Transcript Cat Scratch Fever - Casey Coon Family Nurse Practitioner

CAT SCRATCH FEVER
Casey Coon FNP-S
September 11th, 2013
Definition
• Cat scratch fever (Cat Scratch disease,CSD) is a bacterial
disease caused by Bartonella henselae.
• Caused when a person is scratched or bitten by an
infected cat and developed an infection at the site of
injury.
• Can also be caused when an infected cat’s saliva comes
into contact with broken skin or the white of the eye (US
National Library of Medicine, 2012).
Pathophysiology
• Usually children are diagnosed, but adults may contract
the disease as well
• Common symptoms:
• Papule or pustule at site of infection
• Fatigue and fever (can be cause of FUO)
• Headache
• Lymphadenopathy (unilateral) on affected side nearest exposure
• Overall malaise
(US National Library of Medicine, 2012).
Figure 1. Cat Scratch Disease. (nlm.nih.gov, 2013).
Etiology
• Caused by an infected cat or kitten (kittens are more likely
to be infected and more likely to spread infection)
• Cats are infected with the Bartonella henselae bacteria
which is gram negative.
• Can be spread between cats by fleas
• Approximately 50 percent of cats harbor B. henselae and
are entirely asymptomatic
(Klotz, Ianas, & Elliott, 2011).
Incidence
• Has been described in all areas of North America and
world-wide
• In northern temperate zones, occurs more often AugustOctober in warm, humid zones.
• There is estimated 22,000 new cases diagnosed each
year in the U.S.
(Klotz, Ianas, & Elliott, 2011).
Screening/Risk Factors
• Any person who owns cats is at risk
• People with kittens (especially if they have fleas) are at
increased risk
Figure 2. Lymphadenopathy.
(Lieberman, 2009).
Clinical Findings
• Tender regional adenopathy (with hx of exposure to cats)•
•
•
•
•
symptom in 85-90% of PT
Vesicle at inoculation site
Aching, malaise, anorexia
FEVER
Myalgia, arthralgia and arthritis
Hepatosplenomegaly
(US National Library of Medicine, 2012).
Differential Diagnosis
• Cytomegalovirus lymphadenopathy
• Epstein-Barr virus lymphadenopathy
• Group A streptococcal adenitis
• HIV lymphadenopathy
• Nontuberculous mycobacterial lymphadenitis
• Staphylococcus aureus adenitis
• Toxoplasmosis lymphadenopathy
• Malignancy- lymphoma, leukemia
(Klotz, Ianas, & Elliott, 2011).
Social/Environmental Considerations
• Cannot be spread person to person
• Can be spread from cat to cat through fleas
• Is usually spread in the autumn and winter, when there is
more time for contact with cats
• Has been found world-wide, including U.S.
(University of Rochester Medical Center, 2013).
Laboratory Tests
• CBC, Sedimentation rate, Bartonella antibody testing,
polymerase chain reaction amplification (PCR), and skin
tissue sampling (Magno & Spatar, 2009).
• If CSD is suspected, a serologic blood test should be
performed- Bartonella henselae immunofluorescence
assay (IFA)
• Occasionally, a lymph node biopsy is completed in
patient’s who lymph nodes do not involute, or if the
diagnosis is uncertain
(Klotz, Ianas, & Elliott, 2011).
Management/Treatment Guidelines
• Non-Pharmacological• Monitor for 2-8 weeks
• Medical treatment not usually needed
• Treat symptoms
• Pharmacologic• Medications to treat symptoms
• Tylenol, Ibuprofen
• Antibiotics including:
• Azithromycin, ciprofloxacin or sulfamethoxazole
(Klotz, Ianas, & Elliott, 2011).
Complications
• Encephalopathy
• Neuroretinitis
• Osteomyelitis
• Endocarditis
• Spleen/hepatomegaly
(Magno &
Spatar, 2009).
Follow-Up
• CSD usually subsides in 2-4 weeks, so follow-up in 1
month would be appropriate for patients with normal
immune function
• For patients who are immunocompromised, CSD can last
6-12 weeks, so monthly follow-up would be appropriate
for them as well.
(Magno & Spatar, 2009).
Counseling/Education
• Avoid contact with cats if possible
• If you own a cat, wash your hands thoroughly after
•
•
•
•
playing with the cat
Avoid being scratched or bitten by a cat
Avoid cat saliva to reduce your chances of infection
If you have had contact with a cat and develop swollen
lymph nodes, see your PCP
Avoid stray cats
(U.S. National Library of Medicine, 2012).
Consultation/Referral
• If complications arise, may need to see a specialist
• Ophthalmologist
• Cardiologist
• Surgeon
• Neurologist
Questions
• What is the cause of cat scratch disease?
• A. Staph Aureus
• B. Clostridium Difficile
• C. Bartonella henselae
• How do you get cat scratch fever?
• A. From not washing your hands after using the toilet
• B. From a cat scratch or bite
• C. From another person’s sneeze or cough
• Who is at risk for cat scratch fever?
• A. Anyone who has contact with cats
• B. Children
• C. Adults
Questions
• What are some symptoms of cat scratch fever?
• A. Sneezing, coughing, headache
• B. Fever, malaise, lymphadenopathy
• C. Abdominal pain, nausea, vomiting
• As a PCP, what would you look for when you suspect cat
scratch fever?
• A. History of having contact with a cat and swollen lymph nodes
• B. Travel out of the country and diarrhea
• C. Family history of the disease
• What are some complications of cat scratch fever?
• A. Sepsis
• B. Pulmonary Emboli
• C. Encephalopathy
Questions
• How would you treat cat scratch fever?
• A. Chelation therapy
• B. Antibiotics
• C. Radiation therapy
• How long does cat scratch fever usually last?
• A. 2-4 weeks
• B. 5-7 days
• C. 3-6 months
• How can you prevent cat scratch disease?
• A. Get a vaccine
• B. Wear long pants when walking through the woods
• C. Avoid contact with cats
Last one!
• What are some differential diagnosis for cat scratch
disease?
• A. Pneumonia
• B. Epstein-Barr virus lymphadenopathy
• C. Rhabdomyolysis
References
Florin, T. A., Zaoutis, T. E., & Zaoutis, L. B. (2008, May). Beyond Cat Scratch Disease: Widening Spectrum
of Bartonella henselae Infection. Pediatrics, 121(5), e1413-e1426. doi:10.1542/peds.2007-1897
Klotz, S. A., Ianas, V., & Elliott, S. P. (2011, January 15). Cat Scratch Disease. American Family Physician.
Retrieved from http://www.aafp.org/afp/2011/0115/p152.html#afp20110115p152-t1
Lieberman, J. M. (2009, April). Figure 2 Lymphadenopathy. Pediatric Annals, 38(4), 193-194. Retrieved
from Cinahl Plus.
Lieberman, J. M. (2009, April). North American Zoonoses. Pediatric Annals, 38(4), 193-194. Retrieved
from Cinahl Plus.
Magno, S. L., & Spatar, L. (2009, May). Cat Scratch Disease in Primary Care. The Journal for Nurse
Practitioners, 5(5), 353-358. Retrieved from Cinahl Plus.
University of Rochester Medical Center. (2013). Cat Scratch Disease in Children. Health Encyclopedia.
Retrieved from
http://www.urmc.rochester.edu/Encyclopedia/Content.aspx?ContentTypeID=160&ContentID=5
0
US National Library of Medicine. (2012). Cat Scratch Disease. Pub Med Health. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002581/
US National Library of Medicine. (2012). Figure 1. Cat Scratch Disease. Pub Med Health. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002581/