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Cats are a common source of minor infectionsCat Scratch Disease (CSD) seems fairly self-explanatory. A cat scratches you andyou get a disease. Maybe this is why dogs are Man’s best friend: except for theoccasional “mad dog” episode they don’t have many infectious agents that are passedreadily to humans.Cats, on the other hand, won’t come when you call them, disappear for days at atime, leave toxoplasmosis parasites in their litter boxes, and will scratch your hand rawwhenever the mood strikes them. (Despite the aforementioned, I like cats.)This infection was first described in the 19
th
century and cats were fingered as thesource of the infection in 1931. By 1985, the agent of CSD was identified as a bacteriumcalled, Bartonella henselae.Many cats are carriers of B. henselae, but show no signs of illness. Kittens alsoseem to be a frequent source CSD, perhaps because they are overly “playful” or nervousscratchers 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-limitinginfection 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 atthe site and persist for some weeks. Swollen lymph nodes in the neck or upper body arethe most common symptoms of CSD. Some people also may experience fever, headacheand fatigue. The infection usually resolves without treatment over the course of severalweeks.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.,1
 
 bacillary angiomatosis), and prolonged antibiotic therapy may be necessary to prevent alife-threatening infection and related complications. Common antibiotics for treatingCSD include erythromycin, doxycycline and azithromycin.Patients with HIV or other immune disorders should avoid close contact with catsand their fleas.The February issue of 
 Lancet Infectious Diseases
described an unusual case of a12-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 lesionson his liver and spleen, and recovered fully after one month.Fleas appear to play an important role in maintaining Bartonella infections withincat populations. The prevalence of Bartonella infection in cats also seems to vary withclimate. Northern countries have few infected cats; warmer, humid climates where fleasare more active tend to have more infected cats. It’s unclear how important the flea is indirectly transmitting CSD to people through bites, but a flea collar (for the cat) probablywould 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 catsand their fleas.2
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