eMedicine Specialties > Emergency Medicine > Infectious Diseases
Catscratch Disease: Treatment & Medication
Updated: Mar 6, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Emergency Department Care
ED management of CSD is primarily symptomatic, as the disease spontaneously resolves in 2-4 months.
- Administer antipyretics and analgesics as needed.
- Local heat may be applied to the involved lymph nodes.
- Avoid incision and drainage because this may leave scars and draining fistulae without hastening recovery.
- Aspiration of tender, fluctuant nodes may relieve pain.
- Antibiotics are not indicated in most cases, but they may be considered for severe or systemic disease. Reduction of lymph node size has been demonstrated with a 5-day course of azithromycin and may be considered in patients with severe, painful lymphadenopathy; however, no advantage is shown in the duration of symptoms.
- Immunocompromised patients should be treated with antibiotics because they are particularly susceptible to systemic disease and bacteremia. Drugs of particular effectiveness include the following:
- Trimethoprim-sulfamethoxazole
- Gentamicin
- Ciprofloxacin
- Rifampin
- B henselae is generally resistant to penicillin, amoxicillin, and nafcillin.
- Immunocompromised patients should be treated with antibiotics because they are particularly susceptible to systemic disease and bacteremia. Drugs of particular effectiveness include the following:
Consultations
Emergent consultation is not usually required. Consider emergent or outpatient consultation in cases of diagnostic uncertainty or with specific organ system involvement as indicated.
- Infectious disease specialist
- Ophthalmologist (in neuroretinitis)
- Neurologist (in encephalitis or seizures)
Medication
In general, treatment beyond administration of analgesia and recommendation for warm compresses is unnecessary because the condition spontaneously resolves without sequelae in most cases. Response to antibiotics in patients with systemic manifestations has been shown only anecdotally.
Antibiotics
Although not indicated in all patients, those with painful lymph node enlargement refractory to needle aspiration may benefit from a short course of antibiotics. As discussed, antibiotics are generally recommended for a patient with underlying immune compromise with CSD.
Rifampin (Rifadin, Rimactane)
Inhibits DNA-dependent bacterial but not mammalian RNA polymerase. Cross-resistance may occur.
Adult
600-900 mg PO/IV qd
Pediatric
10-20 mg/kg PO/IV qd; not to exceed 600 mg
Multiple drug-drug interactions; notably, decreases serum levels of most antiretrovirals; decreases effectiveness of beta-blockers; decreases effectiveness of oral contraceptives; decreases phenytoin levels; decreases effectiveness of anticoagulants and sulfonylureas; increases conversion of INH into its hepatotoxic metabolites; levels increase with concurrent use of antiretrovirals and TMP-SMZ; also decreases levels of methadone, precipitating withdrawal
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Monitor liver enzymes before starting therapy and repeat if symptoms of potential hepatotoxicity develop; causes brownish discoloration of body fluids; stains contact lenses; may cause drug-induced lupus; if taken irregularly or restarted after an interval of no medication, may cause "flu syndrome" with fever, chills, myalgias, and dyspnea
Azithromycin (Zithromax)
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, arresting RNA-dependent protein synthesis.
Adult
Day 1: 500 mg PO
Days 2-5: 250 mg PO
Pediatric
Not established
May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine
Documented hypersensitivity; hepatic impairment; do not administer with pimozide
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Site reactions can occur with IV route; bacterial or fungal overgrowth may result from prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function, prolonged QT intervals, or pneumonia; caution in hospitalized patients, geriatric patients, or debilitated patients
More on Catscratch Disease |
| Overview: Catscratch Disease |
| Differential Diagnoses & Workup: Catscratch Disease |
 Treatment & Medication: Catscratch Disease |
| Follow-up: Catscratch Disease |
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References
Jackson LA, Perkins BA, Wenger JD. Cat scratch disease in the United States: an analysis of three national databases. Am J Public Health. Dec 1993;83(12):1707-11. [Medline].
Reynolds MG, Holman RC, Curns AT, O'Reilly M, McQuiston JH, Steiner CA. Epidemiology of cat-scratch disease hospitalizations among children in the United States. Pediatr Infect Dis J. Aug 2005;24(8):700-4. [Medline].
Adal KA, Cockerell CJ, Petri WA. Cat scratch disease, bacillary angiomatosis, and other infections due to Rochalimaea. N Engl J Med. May 26 1994;330(21):1509-15. [Medline].
Anbu AT, Foulerton M, McMaster P, Bakalinova D. Basal ganglia involvement in a child with cat-scratch disease. Pediatr Infect Dis J. Oct 2003;22(10):931-2. [Medline].
Anderson BE, Neuman MA. Bartonella spp. as emerging human pathogens. Clin Microbiol Rev. Apr 1997;10(2):203-19. [Medline].
Bass JW, Freitas BC, Freitas AD, et al. Prospective randomized double blind placebo-controlled evaluation of azithromycin for treatment of cat-scratch disease. Pediatr Infect Dis J. Jun 1998;17(6):447-52. [Medline].
Bogue CW, Wise JD, Gray GF. Antibiotic therapy for cat-scratch disease?. JAMA. Aug 11 1989;262(6):813-6. [Medline].
Carithers HA. Cat-scratch disease. An overview based on a study of 1,200 patients. Am J Dis Child. Nov 1985;139(11):1124-33. [Medline].
Carithers HA. Cat-scratch disease; notes on its history. Am J Dis Child. Mar 1970;119(3):200-3. [Medline].
Carithers HA. Diagnosis of cat-scratch disease. Pediatrics. Aug 1985;76(2):325-6. [Medline].
Chomel BB, Kasten RW, Floyd-Hawkins K, et al. Experimental transmission of Bartonella henselae by the cat flea. J Clin Microbiol. Aug 1996;34(8):1952-6. [Medline].
English CK, Wear DJ, Margileth AM, et al. Cat-scratch disease. Isolation and culture of the bacterial agent. JAMA. Mar 4 1988;259(9):1347-52. [Medline].
Gerber MA. Bartonella species (cat-scratch disease, bacillary angiomatosis, bacillary peliosis). In: Long, ed. Principles and Practice of Pediatric Infectious Diseases. 2nd ed. 2003.
Hajjaji N, Hocqueloux L, Kerdraon R, Bret L. Bone infection in cat-scratch disease: A review of the literature. J Infect. Nov 28 2006;[Medline].
Hansmann Y, DeMartino S, Piemont Y, et al. Diagnosis of cat scratch disease with detection of Bartonella henselae by PCR: a study of patients with lymph node enlargement. J Clin Microbiol. Aug 2005;43(8):3800-6. [Medline].
Infectious Diseases and Immunization Committee, Canadian Paediatric Society (CPS. Cat scratch disease: Diagnosis and management. Paediatr Child Health. 1997;2(4):275-8.
Koehler JE, Glaser CA, Tappero JW. Rochalimaea henselae infection. A new zoonosis with the domestic cat as reservoir. JAMA. Feb 16 1994;271(7):531-5. [Medline].
Little S. Cat Scratch Disease. Cat Fancier's Association [Web site]. Available at http://www.cfa.org/articles/health/csd.html.
Margileth AM. Antibiotic therapy for cat-scratch disease: clinical study of therapeutic outcome in 268 patients and a review of the literature. Pediatr Infect Dis J. Jun 1992;11(6):474-8. [Medline].
Regnery RL, Olson JG, Perkins BA, Bibb W. Serological response to "Rochalimaea henselae" antigen in suspected cat-scratch disease. Lancet. Jun 13 1992;339(8807):1443-5. [Medline].
Rolain JM, Lepidi H, Zanaret M, et al. Lymph node biopsy specimens and diagnosis of cat-scratch disease. Emerg Infect Dis. Sep 2006;12(9):1338-44. [Medline].
Tompkins LS. Bartonella Infections, including cat-scratch disease. In: Harrison's Textbook of Medicine. 16th ed. 2006.
Vermeulen MJ, Herremans M, Verbakel H, Bergmans AM, Roord JJ, van Dijken PJ. Serological testing for Bartonella henselae infections in The Netherlands: clinical evaluation of immunofluorescence assay and ELISA. Clin Microbiol Infect. Jun 2007;13(6):627-34. [Medline].
Wear DJ, Margileth AM, Hadfield TL, et al. Cat scratch disease: a bacterial infection. Science. Sep 30 1983;221(4618):1403-5. [Medline].
Weiss EL. Wilderness-acquired zoonoses: cat-scratch disease. In: Wilderness Medicine. 4th ed. 2001:142-148.
Zangwill KM, Hamilton DH, Perkins BA, et al. Cat scratch disease in Connecticut. Epidemiology, risk factors, and evaluation of a new diagnostic test. N Engl J Med. Jul 1 1993;329(1):8-13. [Medline].
Further Reading
Keywords
CSD, cat-scratch disease, Parinaud oculoglandular disease, kitten scratch disease, la maladie des griffes du chat, benign inoculation lymphoreticulosis, benign inoculation reticulosis, catscratch fever, cat-scratch fever, regional granulomatous lymphadenitis, regional lymphadenopathy, regional lymphadenitis, conjunctival granuloma with conjunctivitis, suppurative preauricular adenitis,encephalopathy, erythema thrombocytopenic purpura nodosum, arthritis, synovitis, pneumonia, splenomegaly, pharyngitis, transient truncal maculopapular rash, preauricular adenopathy, encephalitis with seizures, facial nerveparesis,myelitis, neuroretinitis, polyneuritis, radiculitis, optic neuritis withtransient blindness, osteitis, osteomyelitis, hepatomegaly, hepatosplenomegaly with hepatic granulomata, erythema nodosum, erythema marginatum, erythema multiforme, Afipia felis, Afelis, Bartonella henselae, B henselae, Rochalimaea henselae, R henselae
