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Cat Scratch Disease

The Nemours Foundation

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About Cat Scratch Disease

Cat scratch disease, a bacterial infection that causes swelling of the lymph nodes, usually is due to the scratch, lick, or bite of a cat — more than 90% of people who contract it had contact with cats or kittens.

Bartonella henselae, the bacterium that causes this disease, is found in all parts of the world. In the United States, about 22,000 cases are diagnosed annually, more often in the fall and winter and usually in kids, probably because they're more likely to play with cats and be bitten or scratched.

Fleas spread the bacteria between cats, although there's no evidence that fleas can transmit the disease to humans. The bacteria live in infected cats' saliva but don't make the animals sick; in fact, kittens or cats may carry the bacteria for months.

Experts believe that almost half of all cats have a Bartonella henselae infection at some time in their lives, with those younger than a year old are more likely to be infected.

Signs and Symptoms

Most people with cat scratch disease remember being around a cat, but often cannot recall receiving a scratch or a bite. A blister or a small bump develops several days after the scratch or bite and may be mistaken for a bug bite. This blister or bump is called an inoculation lesion (a wound at the site where the bacteria enter the body), and it is most commonly found on the arms and hands, head, or scalp. These lesions are generally not painful.

Usually within a couple of weeks of a scratch or bite, one or more lymph nodes close to the area of the inoculation lesion will swell and become tender. (Lymph nodes are round or oval-shaped organs of the immune system that are often called glands.) For example, if the inoculation lesion is on the arm, the lymph nodes in the elbow or armpit will swell.

These swollen lymph nodes appear most often in the underarm or neck areas, although if the inoculation lesion is on the leg, the nodes in the groin will be affected. They range in size from about ½ inch to 2 inches in diameter and may be surrounded by a larger area of swelling under the skin. The skin over these swollen lymph nodes can become warm and red, and occasionally the lymph nodes drain pus.

In most kids, swollen lymph nodes are the main symptom of the disease and the illness often is mild. If people have other general symptoms, they might include fever (usually less than 101ºF or 38.3ºC ), fatigue, loss of appetite, headache, rash, sore throat, and an overall ill feeling.

Atypical cases do occur, but are not common. In such cases, someone might have infections of the liver, spleen, bones, joints, or lungs, or a lingering high fever without other symptoms. Some get an eye infection (Parinaud oculoglandular syndrome), with symptoms including a small sore on the conjunctiva (the membrane lining the eye or inner eyelid), redness of the eye, and swollen lymph nodes in front of the ear. Others may develop inflammation of the brain or seizures, although this is rare. All of these complications of cat scratch disease usually resolve without any lasting illness.

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