BARTONELLA AND CAT SCRATCH DISEASE
THE HUMAN DISEASE
Infection with Bartonella henselae in the immunocompetent person (i.e., a normal person) leads to “cat scratch disease.” The inoculation site (a scratch from a claw containing bits of flea dirt) develops a small red bump (a “papule.”) About 2-3 weeks following contact with the infected cat, the lymph node in the area of the contact will swell and become painful and a fever develops. These signs generally resolve on their own and the condition is minor.
If the patient does not have a competent immune system (in other words, they are very old, very young, debilitate from another condition etc.), one of several much more serious syndromes can result. The infection goes deeper into the body causing spleen enlargement, and potentially encephalitis, heart valve infection, and other conditions. These syndromes are still rare even in people who are immunocompetent.
For more detail on the Cat Scratch Disease in humans we recommend:
HOW LIKELY IS IT FOR A CAT TO BE INFECTED?
Since fleas carry the bacteria, cats with insufficient flea control are at highest risk. This means cats living in climates that are warm and humid (conditions where fleas thrive best) are most likely to be infected. If conditions are right, up to 40% of cats in an area may be infected. If a person is diagnosed with cat scratch disease, there is a 90% chance that the cats they own will be found infected as well.
This sounds somewhat concerning for the cat-owners in a flea area but it is important to realize that an infected cat cannot transmit the infection without a claw full of flea dirt. If the fleas are removed from the infected cat, there will be no flea dirt in the coat and no risk of disease transmission.
DO INFECTED CATS GET SICK?
This is a highly controversial question. It was only relatively recently discovered (1992) that cats themselves were more than simple carriers of Bartonella henselae and that they could actually become infected themselves. Several illnesses seem to have been associated with Bartonella infection (fever, deep eye inflammation, lymph node enlargement, muscle pain, reproductive failure, and bacterial heart valve deposits called “endocarditis.”)
There is some evidence that Bartonella henselae infection may be one cause of the progressive oral disease of the cat called Plasma Cell Stomatitis though this remains controversial. It seems that cats co-infected with Bartonella henselae and the Feline Immunodeficiency Virus have an increased incidence of Plasma Cell Stomatitis compared to what would be expected from either infection alone.
Further, many cats with Plasma Cell Stomatitis test strongly positive for Bartonella henselae though this may simply reflect a high incidence of exposure in the community. Some cats show tremendous improvement in their oral disease with antibiotics focused on eradication of Bartonella; however, since secondary infections are common with Plasma Cell Stomatitis, antibiotic response is not surprising. The jury is still out and the controversy rages on, but there is certainly nothing harmful in treating a cat with Plasma Cell Stomatitis for Bartonella; lasting results have been reported in some individuals.
It has been suggested that Bartonella infection may be at the root of numerous chronic inflammatory conditions of the cat. With such high numbers of infected cats present regionally (up to 40%), it is going to be difficult to prove one way or the other whether there is a real association or just coincidence.
CAN DOGS GET INFECTED?
IS MY CAT INFECTED?
There are 5 tests available to detect Bartonella henselae: ELISA, IFA, PCR, Culture, and Western Blot. All the tests have pros and cons and no method seems to shine above the others.
The ELISA, IFA, and Western Blot tests are tests for antibody detection, the idea being that if antibodies against Bartonella are there then Bartonella must be there as well. For most diseases where antibody levels are used to establish a diagnosis, a mimimum “titer” or antibody amount is considered necessary to say “yes, this patient is infected.” The problems for Bartonella is that no such guidelines have been established. Making matters worse, we know that up to 11% of cats with Bartonella organisms happily circulating in their bloodstreams will not make antibodies and will thus test negative. At least this means that when the test is negative there is an 89% or greater chance that the cat is truly negative.
The most reliable test is the blood culture; however, several consecutive cultures are needed as the organism tends to only circulate intermittently. A positive culture is proof of infection though a negative culture may simply not have been taken at the time when organism is circulating.
PCR is a very sensitive DNA test for the presence of Bartonella DNA but because the organism only intermittently circulates, this may not offer much advantage over culture (except that results can be obtained slightly sooner).
In humans, a delayed hypersensitivity skin test is used as part of the diagnostic criteria for Cat Scratch Disease but this test has not been useful in cats. In this test, similar to the Tuberculosis test most of us are familiar with, a scratch on the skin is made and a reaction to the introduced antigens may occur either right away or in approximately 48 hours (delayed hypersensitivity reaction). Cats are poor delayed hypersensitivity responders.
TREATMENT OF THE CAT
An assortment of antibiotics have been used against Bartonella henselae in cats: amoxicillin, doxycycline, enrofloxacin, pradofloxacin and probably others. Efficacy has been mixed and Bartonella henselae rapidly becomes resistant to therapy.Treatment is currently recommended for cats showing symptoms of disease; if the goal is to reduce potential for human infection, this is best accomplished with flea control. Studies are on-going to determine which antibiotic is best for sick cats. It appears concurrent use of at least two antibiotics is associated with the best chance of fully eliminating infection. Presently doxycycline with pradofloxacin adding in a week or so later is favored. Treatment lasts a minimum of 4-6 weeks.
PREVENTION OF HUMAN INFECTION:
Prevention of Exposure
Prevention of Disease
Page last updated: 5/27/2018