If you have a pet cat at home, be wary of cat scratch disease
Cat Scratch Disease 3 Causes
1. Low autoimmunity. Menstruating women, cold patients, allergic patients, pregnant women, and patients with low immunity are more likely to be infected with Bartonella henselae and cause cat scratch disease.
2. The skin is damaged. When people with damaged skin are in close contact with cats, pathogens may enter the body through the wound and cause infection.
3. The hygiene of the cat is not good. If the cat owner does not bathe and deworm the cat regularly, there will be various parasites and fleas on the cat. Humans can develop cat scratch disease after coming into contact with cats.
There are 3 typical symptoms
The incubation period of cat scratch disease is generally 2 to 14 days, and the clinical manifestations are various, and the severity mainly depends on the immune status of the host. In most cases the disease resolves spontaneously within 2 to 4 weeks, but more severe disseminated disease may also occur. Among them, the typical symptoms of cat scratch disease are:
1. Local symptoms. 3 to 7 days after the patient was scratched or bitten, primary skin lesions appeared, manifested as erythematous papules, with no significant pain. The surrounding skin lesions leave short-term pigmentation or scabs and heal.
2. Lymph node symptoms. Four weeks after the patient was scratched or bitten, swollen lymph nodes appeared in the proximal part of the injured site, which was common in the head and neck, armpits, and groin. The disease usually subsides by itself in 2 to 4 months, and a few can last for several months.
3. Systemic symptoms. About 50% of patients have low-grade fever, rarely exceeding 39°C, accompanied by headache, chills, general malaise, fatigue, anorexia, nausea, and vomiting.
In addition, atypical cat scratch disease manifestations were found clinically, and 5% to 13% of patients had special and severe clinical manifestations. Among them, liver and spleen type: the clinical manifestations are ultrahigh (>40°C), general malaise and anorexia, elevated liver enzymes, and multiple hypoechoic and low-density areas on the liver and/or spleen can be seen on abdominal ultrasound or CT. Cerebral type: the incidence rate is low, manifested as encephalitis, meningitis, myelitis, etc. Eye disease type: the main manifestations are conjunctivitis, uveitis, choroiditis and so on.
Diagnosis requires 5 inspections
1. Pathogen culture. Bartonella henselae can be isolated and cultured from the patient’s blood, lymph node pus, and primary skin lesions, but the bacterium has complex nutritional requirements and takes a long time to culture, so routine culture is difficult.
2. PCR detection. It is used to detect Bartonella infection, but there is a possibility of laboratory contamination.
3. Serological testing. The indirect immunofluorescent antibody test uses fluorescein-labeled antigen to detect the specific antibody of Bartonella henselae in the patient’s serum, and its titer ≥ 1:64 is positive. Although specificity is high, sensitivity is lacking. Anti-B. henselae IgM antibody was detected by enzyme-linked immunosorbent assay, and its titer ≥ 1:15 was positive.
4. Pathological examination of lymph nodes. Typical manifestations are the formation of small inflammatory granulomatous abscesses, and specific pathogenic bacteria are found by saturated silver staining. However, lymph node pathology lacks typicality.
5. High-throughput gene sequencing technology (NGS). Traditional methods are difficult to diagnose the disease. With the continuous development of molecular detection technology, next-generation NGS sequencing has been widely used in clinical practice. NGS sequencing of lymph node pus can quickly isolate Bartonella henselae nucleic acid. When some traditional detection methods cannot identify pathogens and new or rare pathogen infections, NGS is more superior than traditional methods. However, the cost of this examination is relatively high, which needs to be considered in consideration of the patient’s economic situation.
symptomatic treatment is important
Cat scratch disease is a self-limiting disease, and for patients with mild symptoms, only symptomatic treatment is enough. Severely ill patients and patients with atypical cat scratch disease should be treated with sensitive antibiotics, which can improve the prognosis, shorten the course of the disease, and reduce sequelae. For patients with long-term enlarged lymph nodes and suppurative lymph nodes, surgical treatment can be used.
1. Symptomatic and local treatment. For patients with fever, antipyretic drugs can be taken orally, or physical cooling methods such as alcohol wipes or cold compresses can be used, and the skin of scratches or bites should be debrided and disinfected.
2. Drug treatment. If the wound infection is aggravated after being scratched or bitten by a cat, antibiotic treatment can be considered. Aminoglycosides, ciprofloxacin, rifampicin, doxycycline, azithromycin, etc. are often used, and they can also be used in combination. Course of treatment: 2 weeks for those with normal immunity, at least 6 weeks for those with compromised immunity.
3. Surgical treatment. If the lymph nodes are red, swollen, hot and painful, and purulent changes appear, local lymph node puncture and drainage, dressing change, and surgical resection may be considered.
It should be noted that the following symptoms should be treated urgently after being scratched or bitten by a cat: symptoms that do not subside for a long time or even worsen; reddened areas appear to expand; high fever for more than 2 consecutive days; severe pain.
Essential for daily care
Cat scratch disease is a self-limiting disease with a generally good prognosis. For people with normal immunity, they can generally recover within half a year without serious sequelae. If the patient is immunocompromised, severe infection can lead to death if not aggressively treated with antibiotics. After starting treatment, patients need regular weekly follow-up visits. If adverse reactions occur during treatment, seek medical attention in time.
For patients with cat scratch disease, it is necessary to ensure a balanced diet and a reasonable combination. After dietary adjustment, the patient’s physical recovery can be promoted and immunity can be improved. Patients should implement a light diet to ensure the daily protein, vitamins and other easily digestible foods, and avoid stimulating and spicy foods. Patients should mainly eat semi-liquid food, reduce chewing as much as possible, avoid eating hot, cold and acidic food, and ensure oral hygiene is in place, and insist on gargling after meals. Patients are suitable to eat fruits and vegetables with high fiber content such as mustard greens, cabbage, kelp, and seaweed. They should not eat peppers, raw garlic, white wine, abalone, clams, shrimp, and crabs. In addition, smoking and alcohol are prohibited.
In addition, patients need to actively cooperate with medical staff for treatment, understand the basic knowledge of cat scratch disease, treatment plans, daily precautions, etc. through the explanation and introduction of medical staff, and follow the doctor’s instructions. Nursing staff should patiently guide and comfort patients, strengthen nurse-patient communication, understand whether patients have signs of lymphadenopathy, cooperate with doctors to carry out early diagnosis work, and cooperate with family members to effectively reduce patient anxiety and build self-confidence, which can Relieve negative emotions of patients by listening to music, watching movies, playing games, etc.
For patients with severe diseases such as encephalitis and immunodeficiency, combined treatment with two antimicrobial drugs is required, and patients must be prescribed medication according to the doctor’s advice; if the condition worsens, they should go to the hospital for treatment in time to avoid delaying the condition. In view of the primary skin lesions that many patients will experience, including impetigo, urticaria, and erythema nodosum, etc., are common on the lower legs and arms, and last for about 2 to 3 weeks. Change clothing and bed linen to prevent pollutants from impregnating the skin. If the patient has severe local skin damage and infection, a new type of dressing should be used.
Most cat scratch disease patients are caused by animal bites and scratches, so it is necessary to start with the prevention of the cause and develop good living habits in life. If the physique is poor and the immunity is low, you should avoid keeping pets. For cat owners, it is necessary to avoid being scratched by cats, and to take good protection when bathing cats. Cats should also be vaccinated regularly and dewormed in vivo and in vitro. Avoid irritating, teasing animals, and avoid being scratched or bitten. If you are accidentally scratched by cats and other animals, you need to seek medical advice in time.