibody testing, polymerase chain reaction amplification (PCR), and skin tissue sampling (Magno & Spatar, 2009).If CSD is suspected, a serologic blood test should be performed- Bartonella henselae immunofluorescence assay (IFA) Occasionally, a lymph node biopsy is completed in patients who lymph nodes do not involute, or if the diagnosis is uncertain

(Klotz, Ianas, & Elliott, 2011).

Management/Treatment GuidelinesNon-Pharmacological-Monitor for 2-8 weeks Medical treatment not usually neededTreat symptomsPharmacologic-Medications to treat symptomsTylenol, IbuprofenAntibiotics including:Azithromycin, ciprofloxacin or sulfamethoxazole

(Klotz, Ianas, & Elliott, 2011).

ComplicationsEncephalopathyNeuroretinitisOsteomyelitisEndocarditisSpleen/hepatomegaly

(Magno & Spatar, 2009).Follow-UpCSD usually subsides in 2-4 weeks, so follow-up in 1 month would be appropriate for patients with normal immune functionFor patients who are immunocompromised, CSD can last 6-12 weeks, so monthly follow-up would be appropriate for them as well.

(Magno & Spatar, 2009).

Counseling/EducationAvoid contact with cats if possibleIf you own a cat, wash your hands thoroughly after playing with the catAvoid being scratched or bitten by a catAvoid cat saliva to reduce your chances of infectionIf you have had contact with a cat and develop swollen lymph nodes, see your PCPAvoid stray cats

(U.S. National Library of Medicine, 2012).Consultation/ReferralIf complications arise, may need to see a specialist Ophthalmologist CardiologistSurgeonNeurologist

Questions What is the cause of cat scratch disease?A. Staph AureusB. Clostridium DifficileC. Bartonella henselaeHow do you get cat scratch fever?A. From not washing your hands after using the toiletB. From a cat scratch or biteC. From another persons sneeze or coughWho is at risk for cat scratch fever?A. Anyone who has contact with catsB. ChildrenC. Adults

QuestionsWhat are some symptoms of cat scratch fever?A. Sneezing, coughing, headacheB. Fever, malaise, lymphadenopathyC. Abdominal pain, nausea, vomitingAs a PCP, what would you look for when you suspect cat scratch fever?A. History of having contact with a cat and swollen lymph nodesB. Travel out of the country and diarrheaC. Family history of the diseaseWhat are some complications of cat scratch fever?A. SepsisB. Pulmonary EmboliC. Encephalopathy

QuestionsHow would you treat cat scratch fever?A. Chelation therapyB. AntibioticsC. Radiation therapyHow long does cat scratch fever usually last?A. 2-4 weeksB. 5-7 daysC. 3-6 monthsHow can you prevent cat scratch disease?A. Get a vaccineB. Wear long pants when walking through the woodsC. Avoid contact with cats

Last one!What are some differential diagnosis for cat scratch disease?A. PneumoniaB. Epstein-Barr virus lymphadenopathyC. RhabdomyolysisReferences