Dealing with Cat Scratch Disease

While there have been advances in understanding Cat Scratch Disease (CSD), relatively little is still known about how medical doctors diagnose, treat and prevent it.

The main etiological agent of this bacterial infection is Bartonella henselae but other species of the same gender have been also recognized. They are transmitted by fleas to cats, which spread it to humans via scratches or bites.

This study, conducted in the USA, set out national patterns of clinician-diagnosed CSD and assessed medical doctors’ knowledge of current clinical guidelines. It is based on a national survey containing questions about the disease, which was carried out in 2014 and 2015 and considered responses from more than 3,000 primary care providers.

The number of diagnoses differed by region and was largely correlated with previous studies and the zoonotic epidemiology of CSD. When responding to questions about uncomplicated CSD treatments, the majority of respondents (71.4%) selected antibiotics; 13.4% chose lymph node aspiration and the remainder preferred analgesics and monitoring. These results highlight a difference between what the current clinical guidelines for treating the disease recommend and what medical doctors recommend. Antibiotics are not recommended for immunocompetent individuals with uncomplicated CSD, for instance, as this could increase antibiotic resistance without any proven benefit. Lymph nodes aspiration can lead to infection and fistula formation so the clinical guidelines state that it should only be used as symptom relief in cases where there are suppurative nodes or when there are doubts about the diagnosis.

Differences were also noted between clinicians in different speciality areas: family practitioners were more likely to prescribe antibiotics; internists were more likely to select aspiration and paediatricians were likely to recommend analgesics.

This investigation, described in detail in the full article, emphasizes the need for education and enhanced resources to raise awareness of the current clinical guidelines to raise standards in the treatment of CSD.

Nelson CA, Moore AR, Perea AE, Mead PS. Cat scratch disease: U.S. Clinicians’ experience and knowledge. Zoonoses Public Health. 2017;1–7.DOI: 10.1111/zph.12368