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Media Gallery

Papulopustular lesions of a primary inoculation site on the hand of a 16-year-old patient. These lesions had been present for approximately 3 weeks. A cat scratch antigen skin test was positive with 15-mm induration. No treatment was administered, and her condition resolved spontaneously in 2.5 months. Courtesy of Andrew Margileth, MD.
A crusted primary inoculation papule on the neck of a 4-year-old child. Note the adjacent lymphadenitis. This patient had contact with cats and had multiple scratches. Courtesy of Andrew Margileth, MD.
This 13-year-old girl developed fatigue and malaise after being licked and scratched by a cat. The typical conjunctival granuloma was accompanied by a parotid mass and intraparotid adenitis. No treatment was administered, and all her signs and symptoms resolved in 3 months. Courtesy of Andrew Margileth, MD.
This 9-year-old boy developed cat scratch disease (CSD) encephalitis and a papular pruritic dermatitis after sustaining cat scratches and developing regional lymphadenitis. He was in a coma for 4 days, but experienced a complete and rapid recovery within 3 weeks. Biopsy of the skin rash revealed nonspecific changes. The CSD antigen skin test result was positive. Courtesy of Andrew Margileth, MD.
This 2.5-year-old boy was recovering from cat scratch disease acquired 10 months before when he developed this neck abscess over a period of 3 weeks. Biopsy revealed caseating granulomas; acid-fast bacillus and Warthin-Starry stain results were negative. Courtesy of Andrew Margileth, MD.
This 10-year-old child had contact with dogs, but not cats. The impressive lymphadenitis had been present for 5 weeks and was not tender. Pathologic examination of a biopsy specimen of the lymph node revealed nonspecific changes. She had a positive cat scratch disease skin test result and negative purified protein derivative skin test results. Treatment with cephalexin was administered with a good response. Complete resolution occurred in 4.5 months. Courtesy of Andrew Margileth, MD.
Warthin-Starry stained sections of lymph node showing chains and clusters of organisms. Courtesy of Andrew Margileth, MD.

of 7

Table 1. Clinical Manifestations of CSD ^[4]

Sign or Symptom	Percentage, %	Average Duration, d
Adenopathy	100	14-180
Adenopathy only	52	14-180
Inoculation site	59-93	7
Fever >101°F (38.3°C)	32-60	6
Malaise/fatigue	29	13
Headache	13	4
Anorexia, weight loss, emesis	14	5
Splenomegaly	12	11
Sore throat	5	2
Rash	5	8.5
Parotid swelling	2	-
Conjunctivitis	4.5	-

Table 2. Clinical Manifestations of Atypical CSD ^{[16, 3]}

Clinical Feature	Margileth, n = 1174, %	Carithers, n = 1200, %
Typical presentation	88.4	95
Inoculation lesion (skin, eye, mucous membrane)	58.6
Unusual presentation	11.6	5
Parinaud oculoglandular syndrome	6.3	4
Encephalopathy	2.3	0.25
Systemic disease, severe, chronic	2
Erythema nodosum	0.6	0.42
Atypical pneumonia	0.2
Breast tumor	0.2
Thrombocytopenic purpura	0.1	0.08

Table 3. Response to Medications

Ciprofloxacin 500 PO bid	Case Report 5 adults	"Dramatic improvement" in a few days; defined as resolution of symptoms (ie, malaise and pain)	Holley^[68]
Gentamicin 5 mg/kg/d IV/IM	Case Report 3 febrile children; 2 with hepatitis, 1 with painful regional lymphadenopathy	Resolution of fever and systemic symptoms in 1-2 days	Bogue et al^[69]
TMP-SMZ 6-8 mg TMP/kg/d PO	Uncontrolled retrospective study 60 patients with prolonged fever and systemic symptoms	58% effective, 7-day course (see above)	Margileth^[48]
Rifampin 10-20 mg/kg/d PO/IV	Uncontrolled retrospective study 60 patients with prolonged fever and systemic symptoms	87% effective, 7- to 14-day course (see above)	Margileth^[65]
Azithromycin 500 mg PO qd for 1 day, then 250 mg PO qd for 4 days	Prospective placebo-controlled, double-blind study 29 patients	80% of lymph node volume (as measured by ultrasonography) resolved in 30 days in 7 of 15 patients on azithromycin vs 1 of 15 control patients	Bass et al^[64]

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Joyce R Drayton, MD Assistant Professor, Department of Internal Medicine, Division of Infectious Disease, Morehouse School of Medicine

Joyce R Drayton, MD is a member of the following medical societies: American College of Preventive Medicine, Alpha Omega Alpha, American College of Physicians, American Holistic Medical Association, Infectious Diseases Society of America, Phi Beta Kappa

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Rajendra Kapila, MD, MBBS † Professor, Department of Medicine, Rutgers New Jersey Medical School

Rajendra Kapila, MD, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, Infectious Diseases Society of New Jersey

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Rose A Ressner, DO Staff, Department of Infectious Diseases, Walter Reed Army Medical Center

Rose A Ressner, DO is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.

Stephen J Nervi, MD Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Stephen J Nervi, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Acknowledgements

Jeffrey Glenn Bowman, MD, MS Consulting Staff, Highfield MRI

Disclosure: Nothing to disclose.

Itzhak Brook, MD, MSc Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases,Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

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Jack A Coleman, MD Consulting Staff, Franklin Surgical Associates

Jack A Coleman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society for Laser Medicine and Surgery, and Association of Military Surgeons of the US

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Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

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Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Allan D Friedman, MD, MPH Chairman, Division of General Pediatrics, VCUH Health System; Professor of Pediatrics, Virginia Commonwealth University

Allan D Friedman, MD, MPH is a member of the following medical societies: American Academy of Pediatrics

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Lynn L Horvath, MD Clinical Assistant Professor of Medicine/Infectious Disease, University of Texas Health Science Center; Consulting Staff, Department of Infectious Disease, Brooke Army Medical Center

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Robert M Kellman, MD Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society

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John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

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Carrie L Kovarik, MD Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

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John M Leedom, MD Professor Emeritus of Medicine, Keck School of Medicine of the University of Southern California

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Kim Lundstrom, MD Consulting Staff, Department of Otolaryngology-Head and Neck Surgery, Longmont Clinic

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Gauri Mankekar, MBBS, MS, DNB, PhD Consultant Otorhinolaryngologist, Department of Otolaryngology, PD Hinduja National Hospital, India

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Jill McKenzie, MD Resident, Division of Dermatology, University of Washington School of Medicine

Jill McKenzie, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and American Medical Association

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Arlen D Meyers, MD, MBA Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

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Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

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Gregory J Raugi, MD, PhD Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

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Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

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Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

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Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael J Wells, MD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Sections Cat Scratch Disease (Cat Scratch Fever)
Overview
Presentation
DDx
Workup
Treatment
Medication
Questions & Answers
Media Gallery
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References

Cat Scratch Disease (Cat Scratch Fever) Questions & Answers

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