Cat scratch disease: What to do with the cat?

Area of Science:

• Ophthalmology
• Infectious Diseases
• Veterinary Medicine

Background:

• Cat scratch disease (CSD), caused by Bartonella henselae, often presents with ocular manifestations like neuroretinitis.
• Ophthalmologists frequently encounter CSD but lack clear guidelines for managing the associated pet-related risks.
• Published recommendations are often insufficient for complex real-life situations involving patient-pet interactions.

Observation:

• A 10-year-old boy with CSD developed neuroretinitis, including optic nerve edema and a macular star.
• The patient's family had recently adopted kittens, and the boy and his sister had been scratched.
• This case highlights the dilemma faced by physicians and families regarding pet management after a CSD diagnosis.

Findings:

• Bartonella henselae is present in various mammals and can be transmitted by fleas, even from asymptomatic animals.
• Infection risk depends on bacterial factors and host immunity; the very young and immunocompromised are at higher risk.
• Veterinary recommendations include serological and PCR testing, with treatment using doxycycline and quinolones for infected animals.

Implications:

• Ophthalmologists should be prepared to discuss Bartonella transmission risk reduction strategies with CSD patients.
• Effective pet management involves veterinary consultation, flea control, and potential animal testing and treatment.
• Adopting a One Health approach is crucial for managing zoonotic diseases like CSD effectively.