Cat Scratch Disease: Symptoms, Timeline, and Key Features

Cat scratch disease (CSD) is caused by Bartonella henselae, transmitted via cat scratch/bite (kittens higher risk). Blisters are not typical.

Typical Timeline

1. Inoculation: Scratch/bite → papule at site (3–10 days)
2. Lymphadenopathy: Regional nodes enlarge, tender (1–3 weeks post-scratch); lasts weeks–months.
3. Systemic symptoms (50%): Low-grade fever, fatigue, headache, anorexia.

Atypical/Severe Manifestations

• Parinaud's oculoglandular syndrome (conjunctivitis + preauricular nodes)
• Neuroretinitis, encephalopathy
• Hepatosplenic granulomas
• Endocarditis (in immunocompromised)
• Bacillary angiomatosis/peliosis (HIV/AIDS)

Diagnosis

• Clinical: History + lymphadenopathy + cat exposure
• Serology: B. henselae IgG/IgM (cross-reactivity possible)
• PCR: Lymph node aspirate (gold standard)
• Warthin-Starry stain: Visualizes organisms

Treatment

• Self-limited (2–4 months) in immunocompetent → supportive care
• Azithromycin 5 days may shorten lymphadenopathy
• Severe/disseminated: Doxycycline/rifampin ± gentamicin

Prevention

• Wash scratches immediately
• Avoid rough play with kittens
• Flea control (vector for cat-to-cat transmission)
• Immunocompromised: adopt adult cats, avoid scratches