You may find it hard to believe that a small household pet like a cat can cause your child to become ill for a long period of time. A common bacterial infection called cat-scratch disease (CSD) can make your youngster sick for weeks or even months, all because, as the name suggests, a cat has bitten or scratched him. Most cases occur in people younger than 20 years.
Cat-scratch disease is caused by an organism called Bartonella henselae, which is transmitted to humans by cats (usually kittens) that appear healthy, but are infected with this bacteria. The disease spreads from cat to cat by fleas, but cannot be transmitted from person to person. It takes a week or more from the time a person is scratched for the first symptoms to appear, sometimes as long as a month and a half.
Signs and Symptoms
The most common sign of CSD is one or more swollen lymph nodes or glands, a condition called lymphadenopathy. The affected lymph nodes may be in your child’s armpit, on his neck, or in the area of the groin. In most cases, children have a small sore on the skin where the cat scratch or bite occurred. This bump usually appears 1 to 2 weeks before the lymph nodes become swollen and can last for many weeks.
The skin over the swollen lymph nodes is warm, reddened, hardened, and tender to the touch. Children may also have a fever, headaches, tiredness, and a decreased appetite.
In a small number of cases, children with CSD—typically those who also have a weak immune system because of cancer, human immunodeficiency virus (HIV), or an organ transplantation—may develop infections in other parts of the body. Some children with normal immune systems develop infections in the liver and spleen. These children have prolonged fever, which is called fever of unknown origin. Rarely, a child with CSD develops brain inflammation (encephalitis), inflammation of the retina of the eye, a bone infection, pneumonia, or tender purple-red bumps on the skin (erythema nodosum).
An unusual complication called Parinaud oculoglandular syndrome occurs when the bacteria enters the body through the eyelid. In this case, the eyelid lining, the white of the eye (conjunctiva), or both are red. The lymph node in front of the ear on the same side of the infected eye will be swollen.
What You Can Do
If a cat scratches or bites your child, immediately wash the area with soap and water.
When to Call Your Pediatrician?
Contact your pediatrician if your child develops swollen lymph nodes. This swelling can have a number of causes, including CSD.
How is the Diagnosis Made?
Your pediatrician will ask whether your child has had exposure to cats and kittens. The pediatrician will look for a small bump where the cat scratch has occurred and evaluate any swollen lymph nodes that may be present. Laboratory tests are available to detect antibodies in the blood related to CSD, but many commercial tests are considered unreliable. In most cases, your pediatrician will not use this test.
Treatment
Your pediatrician may recommend treatments aimed at easing the symptoms of CSD in your child. For example, if your youngster has a painful, pus-filled lymph node, the doctor may drain the pus with a needle to make your child more comfortable.
Antibiotics may speed recovery.
What is the Prognosis?
Cat-scratch disease is self-limited, meaning that the infection and the lymph node swelling will usually go away on their own in 2 to 4 months, even without treatment.
Prevention
Do not allow your child to play roughly with cats and kittens. This kind of play can increase the chances of a scratch or bite. Teach your child how to interact with animals. A child should never try to take food away from a cat and should avoid teasing, petting, or trying to capture stray cats.