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Cat-Scratch Disease

(Cat-Scratch Fever)


Larry M. Bush

, MD, FACP, Charles E. Schmidt College of Medicine, Florida Atlantic University

Reviewed/Revised Apr 2022 | Modified Sep 2023
Topic Resources

Cat-scratch disease is infection caused by the gram-negative bacteria Overview of Gram-Negative Bacteria Bacteria are classified by how they appear under the microscope and by other features. Gram-negative bacteria are classified by the color they turn after a chemical process called Gram staining... read more Bartonella henselae and transmitted by a scratch or bite from an infected cat, often causing a crusted bump and swollen lymph nodes.

  • People with cat-scratch disease have a red, painless bump at the site of the scratch, and some have a fever, headache, poor appetite, or swollen lymph nodes.

  • In people with a weakened immune system, the infection may spread throughout the body and, without treatment, may result in death.

  • Doctors do blood and fluid tests to check for the bacteria.

  • Usually, applying heat to the infected area and taking pain relievers are all that is needed, but if people have a weakened immune system, doctors give them antibiotics.

Most domestic cats, particularly kittens, throughout the world are infected but most show no signs of illness. Fleas transmit the Bartonella bacteria from one cat to another. People become infected by a cat bite or scratch, which does not need to be severe for infection to occur. Children are most often affected.

Symptoms of Cat-Scratch Disease

At the site of a cat bite or scratch, a red, painless bump develops within about 3 to 10 days. The bump usually has a crust and sometimes contains pus. Within 2 weeks (sometimes after the scratch has healed), nearby lymph nodes swell and become tender and filled with pus. People may have a fever, headache, and poor appetite. Sometimes pus drains from the swollen lymph nodes.

Usually, people have no other symptoms, and cat-scratch disease resolves on its own. But in people with human immunodeficiency virus (HIV) infection, AIDS, or another condition that weakens the immune system, infection can spread throughout the body and, without treatment, can be fatal.

Diagnosis of Cat-Scratch Disease

  • Blood tests

  • Sometimes blood culture

  • Sometimes lymph node fluid aspiration or biopsy

To diagnose cat-scratch disease, doctors measure antibodies to the bacteria in the blood. (Antibodies Antibodies One of the body's lines of defense ( immune system) involves white blood cells (leukocytes) that travel through the bloodstream and into tissues, searching for and attacking microorganisms and... read more Antibodies are proteins produced by the immune system to help defend the body against a particular attacker, such as the bacteria that cause cat-scratch disease.) In very sick people or people with a weakened immune system, doctors may also take a sample of blood and send it to a laboratory to grow (culture) and identify the bacteria. Or doctors may insert a needle in an infected lymph node to remove a sample of fluid. Doctors then use the polymerase chain reaction (PCR) technique on this sample to increase the amount of the bacteria's DNA so that the bacteria can be detected quickly.

If the diagnosis is unclear, particularly if cancer is suspected, doctors take a sample of tissue from a swollen lymph node and analyze it (lymph node biopsy).

Treatment of Cat-Scratch Disease

  • Heat and pain relievers

  • Sometimes an antibiotic

For people with a healthy immune system, applying heat to the infected area and taking pain relievers are usually adequate.

Sometimes doctors also give antibiotics such as azithromycin to reduce swelling in the lymph nodes and to keep the disease from spreading.

If people with a weakened immune system (particularly those with HIV infection or AIDS) have an infection that has spread, they need to take antibiotics. Antibiotics that may be used include ciprofloxacin, gentamicin, and doxycycline. These antibiotics need to be taken for weeks to months.

People with a weakened immune system can avoid getting the infection by avoiding domestic cats.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

  • Centers for Disease Control and Prevention (CDC): Cat-Scratch Disease: A resource providing information about cat-scratch disease, including prevention

Drugs Mentioned In This Article

Generic Name Select Brand Names
Azasite, Zithromax, Zithromax Powder, Zithromax Single-Dose , Zithromax Tri-Pak, Zithromax Z-Pak, Zmax, Zmax Pediatric
Cetraxal , Ciloxan, Cipro, Cipro XR, OTIPRIO, Proquin XR
Garamycin, Genoptic, Genoptic SOP, Gentacidin, Gentafair, Gentak , Gentasol, Ocu-Mycin
Acticlate, Adoxa, Adoxa Pak, Avidoxy, Doryx, Doxal, Doxy 100, LYMEPAK, Mondoxyne NL, Monodox, Morgidox 1x, Morgidox 2x , Okebo, Oracea, Oraxyl, Periostat, TARGADOX, Vibramycin, Vibra-Tabs
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