The signs and symptoms of the disease are mild to moderate and are usually self-limiting. They develop after an incubatory period of 1 to 2 weeks or even longer after the initial bite. The onset of the symptoms is gradual. The salient clinical features are swollen and painful lymph nodes (lymphadenopathy), in particular the axillary, cervical and inguinal lymph nodes [4]. There may be formation of erythematous vesicles or pustules at the initial site of infection (bite or scratch). The patient has low grade fever of about 101 F which may be associated with chills. Other non-specific symptoms such as malaise, loss of appetite and weight loss occur. The patient also feels pain in various regions of the body. These include abdominal pain, back ache, muscle aches, sore throat and headache.

In rare cases, the patient may have other severe symptoms. Encephalopathy along with seizures may develop in these patients [5]. They may also have involvement of the heart in the form of endocarditis. Involvement of the liver (granulomatous hepatitis) and spleen may also be seen [6] [7]. Occasionally, there may be osteomyelitis and osteolytic lesions of the bone [8] [9]. Joints may also be affected.

Involvement of the eyes and ears can also occur, including visual disorders, neuroretinitis and otic neuralgia. Other serious complications include involvement of the lungs, Parinaud’s syndrome and thrombocytopenic purpura.

• Splenomegaly

  Physical examination for hepatomegaly and splenomegaly. The cultures obtained from the victim can reveal the presence of Bartonella through Warthin–Starry stain or a Brown-Hopp tissue Gram stain. [symptoma.com]

  Other symptoms are sometimes present as well, including anorexia, splenomegaly, sore throat, parotid swelling, rash, and/or conjunctivitis. [web.archive.org]

  A report from Canada describes CSD presenting as acute mastoiditis in a 6-year-old girl. [37] Less common symptoms are splenomegaly (11%), exanthems (4.5%), conjunctivitis (4.3%), and parotid swelling (1.4%). [emedicine.medscape.com]

  Splenomegaly (Patients 1, 3, 4, 5, 6, and 8) and abdominal or retroperitoneal lymphadenopathy (Patients 1, 2, 4, 5, 6, and 8) were also detected clinically or by imaging studies. [doi.org]

  Additional findings may include a temporary skin rash consisting of flat (macular) or raised (papular) lesions, and/or enlargement of the liver or spleen (hepatomegaly or splenomegaly). [rarediseases.org]

• Cervical Lymphadenopathy

  Gray-scale sonographic evaluation of cervical lymphadenopathy in cat-scratch disease. J Clin Ultrasound 2001 ;29: 140 – 5 Google Scholar | Medline | ISI 13.. Ridder, GJ, Richter, B, Laszig, R. [doi.org]

• Inguinal Lymphadenopathy

  Inguinal lymphadenopathy has been reported in 17% of cases. Lymphadenopathy can be moderately tender, with erythema and increased warmth of the overlying skin. [emedicine.medscape.com]

• Cat Scratch

  […] called also cat scratch fever First Known Use of cat scratch disease 1952, in the meaning defined above Learn More about cat scratch disease Resources for cat scratch disease Statistics for cat scratch disease More Definitions for cat scratch disease [merriam-webster.com]

  […] kissanraapaisutauti Termer på andra språk engelska Bartonella henselae Infection Bartonella henselae Infections Cat Scratch Disease Cat Scratch Diseases Cat Scratch Fever Cat Scratch Fevers Catscratch Disease Catscratch Diseases Fever, Cat Scratch Infection [finto.fi]

  Cat Scratch Disease ( Bartonella henselae Infection) What is cat scratch disease? Cat scratch disease (CSD) is a bacterial disease caused by Bartonella henselae. [web.archive.org]

  The osteolysis associated with cat-scratch fever resembles more ominous conditions. The combination of osteolysis and unilateral regional adenopathy in a child or adolescent should suggest cat-scratch disease. [ncbi.nlm.nih.gov]

  Cat-scratch disease - Connecticut, 1992-1993. J Infect Dis 1995 ;172: 570 – 3 Google Scholar | Medline | ISI 12.. Ridder, GJ, Richter, B, Disko, U. Gray-scale sonographic evaluation of cervical lymphadenopathy in cat-scratch disease. [doi.org]

• Fever

  Cat Scratch Fevers Catscratch Disease Catscratch Diseases Fever, Cat Scratch Infection, Bartonella henselae Infections, Bartonella henselae Inoculation Lymphoreticuloses Inoculation Lymphoreticulosis Inoculative Lymphoreticuloses Inoculative Lymphoreticulosis [finto.fi]

  Cat Scratch Fever? Really? Cats, fleas, and the many faces of bartonellosis By Claudia S. [web.archive.org]

• Pain

  Low grade fever, generalized fatigue, muscle pain. Lower back pain, abdominal pain, loss of appetite and weight commonly develop in the patients. With proper treatment, the symptoms completely regress and patients can be completely cured. [symptoma.com]

  The nodes are often painful and spontaneously suppurate in 25-30% of cases. [patient.info]

  A year later, the oldest son was seen for enlarged lymph nodes in the neck, and the mother had developed a host of neurological symptoms including fatigue, headaches, joint pain, eye pain, insomnia, memory loss, disorientation, irritability, weakness [web.archive.org]

• Fatigue

  Additionally, a person with CSD may experience fever, headache, fatigue, and a poor appetite. Rare complications of B. henselae infection are bacillary angiomatosis and Parinaud's oculolandular syndrome. [web.archive.org]

  Decades of case reports hint at associations between fatigue, chronic headaches, numbness, pain and cognitive impairment and infection with Bartonella. Yet researchers still do not have clear answers. [scientificamerican.com]

  Some patients experience fever, fatigue, headaches or sore throat as well. [icd10data.com]

• Lymphadenopathy

  According to one study, 46 percent of patients develop lymphadenopathy of the upper extremities, 26 percent develop lymphadenopathy of the neck and jaw, 18 percent develop lymphadenopathy of the groin, and 10 percent develop lymphadenopathy of other areas [aafp.org]

  Because it is a benign and self-limiting condition, with most cases of regional lymphadenopathy resolving spontaneously in two to four months, no specific treatment is usually necessary. [dermnetnz.org]

  Table 1 Diagnoses for 454 patients with lymphadenopathy in the head and neck. Table 1 Diagnoses for 454 patients with lymphadenopathy in the head and neck. [doi.org]

  One to three weeks after the appearance of the primary lesion, regional lymphadenopathy appears, usually next to the inoculation site. [patient.info]

• Loss of Appetite

  Other non-specific symptoms such as malaise, loss of appetite and weight loss occur. The patient also feels pain in various regions of the body. These include abdominal pain, back ache, muscle aches, sore throat and headache. [symptoma.com]

  Other symptoms include fatigue, loss of appetite, weakness, chills, aches, and a general feeling of being ill. [health.hawaii.gov]

  Cat scratch fever may cause: A crusting sore or blister that forms over the site of a cat scratch or bite Swollen, painful lymph nodes Low fever Flu-like symptoms such as weakness, nausea, chills, loss of appetite, and body aches Eye involvement Copyright [health.cvs.com]

  For most people, this will be the extent of the illness, but around a third of those infected will go on to develop other symptoms including slight fever headache backache fatigue loss of appetite rash chills sore throat abdominal pain minor convulsions [felineforever.com]

  Bump (papule) or blister (pustule) at the site of scratch or bite Fatigue Fever Headaches Lymph node swelling near the site of the scratch or bite Overall discomfort Less common symptoms may include: Loss of appetite Sore throat Weight loss Even a slight [pediatrics.about.com]

• Abdominal Pain

  The patient also feels pain in various regions of the body. These include abdominal pain, back ache, muscle aches, sore throat and headache. In rare cases, the patient may have other severe symptoms. [symptoma.com]

  For most people, this will be the extent of the illness, but around a third of those infected will go on to develop other symptoms including slight fever headache backache fatigue loss of appetite rash chills sore throat abdominal pain minor convulsions [felineforever.com]

  Abdominal pain may be a presenting complaint in these patients. Children with hepatosplenic CSD usually present with prolonged fever, with or without abdominal pain. Patients may also have chills, headaches, and weight loss. [clinicaladvisor.com]

  Fundal signs include discrete white retinal/choroidal lesions, optic disc swelling, macular star and branch retinal vein occlusion (in order of frequency). [ 8 ] Abdominal pain - this can occur with associated hepatitis/splenitis, a self-limited granulomatous [patient.info]

• Vomiting

  About 50% of patients will experience additional signs and symptoms including: fever malaise /fatigue headache nausea and vomiting sore throat rash stomach pains conjunctivitis Less common problems occur in about 10% of patients. [dermnetnz.org]

  Symptoms requiring veterinary care include fever, vomiting, lethargy, red eyes, swollen lymph nodes or decreased appetite. My daughter got scratched by the neighbor’s kitten and now my husband is worried about “cat scratch disease.” [cdc.gov]

  Some symptoms you can expect with cat scratch fever may include swollen lymph nodes, chills, vomiting, fever and fatigue. The best way to prevent cat scratch disease is to avoid situations in which you might be bitten or scratched by a cat. [vetmed.tamu.edu]

• Nausea

  About 50% of patients will experience additional signs and symptoms including: fever malaise /fatigue headache nausea and vomiting sore throat rash stomach pains conjunctivitis Less common problems occur in about 10% of patients. [dermnetnz.org]

  Cat scratch fever may cause: A crusting sore or blister that forms over the site of a cat scratch or bite Swollen, painful lymph nodes Low fever Flu-like symptoms such as weakness, nausea, chills, loss of appetite, and body aches Eye involvement Copyright [health.cvs.com]

  The symptoms may include: Pimples/nodules at the site of the scratch that last one to four weeks Swollen, tender lymph nodes Warm, red skin that lasts four to six weeks Fatigue Nausea Vomiting Fever (Develops in less than half of those infected) The majority [cats.lovetoknow.com]

• Hepatomegaly

  Physical examination for hepatomegaly and splenomegaly. The cultures obtained from the victim can reveal the presence of Bartonella through Warthin–Starry stain or a Brown-Hopp tissue Gram stain. [symptoma.com]

  Hepatomegaly was present in all cases. [doi.org]

  Additional findings may include a temporary skin rash consisting of flat (macular) or raised (papular) lesions, and/or enlargement of the liver or spleen (hepatomegaly or splenomegaly). [rarediseases.org]

  Klinisch manifestiert sich die BA mit Fieber (93%), niedriger CD4-Lymphozytenzahl, kutanen oder subkutanen Läsionen (55%), Lymphadenopathie (76%), Hepatomegalie (50%) und Splenomegalie (33%) [140]. [antibiotikamonitor.at]

• Arthralgia

  Other symptoms such as arthralgia and sore throat may also be seen. These are typically observed in immunocompromised patients (e.g., HIV/AIDS). In immunocompromised patients, a very severe form of CSD, bacillary angiomatosis, may occur. [news-medical.net]

  Patients may also experience headaches, fever (30% to 50%, can be as high as 104°F, 40°C), malaise, anorexia, arthralgias, sore throat, and abdominal, neck, back or extremity pain. [hawaii.edu]

  In September 2000, a girl aged 10 years with a bicommisural aortic valve had persistent low-grade fever, myalgias, arthralgias, weight loss, splinter hemorrhages, and hematuria and was admitted to TCH for evaluation and surgical management of endocarditis [cdc.gov]

  Conditions diagnosed before referral included Lyme disease (46.6%), arthralgia/arthritis (20.6%), chronic fatigue (19.6%), and fibromyalgia (6.1%). [borrelioosifoorumi.net]

  Musculoskeletal manifestations, especially myalgia, arthralgia, and arthritis, are common and occur in more than 10 percent of patients. 5 Visceral involvement has been reported 6 and usually presents as hepatosplenomegaly with or without lymphadenopathy [aafp.org]

• Papule

  Symptoms are a local papule and regional lymphadenitis. Diagnosis is clinical and confirmed by biopsy or serologic tests. Treatment is with local heat application, analgesics, and sometimes antibiotics. [merckmanuals.com]

  These symptoms consist of one or more papules (small raised areas on the skin with no fluid inside) or pustules (like papules but with pus inside) on the skin where the cat scratch, bite, or lick occurred. [emedicinehealth.com]

  It may compromise any tissue, especially the skin, presenting papules, nodules or angiomatous tumours. [ 4 ] A case of aseptic meningitis related to cat scratch disease has been reported. [patient.info]

• Macula

  Zacchei AC, Newman NJ, and Sternberg P: Serous retinal detachment of the macula associated with cat scratch disease. Am J Ophthalmol 1995; 120: pp. 796-797. 5. Cunningham ET, and Koehler JE: Ocular bartonellosis. [eyewiki.aao.org]

  The optic disc appears edematous, and exudates frequently surround the macula. Neuroretinitis is possibly due to a subretinal angiomatous nodule similar to that seen in bacillary angiomatosis. [emedicine.com]

• Night Sweats

  After a weeklong fever, the 46-year-old woman went to the hospital and told doctors she was tired, and was having night sweats and pain in her upper right abdomen — symptoms that were "all very vague," said Dr. [livescience.com]

• Neck Mass

  Specifically, lymphadenopathy of the head and neck was more frequent among nonelderly patients than among elderly patients (22% vs. 9.6%; OR, 0.4; P = .03). [academic.oup.com]

• Headache

  Additionally, a person with CSD may experience fever, headache, fatigue, and a poor appetite. Rare complications of B. henselae infection are bacillary angiomatosis and Parinaud's oculolandular syndrome. [web.archive.org]

  Generalized headache and transient nuchal rigidity are often present. [emedicine.medscape.com]

  People with cat-scratch disease have a red bump at the site of the scratch, and some have a fever, headache, poor appetite, or swollen lymph nodes. [msdmanuals.com]

Physical examination for hepatomegaly and splenomegaly. The cultures obtained from the victim can reveal the presence of Bartonella through Warthin–Starry stain or a Brown-Hopp tissue Gram stain.

The following tests are also helpful:

• Polymerase chain reaction (PCR)
• Erythrocyte sedimentation rate (ESR)
• Enzyme linked immunosorbent assay (ELISA)
• Serological testing for indirect fluorescent antibody (IFA) of Bartonella (high titers of IgG greater than 1:256 are diagnostic)
• Analysis of the cerebrospinal fluid (CSF)
• Lymph node biopsy [10]
• Electroencephalography (EEG)
• Ultrasound
• Computerized tomography (CT) and magnetic resonance imaging (MRI)

• Bartonella Henselae

  henselae Infection Bartonella henselae Infections Cat Scratch Disease Cat Scratch Diseases Cat Scratch Fever Cat Scratch Fevers Catscratch Disease Catscratch Diseases Fever, Cat Scratch Infection, Bartonella henselae Infections, Bartonella henselae Inoculation [finto.fi]

  Cat Scratch Disease ( Bartonella henselae Infection) What is cat scratch disease? Cat scratch disease (CSD) is a bacterial disease caused by Bartonella henselae. [web.archive.org]

  According to the CDC, 41% of healthy cats harbor Bartonella henselae. Bartonella henselae is also more common in young cats and strays. Cats typically become infected when bitten by an infected flea. [pethealthnetwork.com]

  Rochalimaea henselae infection. A new zoonosis with the domestic cat as reservoir. JAMA 1994 ;271: 531 – 5 Google Scholar | Medline | ISI 6.. Chomel, BB, Kasten, RW, Floyd-Hawkins, K. Experimental transmission of Bartonella henselae by the cat flea. [doi.org]

  Infection with Bartonella henselae bacterium is responsible for the disease. Afipia felis and Bartonella clarridgeiea have also been found in association with cat scratch fever. Cats are the vectors for this agent. [symptoma.com]

• Afipia Felis

  It says, “further study has now discredited Afipia felis as the cause of cat-scratch disease!” [drgreene.com]

  In 1983, the Warthin-Starry silver stain was used to discover a Gram-negative bacillus which was named Afipia felis in 1991 after it was successfully cultured and isolated. [en.wikipedia.org]

  A self-limiting bacterial infection of the regional lymph nodes caused by afipia felis, a gram-negative bacterium recently identified by the Centers for Disease Control and Prevention. and by bartonella henselae. [icd10data.com]

• Lymph Node Hyperplasia

  PCR detection of Bartonella DNA in lymph node specimens. Lymph node specimens were obtained from 21 of the 61 patients with CSD. [doi.org]

The symptoms are usually self-limiting and resolve spontaneously. The following medicines may be used:

• Antipyretics: These are given to reduce fever.
• Analgesics: They are administered to provide relief from pain.
• Antibiotics: Immunocompromised patients can be given antibiotics. These include Trimethoprim-sulfamethoxazole, ciprofloxacin or azithromycin, gentamicin and rifampin.

Complete cure is possible within 2 to 6 months after therapeutic measures are taken. In immunocompromised patients, it may take longer but the prognosis is generally good.

Infection with Bartonella henselae bacterium is responsible for the disease [3]. Afipia felis and Bartonella clarridgeiea have also been found in association with cat scratch fever. Cats are the vectors for this agent. Fleas are responsible for transmission of this agent to cats. Biting, scratching and even licking can transfer the bacterium to humans as saliva of the cats has also been found to contain the organism.

The transfer of the bacterium from cats’ bloodstream to the saliva has, however, not been explained as yet. The transfer of this disease from one human to another has not been proved as yet.

The disease is common in children and in people under 21 years of age. Almost 25,000 cases of cat scratch disease surface every year. There is a seasonal tendency of the disease, with more cases emerging during the early summers and mid-winters.

Bartonella henselae is a gram-negative organism. The infection by this organism evokes a suppurative granulomatous response in the infected patients. In immunocompromised states, it can trigger a vascular reaction followed by recruitment and proliferation of lymphocytes. The bacteria cause angiogenesis in the infected area via adhesin A involvement.

The host’s immune system is activated. Following phagocytosis by macrophages, the internalized bacteria are circulated to the regional lymph nodes. The lymph nodes proximal to the site of infection show granuloma formation, suppuration and hyperplasia on biopsy. Biopsy findings also include stellate abscesses and leucocyte infiltrates. The macrophages release several inflammatory cytokines including interleukin-1 (IL-1) and tumor necrosis factor α (TNFα). These cause recruitment of neutrophils and more macrophages to the site of infection.

Helper T cells are activated by presentation of the invading bacterial antigens by macrophages and dendritic cells. TNF-gamma is produced by the activated helper T cells which triggers the release of NO locally. NO produced cytotoxic elements kill the bacteria. The inflammation and suppurative granulomation ultimately resolves.

In immunocompromised hosts, bacteria can evade the defense mechanisms involving vital organs like brain, retina and liver, leading to atypical manifestations of the disease.

• Cat bites and licks should be washed immediately.
• Children should be made to wash their hands every time after playing with cats.
• Going near or playing with pet cats should be avoided in case an individual is supporting an open wound or is suffering from an immunocompromised state (for example, diabetes, HIV, chemotherapy, organ transplantation)
• Pet cats should be looked after. Their claws should be trimmed to avoid harboring the flea dirt. Flea products should be used.

Also known as cat scratch disease, bartonellosis or Teeny’s disease, cat scratch fever is a bacterial infection transferred to humans through biting, licking or scratching by infected cats [1] [2].

Bartonella henselae is the bacterium responsible for this condition. The cats are asymptomatic carriers of the agent. The bacterium is transferred to cats by fleas, Ctenocephalides fells. The fleas may also be responsible for direct transference of the bacteria to man. Typical feature of the disease is persistent low grade fever, hence the name cat scratch fever.

Cat scratch fever is a condition that is transferred to man through bite, scratch or lick by cats infected with a certain bacteria. People with pet cats at home are more susceptible to it.

The infected persons develop pustules at the site of scratch or bite. Low grade fever, generalized fatigue, muscle pain. Lower back pain, abdominal pain, loss of appetite and weight commonly develop in the patients.

With proper treatment, the symptoms completely regress and patients can be completely cured. Proper preventive measures should also be taken to avoid getting infected. Cats should be looked after and their hygiene should be maintained. They should be regularly checked for flea infestation. Hands should be washed with antibacterial soap and plenty of water immediately after playing with cats especially in children as their bodies have weaker defense mechanisms and are more susceptible to the disease. If open wounds are present on the skin, one should avoid going near the cats. With proper care, the disease can be prevented altogether.

1. Keefer CS, Greer W. Cat Scratch Fever. Transactions of the American Clinical and Climatological Association. 1950;62:151-164.
2. Marshall CE. Cat scratch fever. Canadian Medical Association journal. Nov 1 1956;75(9):724-732.
3. Blattner RJ. The etiology of cat-scratch fever. The Journal of pediatrics. Jun 1960;56:839-841.
4. Guiyedi V, Haddad H, Okome-Nkoumou M, et al. Cat-scratch disease in adult hospitalized for prolonged-Fever associated with multiple lymphadenopathies and weight loss. The open microbiology journal. 2013;7:152-155.
5. Stevens H. Cat-scratch fever encephalitis. A.M.A. American journal of diseases of children. Aug 1952;84(2):218-222.
6. Laham FR, Kaplan SL. Hepatosplenic cat-scratch fever. The Lancet. Infectious diseases. Feb 2008;8(2):140.
7. Incandela S, Raoult D, Vitale G, Micalizzi A, Mansueto P. Hepatosplenic cat-scratch fever with seropositivity for Bartonella quintana? The Lancet. Infectious diseases. Nov 2008;8(11):663.
8. Herts BR, Rafii M, Spiegel G. Soft-tissue and osseous lesions caused by bacillary angiomatosis: unusual manifestations of cat-scratch fever in patients with AIDS. AJR. American journal of roentgenology. Dec 1991;157(6):1249-1251.
9. Johnson JF, Lehman RM, Shiels WE, Blaney SM. Osteolysis in cat-scratch fever. Radiology. Aug 1985;156(2):373-374.
10. Winship T. Pathologic changes in so-called cat-scratch fever; review of findings in lymph node of 29 patients and cutaneous lesions of 2 patients. American journal of clinical pathology. Oct 1953;23(10):1012-1018.