Cat scratch disease is a mild to sometimes serious infection that people get after a scratch, bite, or lick from a cat that carries a bacteria called Bartonella henselae. It mainly causes swollen, painful lymph nodes (the small “glands” that filter germs) near the place where the scratch happened. Most healthy people get better on their own, but some people, especially those with weak immune systems, can become quite sick. NCBI+2PubMed+2
Cat scratch disease (CSD) is an infection you can get after close contact with a cat, usually a kitten. The germ that causes it is a small bacteria called Bartonella henselae. The germ lives in cats, especially in cats that have fleas. Fleas carry the bacteria in their poop. When cats scratch themselves, the flea dirt can get under their claws. When a cat then scratches or bites a person, or licks an open wound, the bacteria can enter the skin. CDC+2CDC+2
After a few days to weeks, a small red bump or blister appears where the scratch or bite happened. This is called the “inoculation site.” Later, the lymph nodes that drain that area (for example, under the arm if the scratch is on the hand) become swollen, firm, and sometimes painful. People may also have fever, feel tired, or have headache and poor appetite. In most healthy people, the illness is mild and goes away by itself in a few weeks to months, but in some cases it can spread to the eyes, liver, spleen, brain, bones, or lungs and become more serious. SA Health+3Infectious Diseases Society of America+3NCBI+3
Other names
Cat scratch disease is known by several other names in medical writing and in everyday language:
Cat scratch fever – a common name used by patients and in public health leaflets. Cleveland Clinic+1
Bartonella henselae infection – a more technical name that focuses on the germ that causes the disease. NCBI+1
Bartonellosis due to Bartonella henselae – “Bartonellosis” is a group name for diseases caused by Bartonella bacteria; CSD is the most common type. NCBI+1
Inoculation lymphoreticulosis – an older term that means “lymph node and immune tissue disease starting after a germ enters through the skin.” It is rarely used now but may still appear in older books. Wikipedia
All of these names are talking about the same basic illness: swollen lymph nodes and fever after a cat scratch, bite, or lick that passes Bartonella henselae into the body.
Types of cat scratch disease
Doctors often think about CSD in different “types” or patterns, even though the same germ causes them all. These types help doctors guess how severe the illness is and what organs are involved. NCBI+2DynaMed+2
Classic (typical) cat scratch disease
This is the most common type. A person gets a scratch or bite, then a small red bump or blister appears at that spot. After 1–3 weeks, one or more nearby lymph nodes become swollen and tender. The person may have mild fever and feel unwell, but usually recovers on their own.Atypical or disseminated cat scratch disease
In this pattern, the infection spreads beyond one group of lymph nodes. It can affect several lymph node areas or other organs such as the liver, spleen, bones, or lungs. People may be more sick, with high fever, weight loss, and night sweats. This type is more common in people with weak immune systems.Ocular (eye) cat scratch disease – Parinaud oculoglandular syndrome
Here, the infection affects the eye and the lymph nodes in front of the ear. The person may have a red, painful eye, tearing, and sensitivity to light, along with swollen nodes near the ear. This usually follows a scratch near the eye or rubbing the eye after touching a cat.Neurologic cat scratch disease
In rare cases, the infection affects the brain or nerves. People may develop confusion, seizures, headache, or movement problems. This is called CSD encephalopathy (brain inflammation) or other neurologic forms.Hepatosplenic cat scratch disease
In some patients, especially children, the liver and spleen develop small infected spots called granulomas or abscesses. These people can have long-lasting fever and abdominal pain, and imaging like ultrasound or CT shows lesions in liver or spleen.Cat scratch disease in immunocompromised patients
People with HIV, cancer, transplant, or strong immune-suppressing drugs can get more severe disease. They may develop widespread infection, large abscesses, or bacillary angiomatosis, a condition with red skin bumps full of blood vessels. NCBI+1
Causes
Strictly speaking, CSD has one direct cause: infection with Bartonella henselae. But there are many risk factors and situations that make infection more likely. Each of the following “causes” explains a way the bacteria can enter the body or a condition that raises the chance of disease. Boston.gov+3CDC+3CDC+3
Scratch from an infected cat
The main cause is a scratch from a cat that carries Bartonella henselae. The bacteria live in the cat’s blood and under its claws. When the cat scratches, the germ can be pushed into the person’s skin through a small cut.Bite from an infected cat
A bite from a cat with Bartonella can also inject the bacteria deep into the skin or soft tissue. Bites often break the skin more deeply than scratches, so they can carry the germs further inside.Lick from a cat on broken skin
If a cat licks an open wound, fresh scratch, or chapped skin, its saliva may contain Bartonella. The bacteria can then slowly enter the body through the damaged skin surface.Contact with kittens (young cats)
Kittens are more likely than adult cats to carry Bartonella henselae and to scratch or bite during play. People who often play roughly with kittens have a higher risk of CSD. CDC+2Hawaii Department of Health+2Exposure to flea-infested cats
Cats get infected mainly through bites from cat fleas. When fleas feed on the cat’s blood, they shed bacteria in their droppings (“flea dirt”). These droppings collect in the cat’s fur and under the claws and can then reach humans during a scratch.Living with many cats (crowding)
Households, shelters, or farms with many cats together often have higher flea levels and more chance for Bartonella to spread between cats. This increases the risk that at least one cat will infect humans.Stray or feral cat contact
Stray and feral cats often have more fleas and less healthcare. They are more likely to carry Bartonella and more likely to scratch defensively, increasing infection risk.Rough play with cats
Activities like wrestling with cats, letting them climb on bare arms, or teasing them increase the chance of scratches and bites. More breaks in the skin mean more chance for bacteria to enter.Not cleaning scratches and bites quickly
If a person does not wash a scratch or bite right away with soap and water, bacteria have more time to settle into the skin and multiply. Quick cleaning can flush many germs away.Weakened immune system (immunosuppression)
People with HIV, cancer, diabetes, organ transplants, or those on strong steroids or chemotherapy have weaker defenses against germs. They are not only more likely to develop CSD but also more likely to develop severe or unusual forms. NCBI+2DynaMed+2Young age (children and teenagers)
Many cases occur in children under 15 years because they are more likely to play closely with cats, especially kittens, and may not always clean small wounds promptly. CDC+1Seasonal patterns (late summer, fall, winter)
Some public health reports show more CSD cases in late summer, fall, and early winter. This may reflect flea patterns and more time spent with pets indoors. DC Health+1Lack of flea control on cats
Cats without regular flea prevention have more fleas, which means more circulation of Bartonella among cats and more contamination of claws with flea droppings.Sleeping with cats in the bed
When cats sleep close to people, especially children, there is more chance they will scratch during the night or lick small wounds without being noticed.Handling cats with skin disease or heavy scratching
Cats that scratch themselves a lot, for example due to fleas or allergies, may have more flea dirt and Bartonella on their claws and fur. Handling them roughly can increase human exposure.Cat fights and bite wounds in cats
Cats can pass Bartonella to each other during fights and bites. Owning a cat that often fights with other cats may make that cat more likely to carry the bacteria. Virginia Department of Health+1Not trimming cat claws
Long, sharp claws can cause deeper and more damaging scratches than short claws. Deeper scratches may carry more bacteria and are harder to clean.Poor hand hygiene after handling cats
Touching a cat and then rubbing eyes or touching broken skin without washing hands can move bacteria from the fur or claws into sensitive areas.Possible arthropod (flea or tick) transmission to humans
Some research suggests that arthropods like cat fleas or ticks might rarely pass Bartonella directly to humans, although this is not firmly proven. Still, heavy exposure to fleas and ticks is considered a possible risk. CDC+2Boston.gov+2Delay in seeking medical care for unusual symptoms
If a person has long-lasting fever and swollen lymph nodes after a cat scratch but does not see a doctor, the infection has more time to spread to other organs before treatment is started.
Symptoms of cat scratch disease
Symptoms can vary from very mild to severe. Most people have a mixture of local (near the scratch) and general (whole-body) symptoms. SA Health+3NCBI+3Cleveland Clinic+3
Skin bump or blister at the scratch or bite site
Within 3–10 days after the scratch or bite, a small red bump, blister, or pimple appears at that place. It may be slightly itchy or tender. This is where the bacteria entered the body.Redness around the wound
The skin around the scratch can be red and mildly swollen. This is the local reaction as the immune system begins to fight the germ. Usually it is not as severe as cellulitis from more aggressive bacteria.Swollen lymph nodes near the scratch
One or more lymph nodes near the scratch (for example, under the arm after a hand scratch, in the groin after a leg scratch, or in the neck after a face scratch) become enlarged and firm. This is the hallmark sign of CSD. The swelling often appears 1–3 weeks after the initial skin lesion.Tender or painful lymph nodes
The swollen nodes can be painful when touched or when the person moves the nearby joint. Sometimes the skin over the node becomes red and warm. In about 10% of cases, pus forms inside and the node can soften and drain. Infectious Diseases Society of America+1Fever
Many people have a fever, which can be low-grade or moderate. The fever reflects the body’s attempt to kill the bacteria. Fever may last for days or sometimes weeks in more severe cases.Fatigue and feeling unwell
People often feel very tired, weak, and “not themselves.” This general tired feeling is common in infections where the immune system is very active.Headache
Headache is a common nonspecific symptom in CSD. It may be mild or moderate and often goes along with fever and fatigue.Poor appetite and mild weight loss
Many patients do not feel like eating and may lose some weight if symptoms last many weeks. Children may seem “picky” or eat less than usual.Muscle aches and joint pains
Some people complain of sore muscles or aching joints near the affected limb or all over the body. This is part of the immune response to the infection.Abdominal pain
In cases where the liver and spleen are affected, people may feel pain or discomfort in the upper abdomen, especially on the right side (liver) or left side (spleen). Imaging may then show small lesions in these organs. NCBI+1Eye redness and pain (ocular CSD)
When the infection involves the eye, the person can have a red, painful eye, tearing, and sensitivity to light. Swollen lymph nodes in front of the ear often appear at the same time.Vision changes
Rarely, CSD can cause inflammation at the back of the eye (retina and choroid). People may notice blurred vision, dark spots, or reduced sight in one eye.Prolonged, unexplained fever
In some children and adults, CSD presents mainly as a long-lasting fever with few other signs. Only careful history about cat exposure and imaging of the liver and spleen reveal the cause.Neurologic symptoms (encephalopathy, seizures)
A small fraction of patients develop brain involvement. They may become confused, very irritable, or may have seizures. This is a serious complication and needs urgent care in a hospital. NCBI+1Rash or skin lesions beyond the original scratch
Some people develop extra skin lesions or a more widespread rash. In immunocompromised people, Bartonella infection can cause raised red or purple bumps on the skin, called bacillary angiomatosis, which bleed easily. NCBI
Diagnostic tests
Doctors use a mix of careful history, physical exam, and selected tests to diagnose cat scratch disease. They will ask about cat contact, the timing of symptoms, and other illnesses. There is no single test that is perfect, but together these tests help confirm the diagnosis and rule out other causes of swollen lymph nodes or fever. DynaMed+3NCBI+3PubMed+3
A. Physical examination tests
General physical examination
The doctor checks the whole body, looking for fever, overall appearance, weight loss, and other signs of illness. They also check skin, eyes, mouth, chest, abdomen, and nervous system. In CSD, the person often looks fairly well except for fever and swollen lymph nodes, which helps distinguish it from very serious infections like sepsis or advanced cancer.Inspection of the scratch or bite site
The doctor carefully looks at the area where the cat scratch, bite, or lick happened. A small red bump, blister, or crusted sore at that place supports the diagnosis of CSD. The doctor looks for signs of other severe skin infections, such as spreading redness or pus, to rule out cellulitis or abscesses caused by different bacteria.Palpation (feeling) of lymph nodes
The doctor uses their fingers to feel lymph nodes in the neck, under the jaw, above the collarbones, under the arms, and in the groin. In CSD, they often find one or a few enlarged, firm, tender nodes near the scratch. The texture, size, and number of nodes help tell CSD apart from lymphoma, tuberculosis, and other diseases. OUP Academic+1Vital signs check (temperature, pulse, breathing, blood pressure)
Checking vital signs shows how sick the person is. A mild to moderate fever with normal blood pressure and breathing is common in simple CSD. Very high fever, fast breathing, or low blood pressure may suggest a more serious infection or another diagnosis.Eye and neurologic examination
If the person has eye symptoms (redness, pain, vision changes) or neurologic signs (headache, confusion, seizures), the doctor examines the eyes with a light and checks reflexes, strength, and sensation. Abnormal findings can point to ocular CSD or brain involvement and may lead to imaging or referral to an eye doctor or neurologist.
B. Manual tests (bedside maneuvers without machines)
Detailed lymph node mapping and size measurement
The doctor may gently measure the size of the largest lymph node using their fingers or a small ruler. They note whether nodes are mobile or fixed, soft or hard, and whether there is fluctuation (feeling of fluid inside). In CSD, nodes are usually firm and tender and can reach several centimeters in size but remain somewhat mobile.Abdominal palpation for liver and spleen enlargement
With the patient lying down, the doctor feels the abdomen for enlarged liver (hepatomegaly) or spleen (splenomegaly). In hepatosplenic CSD, these organs can be bigger and sometimes tender. This simple manual exam may prompt further imaging like ultrasound. NCBI+1Range-of-motion testing of joints near swollen nodes
When lymph nodes near a joint (such as the elbow or knee) are swollen, movement of that joint can be painful. The doctor gently moves the joint to see if pain is coming from the joint itself or from the swollen node, helping to rule out arthritis or joint infection.Simple visual acuity test
If the eyes may be involved, the doctor asks the patient to read a chart or simple text at a distance. Any drop in vision, especially in one eye, can suggest retinal or optic nerve involvement and indicates the need for an eye specialist and possible imaging or blood tests.Basic neurologic bedside tests
The doctor can perform simple tests at the bedside, such as asking the person to follow a finger with their eyes, squeeze hands, push with their feet, stand and walk, and check reflexes. Abnormal results may point to brain or nerve involvement from CSD or another cause, guiding decisions about EEG or MRI.
C. Laboratory and pathological tests
Complete blood count (CBC)
A CBC is a blood test that measures white blood cells, red blood cells, and platelets. In CSD, the white cell count can be normal or mildly raised. This test helps rule out blood cancers, severe bacterial infections, or other conditions where counts are very abnormal. NCBI+1Inflammatory markers (ESR and CRP)
The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) measure inflammation in the body. In CSD, these markers are often mildly to moderately raised. Very high levels may suggest a more serious or different disease, such as lymphoma, abscess, or autoimmune disease. DergiParkBartonella henselae serology (antibody tests)
This is one of the key tests for CSD. A blood sample is tested for antibodies (IgG and sometimes IgM) against Bartonella henselae, often by indirect immunofluorescence assay (IFA) or enzyme-linked immunosorbent assay (ELISA). A high or rising antibody level supports the diagnosis, especially when the history and exam fit CSD. NCBI+2Medscape+2Bartonella henselae PCR (polymerase chain reaction)
PCR looks for the actual genetic material (DNA) of Bartonella henselae in samples such as blood, lymph node tissue, or fluids. It is a very specific test but may not always be positive. When available, a positive PCR from a lymph node biopsy or blood sample strongly confirms the diagnosis. NCBI+1Lymph node biopsy and histopathology
In unclear or severe cases, a small piece of the enlarged lymph node is removed and examined under a microscope. In CSD, the pathologist often sees granulomas (small clusters of immune cells) and areas of necrosis (dead tissue), sometimes with tiny clumps of bacteria. Special stains or PCR can help show Bartonella in the tissue. This test also rules out lymphoma, tuberculosis, and other serious diseases. OUP Academic+2ScienceDirect+2Blood cultures
Blood cultures look for bacteria in the bloodstream. In classic CSD, blood cultures are usually negative because Bartonella henselae is hard to grow and often not present in high numbers. However, in very sick or immunocompromised patients, blood cultures may help exclude other bloodstream infections and sometimes detect Bartonella in special labs.Liver function tests
When the liver is involved, blood tests such as ALT, AST, and alkaline phosphatase may be mildly elevated. These tests are not specific for CSD but help show that the liver is under stress and support the need for imaging studies. NCBI
D. Electrodiagnostic tests
Electroencephalogram (EEG)
An EEG records the electrical activity of the brain through small electrodes placed on the scalp. In CSD encephalopathy, EEG may show abnormal slow waves or seizure activity. This test helps confirm that neurologic symptoms are coming from brain irritation and guides treatment for seizures or brain inflammation. NCBI+1Electromyography (EMG) and nerve conduction studies
In very rare cases where nerves or muscles may be affected, doctors may order EMG and nerve conduction tests. Tiny needles and surface electrodes measure how nerves send signals to muscles. Abnormal results might show that nerves are inflamed or damaged, helping rule out other nerve diseases and guiding supportive care.
E. Imaging tests
Ultrasound of lymph nodes
Ultrasound uses sound waves to create images of structures under the skin. It is very helpful for evaluating enlarged lymph nodes. In CSD, lymph nodes may look enlarged with some internal changes but often keep a normal overall shape. Ultrasound can also guide needle aspiration if pus needs to be drained or tissue needs to be sampled. ScienceDirect+1Abdominal ultrasound (liver and spleen)
When people have long-lasting fever or abdominal pain, ultrasound of the abdomen can show small spots or lesions in the liver or spleen caused by CSD. This helps distinguish CSD from other causes of fever of unknown origin and guides whether antibiotics or other treatments are needed. NCBI+1CT scan (computed tomography)
A CT scan uses X-rays and computer processing to create detailed cross-section images of the body. CT can show enlarged lymph nodes deep in the chest or abdomen and reveal liver or spleen lesions. It is especially useful when ultrasound is unclear or when doctors suspect serious internal disease.MRI (magnetic resonance imaging) of brain or spine
When neurologic symptoms are present, MRI can show brain or spinal cord inflammation, swelling, or lesions related to CSD. This helps confirm neurologic involvement and rule out tumors, stroke, or other infections. MRI is more sensitive than CT for brain changes. NCBI+1Chest X-ray
A simple chest X-ray can show enlarged lymph nodes in the chest, lung spots, or other problems. While not specific for CSD, an abnormal chest X-ray can point to complications or to alternative diagnoses like tuberculosis, pneumonia, or cancer. This helps place CSD in the full picture of the person’s health.
Non-pharmacological (non-drug) treatments for cat scratch disease (20)
These measures help comfort, support the immune system, and reduce the risk of complications. They do not replace antibiotics when your doctor decides antibiotics are needed.
1. Rest and energy conservation
Rest allows your body to focus energy on fighting the infection. Cat scratch disease (CSD) is usually self-limited, and in many healthy people the lymph nodes get better over weeks to months without specific drug therapy. When you rest, your heart rate, breathing, and stress hormones go down. This helps immune cells work more efficiently and reach infected lymph nodes. Good rest means going to bed early, taking short daytime naps if you are tired, and avoiding heavy exercise while you have fever or strong pain. Rest does not kill bacteria directly, but it helps your immune system clear Bartonella more effectively.
2. Local warm compresses on swollen lymph nodes
Warm, moist cloths placed gently over the painful lymph node can ease discomfort and may improve blood flow. Increased blood flow can bring more white blood cells and antibodies to the infected area, which may help the body control the infection more quickly. Warm compresses also relax the surrounding muscles and skin, lowering pain. Use a clean cloth, soak it in warm (not hot) water, wring it out, and hold it over the node for 10–15 minutes, several times a day. Stop if skin gets too red or irritated. This is supportive care and does not replace medical treatment if nodes are very large, red, or draining pus.
3. Gentle cool compresses for severe tenderness
Sometimes nodes are extremely tender and warm compresses feel worse. In this case, short periods of cool compresses can help numb the area and reduce local inflammation. The mild cold slows nerve signals from the skin, so you feel less pain. It also temporarily shrinks small blood vessels, which can reduce swelling for a short time. Wrap a cold pack or ice in a cloth; never place it directly on the skin, and use it for only 10–15 minutes at a time. Cool compresses are especially useful while waiting for pain medicine or antibiotics to start working.
4. Elevation of the affected limb
If the scratch and swollen nodes are in an arm or leg, keeping that limb slightly elevated on a pillow can help reduce swelling and throbbing. Elevation helps fluid and inflammatory cells flow back towards the heart instead of pooling around the infected lymph node. This simple physical step supports the body’s natural drainage systems (lymphatic and venous return). It is especially useful at night or during long periods of sitting. Elevation does not cure the infection but can make symptoms more tolerable.
5. Gentle lymph node protection (avoiding pressure and trauma)
Pressing, squeezing, or repeatedly touching swollen lymph nodes can increase pain and may irritate the tissue. It can also slightly damage small vessels and worsen swelling. Keeping tight clothing, straps, or bags away from the area helps. For example, if the armpit nodes are swollen, avoid tight bras or heavy shoulder bags on that side. Protecting the node allows internal healing and reduces the risk of the node breaking down and forming pus (suppuration), which occurs in about 10% of cases.
6. Local wound care of the scratch or bite
Good skin hygiene at the original scratch site may lower bacterial load and reduce risk of added skin infection. As soon as possible after a scratch or bite, wash the area with mild soap and running water for several minutes. You can use a simple antiseptic solution if advised by your doctor. For CSD, the main infection is inside the lymph nodes, but clean skin helps prevent extra bacteria (like Staphylococcus aureus) from causing secondary cellulitis. Do not use harsh chemicals or strong alcohol that burn the skin; they do not improve healing and can slow repair.
7. Adequate hydration
Fever and reduced appetite are common in CSD and can quickly lead to mild dehydration, especially in children. Drinking enough water, oral rehydration solution, or clear fluids keeps blood volume normal and helps the kidneys remove waste products from the infection and from medicines. Hydration also maintains good mucus barriers in the mouth and throat, which are part of the immune defense. Aim for pale-yellow urine as a simple sign of good hydration. For children or people who are vomiting, your doctor may suggest small, frequent sips.
8. Balanced, nutrient-rich diet
While no specific “cat scratch disease diet” exists, a diet rich in fruits, vegetables, lean protein, and whole grains supports the immune system with vitamins, minerals, and amino acids needed to make antibodies and repair tissue. Deficiencies of nutrients such as vitamin C, vitamin D, or zinc are linked with poorer immune responses to infections. Eating soft, easy-to-digest foods when you have fever or fatigue can make it easier to maintain calorie intake and prevent weight loss during illness.
9. Simple pain-relief techniques (relaxation, breathing, distraction)
Pain from swollen nodes can make you tense and anxious, which increases muscle tightness and perceived pain. Relaxation breathing, mindfulness, listening to music, or gentle stretching release muscle tension and lower stress hormones. Lower stress hormones can improve sleep and support immune function over time. These techniques do not replace analgesic drugs when they are needed, but they can reduce the dose of pain medicine required and help you feel more in control.
10. Sleep hygiene and regular sleep schedule
Good sleep is strongly connected to immune function. Disturbed sleep increases inflammatory markers and may reduce certain immune cells. For CSD, going to bed on time, keeping the bedroom dark and quiet, and avoiding screens or caffeine before bed can help you get more restful sleep. Deep sleep boosts the production of cytokines and other immune mediators that help fight infection. Parents should watch children for nighttime pain and treat pain before bedtime if advised by a doctor.
11. Avoiding alcohol and tobacco
Alcohol and smoking both weaken immune function and impair healing. Alcohol can interfere with white blood cell activity and with the metabolism of many antibiotics. Smoking damages blood vessels and reduces oxygen delivery to tissues. For someone with CSD, avoiding alcohol and tobacco during the acute illness gives the immune system the best chance to clear Bartonella and decreases the risk of side effects from medicines.
12. Emotional support and reassurance
CSD can be frightening, especially when lymph nodes are very large or if doctors are evaluating for serious diseases like lymphoma. Clear explanations, family support, and sometimes counseling can reduce fear and improve adherence to follow-up visits and treatment. Lower anxiety is linked with better immune regulation and lower levels of some stress-related hormones. Emotional support does not directly kill bacteria, but it improves overall health behavior and coping.
13. Activity pacing (light movement, avoiding over-exertion)
Completely lying in bed all day can cause stiffness, low mood, and poor sleep. On the other hand, heavy exercise during acute infection can worsen fatigue and strain the heart. Light walking and stretching, when tolerated, maintain circulation and muscle strength without stressing the body. Activity pacing means listening to your body and balancing short periods of movement with rest.
14. Use of over-the-counter (OTC) pain relievers under medical advice
While these are drugs, they are part of basic non-specific care. Paracetamol (acetaminophen) or ibuprofen, when used as directed and approved by your doctor, can lower fever and pain, making it easier to rest and eat. They do not treat Bartonella directly, but better comfort can improve intake and sleep. It is important to follow package instructions and avoid aspirin in children because of the risk of Reye’s syndrome.
15. Needle aspiration of a heavily swollen, pus-filled lymph node (by a doctor)
When a lymph node becomes very large and full of pus, a doctor may drain it with a needle and syringe under sterile conditions and sometimes with ultrasound guidance. This procedure can relieve pain, help the node heal, and lower the risk of spontaneous rupture or fistula formation. It also allows the doctor to send fluid for tests to confirm the diagnosis or rule out other infections. This is not major surgery and is usually done in an outpatient setting.
16. Avoiding contact with new cats during illness
While you are recovering, it is wise to avoid rough play with cats, especially kittens, to prevent new scratches and new bacterial exposure. The main goal is to reduce repeated bacterial challenges while your immune system is busy fighting the first infection. The mechanism is simple “exposure reduction”: fewer scratches mean fewer bacteria entering your skin.
17. Flea control for pets in the household
CSD bacteria are spread between cats mainly by fleas, and then to humans through a scratch that contains flea dirt (feces). Using veterinarian-recommended flea control products on cats and keeping their environment clean reduces Bartonella circulation in the home. This does not treat the person directly, but it prevents further bites and scratches from infected animals and lowers the chance that other family members will get CSD.
18. Good hand hygiene after touching cats
Washing hands with soap and water after playing with cats, cleaning litter boxes, or handling cat bedding removes flea dirt and bacteria from the skin. Hand hygiene is one of the most basic, proven public health tools for reducing many infections. It is especially important before touching your face, eyes, or any open skin area.
19. Protecting eyes and broken skin from cat saliva
Cats sometimes lick people’s hands or faces. If they lick an open wound, the saliva can carry Bartonella and other bacteria into the tissue. Avoid letting cats lick broken skin or the eye area, and wash any area that was licked if the skin is not intact. This simple barrier and cleaning method lowers the chance of unusual CSD forms, such as eye (ocular) disease.
20. Education about disease course and red-flag symptoms
Understanding that typical CSD in a healthy person often improves over weeks but can rarely cause serious complications helps patients and parents know when to be calm and when to seek urgent care. Education improves early recognition of warning signs such as very high fever, vision changes, confusion, severe headache, or shortness of breath, which may indicate spread to the brain, eyes, or heart.
Drug treatments for cat scratch disease
Important safety note:
There is no single antibiotic that is FDA-approved “specifically” for cat scratch disease. Doctors choose antibiotics that are approved for bacterial infections in general (based on FDA labels) and use them “off-label” for CSD when benefits outweigh risks. Most mild CSD in healthy people may not need antibiotics at all. The doses below are typical adult examples only; your doctor will choose the exact drug, dose, and duration based on age, weight, organ function, pregnancy, and disease severity.
Because of space, I will briefly describe each medicine’s class, general dose pattern, purpose, mechanism, and common side effects, based on clinical reviews and FDA prescribing information.
1. Azithromycin
Azithromycin is a macrolide antibiotic. FDA labels show it is approved for many mild to moderate bacterial infections of the respiratory tract, skin, and other sites. In CSD, a small randomized trial showed that 5 days of azithromycin (500 mg on day 1, then 250 mg daily for 4 days in adults) reduces the size of swollen lymph nodes faster than placebo. It works by binding to bacterial ribosomes and blocking protein production, which stops Bartonella from multiplying. Common side effects include nausea, diarrhea, abdominal pain, and, rarely, abnormal heart rhythm and liver problems. According to FDA information, it should only be used when a bacterial infection is likely, to avoid resistance.
2. Doxycycline
Doxycycline is a tetracycline-class antibiotic with broad activity against many bacteria, including Bartonella species. For serious Bartonella infections (such as brain or heart involvement), guidelines often recommend doxycycline combined with another drug. A typical adult dose for bacterial infections is 100 mg twice daily, but dose and duration vary. Doxycycline works by blocking the 30S ribosomal subunit, preventing protein synthesis in bacteria. Side effects include stomach upset, photosensitivity (easy sunburn), esophageal irritation if taken lying down, and, in children, a risk of tooth discoloration, so it is often avoided in young children and pregnancy.
3. Rifampin (rifampicin)
Rifampin is a rifamycin antibiotic mainly used (per FDA label) for tuberculosis and elimination of meningococcal carriers. In Bartonella infections involving the nervous system or heart, it is often combined with doxycycline because together they penetrate tissues and kill bacteria better. Usual adult doses for systemic infections might be 300–600 mg once or twice daily, adjusted individually. Rifampin blocks bacterial RNA polymerase, stopping RNA and protein production. Side effects include orange discoloration of urine and tears, liver inflammation, many drug interactions (for example with warfarin, certain HIV drugs, and oral contraceptives), and flu-like symptoms.
4. Trimethoprim–sulfamethoxazole (TMP-SMX, co-trimoxazole)
This combination is a synthetic antibacterial product that is FDA-approved for a wide range of infections, including urinary, respiratory, and some gastrointestinal infections. In CSD, TMP-SMX is sometimes used as an alternative oral agent, especially when macrolides or tetracyclines cannot be used. It works by blocking two steps in bacterial folate synthesis, which the bacteria need to make DNA. A common adult regimen for various infections is one double-strength tablet (800/160 mg) every 12 hours, but clinical judgment is essential. Side effects include rash, sun sensitivity, bone-marrow suppression in high-risk patients, and rare but serious skin reactions.
5. Ciprofloxacin
Ciprofloxacin is a fluoroquinolone antibiotic approved for many serious gram-negative infections. It has activity against Bartonella and sometimes is used in combination regimens for severe or complicated disease, although evidence is weaker than for azithromycin or doxycycline. The drug blocks bacterial DNA gyrase and topoisomerase IV, enzymes needed for DNA replication. Typical adult doses for systemic infections are 500–750 mg twice daily. Side effects can include stomach upset, tendon inflammation or rupture, effects on blood sugar, and rare nerve or mental side effects, so it is used carefully.
6. Gentamicin
Gentamicin is an aminoglycoside antibiotic given by injection for serious systemic infections. FDA labeling supports its use for severe gram-negative infections. In Bartonella endocarditis (heart valve infection), guidelines recommend gentamicin plus doxycycline for at least 2 weeks as part of combination therapy. Gentamicin binds to the bacterial 30S ribosome, causing incorrect protein synthesis and bacterial death. It is usually dosed based on body weight and kidney function. Side effects include kidney damage and hearing or balance problems, so blood levels and kidney tests must be monitored.
7. Clarithromycin
Clarithromycin is another macrolide antibiotic, related to azithromycin, and is FDA-approved for various respiratory and skin infections. Studies show clarithromycin can be active against Bartonella species. It inhibits bacterial protein synthesis by binding the 50S ribosome. Typical adult doses for respiratory infections are 250–500 mg twice daily. Side effects include bitter taste, stomach upset, increased liver enzymes, and possible heart rhythm changes (QT prolongation). It also has many drug interactions through CYP3A4.
8. Erythromycin
Erythromycin is an older macrolide antibiotic with a long FDA history for respiratory and skin infections. It has some activity against Bartonella, and may be used when newer macrolides are not suitable, although azithromycin is usually preferred because of better tolerance and easier dosing. Erythromycin blocks bacterial protein synthesis, like other macrolides. Typical adult dosing is 250–500 mg every 6 hours for susceptible infections. Side effects include nausea, abdominal cramps, diarrhea, and risk of QT prolongation and drug interactions.
9. Ceftriaxone
Ceftriaxone is a third-generation cephalosporin antibiotic given by injection and FDA-approved for many serious infections including meningitis and sepsis. In severe bartonellosis, such as endocarditis, ceftriaxone may be combined with doxycycline and rifampin, especially while waiting for culture or serology results. It kills bacteria by blocking cell wall synthesis. Typical adult dosing is 1–2 g once daily or twice daily, adjusted by severity. Side effects include allergic reactions, diarrhea, and rare gallbladder sludge.
10. Amoxicillin–clavulanate
Amoxicillin–clavulanate is a β-lactam/β-lactamase inhibitor combination widely used, with many FDA-approved indications. It is not a first-line drug for CSD itself, because Bartonella is less susceptible, but it may be used if there is a secondary skin or soft-tissue infection around the scratch with common bacteria like Staphylococcus or Streptococcus. It inhibits bacterial cell wall synthesis while clavulanate protects amoxicillin from breakdown. Side effects include diarrhea, rash, and possible liver injury.
11. Levofloxacin
Levofloxacin is another fluoroquinolone antibiotic with broad activity. It is sometimes considered in complex Bartonella infections when other agents cannot be used, although evidence is much weaker. It works similarly to ciprofloxacin by blocking DNA gyrase and topoisomerase. Typical adult dosing is 500–750 mg once daily for many infections. Side effects and warnings are similar to ciprofloxacin, including tendon problems, QT prolongation, and central nervous system effects, so doctors use it only when benefits clearly outweigh risks.
12. Moxifloxacin
Moxifloxacin is a newer fluoroquinolone with strong tissue penetration and broad coverage. It is not first-line for CSD but may be discussed in severe, refractory Bartonella infection where other treatments fail. It blocks DNA replication in bacteria. Because of concerns about side effects (QT prolongation, tendon problems, liver effects), guidelines generally prefer more established regimens like doxycycline plus rifampin for severe disease.
13. Combination azithromycin + rifampin
For some complicated Bartonella infections, such as bacillary angiomatosis in immunocompromised patients, clinicians may use combination therapy (for example, azithromycin plus rifampin) to improve bacterial killing and reduce the risk of resistance or relapse. Doses are tailored to disease severity and organ function. The mechanism combines protein synthesis inhibition (azithromycin) with RNA polymerase inhibition (rifampin), giving a two-pronged attack on the bacteria.
14. Doxycycline + rifampin for CNS or endocarditis
For Bartonella infection of the central nervous system or heart valves, the combination of doxycycline and rifampin for at least 6 weeks is often preferred because both drugs penetrate tissues well and have shown benefit in observational studies. Doses and treatment length are carefully managed by infectious disease specialists, and patients may also need surgery for valve replacement (see surgery section).
15. Gentamicin + doxycycline for severe endocarditis
Guidelines suggest that in Bartonella endocarditis, gentamicin for at least 14 days plus doxycycline for 6 weeks provides synergistic killing of bacteria in vegetations. The drugs work through different mechanisms, one damaging protein synthesis and one stopping translation, which together can clear high bacterial loads.
16. Topical antibiotic cream for secondarily infected scratch
If the original scratch or bite becomes secondarily infected with common skin bacteria (red, warm, oozing), doctors may add topical antibiotics such as mupirocin to treat local infection. This does not treat CSD inside the lymph nodes but reduces local bacterial load and prevents spreading cellulitis. Use is guided by local practice and bacterial resistance patterns.
17. Intravenous azithromycin for severe systemic disease
In hospitalized patients who cannot take oral medication, intravenous azithromycin (per FDA label) can be used for severe infections where Bartonella or other bacteria are suspected. The mechanism and side effects are the same as oral azithromycin, but dosing and infusion rates must follow hospital protocols to prevent heart rhythm changes and liver injury.
18. Intravenous doxycycline
For very sick patients with Bartonella involving brain, liver, or heart, intravenous doxycycline may be used at the start of treatment before switching to oral form, because gut absorption may be unreliable in critical illness. FDA labels show doxycycline IV is used for many systemic infections.
19. Analgesic and antipyretic drugs (paracetamol/acetaminophen)
Although these do not treat the bacteria, they are essential supportive drugs. Acetaminophen is widely used and FDA-approved to reduce pain and fever. It helps people with CSD by easing headaches, muscle pains, and node tenderness, making rest, eating, and hydration easier. The mechanism is central pain and temperature regulation in the brain. Overdose can cause serious liver damage, so doses must follow package and doctor guidance.
20. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
Ibuprofen and similar NSAIDs relieve pain and reduce inflammation by blocking prostaglandin production (COX enzymes). For CSD, they are sometimes used to control moderate pain from swollen nodes or joint pain, as long as the patient has no kidney problems, stomach ulcers, or other contraindications. They do not kill Bartonella, but improved comfort supports recovery. Overuse can cause stomach bleeding, kidney issues, and raise heart risk in some patients, so medical guidance is important.
Dietary molecular supplements that may support recovery
There are no supplements proven to cure cat scratch disease. The supplements below have general evidence for supporting immune function or reducing inflammation, but their use should be discussed with a doctor, especially if you take other medicines.
1. Vitamin C
Vitamin C is a water-soluble vitamin and antioxidant. Reviews show that vitamin C supports both innate and adaptive immunity, helps white blood cells function, protects cell membranes, and supports skin barriers against infection. Typical oral doses used for immune support are 200–1000 mg per day in divided doses, but very high doses can cause diarrhea and kidney stones in susceptible people. Functionally, vitamin C donates electrons to neutralize free radicals and acts as a cofactor in collagen and hormone synthesis. Mechanistically, it improves phagocyte function, enhances lymphocyte activity, and may shorten the duration of some viral respiratory infections, though it does not specifically target Bartonella.
2. Vitamin D
Vitamin D is a fat-soluble hormone-like vitamin that modulates the immune system. Studies show that vitamin D receptors are present on many immune cells and its active form can influence both innate and adaptive responses. Typical supplemental doses range from 600–2000 IU daily, but higher doses must be supervised. Functionally, vitamin D helps maintain bone health and calcium balance; mechanistically, it regulates gene expression in immune cells, reduces excessive inflammation, and may lower susceptibility to certain infections. Over-supplementation can cause high blood calcium, so blood tests may be needed.
3. Zinc
Zinc is a trace mineral essential for hundreds of enzymes and for normal immune function. Meta-analyses suggest zinc can reduce the duration or severity of common cold symptoms, although the evidence is mixed and not specific to CSD. Typical oral doses for short-term immune support are 10–30 mg elemental zinc per day, but long-term high dosing can cause copper deficiency and GI upset. Mechanistically, zinc is important for gene expression, antioxidant defenses, and the development and function of T and B cells. It may help your body respond more effectively to infection, but it does not replace antibiotics.
4. Omega-3 fatty acids (EPA/DHA)
Omega-3 fatty acids from fish oil or algae oil have anti-inflammatory and immunomodulatory effects. Reviews show that omega-3s can change the composition of cell membranes, affect inflammatory mediators, and may support better immune balance and recovery after illness or surgery. Typical supplemental doses are 250–1000 mg combined EPA + DHA daily for general health, unless your doctor prescribes more. Mechanistically, omega-3s are converted into specialized pro-resolving mediators that help turn off excessive inflammation. Side effects can include digestive upset and, at high doses, increased bleeding risk.
5. Probiotics
Probiotics are beneficial bacteria (such as Lactobacillus and Bifidobacterium species) that support gut health and immune function. Studies show the gut microbiome influences systemic immunity, and probiotics may reduce the risk or duration of some infections and antibiotic-associated diarrhea. Typical doses range from 1–10 billion CFU per day, depending on the product. Mechanistically, probiotics compete with harmful bacteria, help maintain gut barrier integrity, and modulate immune signaling. They may help people taking antibiotics for CSD, but the best strains and doses vary, and immunocompromised patients should discuss use carefully with their doctor.
6. Curcumin (from turmeric)
Curcumin is the main active compound in turmeric and has anti-inflammatory and antioxidant properties. Reviews describe curcumin’s ability to modulate NF-κB and other inflammatory pathways, decreasing production of pro-inflammatory cytokines. Typical supplemental doses are 500–1000 mg per day of standardized extract, often with piperine to improve absorption. Mechanistically, it dampens excessive inflammation and oxidative stress, which may help with pain and swelling from infected lymph nodes. However, it can interact with blood thinners and may cause digestive upset in some people.
7. Quercetin
Quercetin is a plant flavonoid found in onions, apples, and berries. It has antioxidant and anti-inflammatory effects and may modulate immune cell activity and histamine release. Supplement doses often range from 250–1000 mg per day. Mechanistically, quercetin can scavenge free radicals and influence signaling pathways involved in inflammation and allergy. While not specific to CSD, it may support overall immune balance and reduce oxidative stress during infection. High doses can cause headache or tingling, and data for long-term use are limited.
8. N-acetylcysteine (NAC)
NAC is a precursor to glutathione, one of the body’s main antioxidants. It is also used as a mucolytic and as an antidote for acetaminophen poisoning in medical practice. NAC supplements (often 600–1200 mg per day) can increase glutathione levels and may support immune function by reducing oxidative stress and improving detoxification pathways. Mechanistically, NAC donates sulfur groups, helping rebuild glutathione and modulating inflammatory pathways. It may cause nausea or, rarely, allergic reactions, and should be avoided or used carefully in people with certain medical conditions.
9. Selenium
Selenium is a trace mineral that plays a critical role in antioxidant enzymes (such as glutathione peroxidase) and in immune cell function. Deficiency is linked with more severe viral infections and poor immune responses. Typical supplement doses are 50–100 mcg per day, and the upper safe limit for most adults is 400 mcg daily. Mechanistically, selenium helps enzymes control oxidative stress and supports proper function of T cells and natural killer cells. Too much selenium can cause hair loss, nail changes, and nerve damage, so dosing must be careful.
10. Multinutrient immune-support formulas (with medical guidance)
Some multivitamin or immune-support formulas combine moderate doses of vitamin C, vitamin D, zinc, selenium, and sometimes herbal components. Used appropriately, they may correct small nutrient gaps that could weaken overall immune responses. However, they can also lead to excessive intake if combined with other supplements. Mechanistically, these formulas aim to support multiple pathways at once: antioxidant defenses, immune cell development, and barrier function. The safest approach is a balanced diet first, and supplement formulas only when recommended by a clinician.
Immunity-booster / regenerative / stem-cell-type drugs
For cat scratch disease, there are currently no approved stem cell drugs or specific “immune booster” prescription drugs that are proven and recommended for routine use. Management focuses on antibiotics and supportive care. Instead of listing unproven or unsafe products, it is more accurate and safer to explain what is realistically used:
Appropriate antibiotics as “targeted immune helpers”
Antibiotics such as azithromycin or doxycycline are the main active medicines. By lowering the number of Bartonella bacteria, they reduce the “burden” on the immune system, letting your natural defenses finish the job. In this sense, antibiotics act as helpers, not as immune boosters, and they are the only drug type with clear evidence in CSD.Vaccines (for overall immune protection, not specific to CSD)
Routine vaccines (such as influenza or pneumococcal vaccines) do not treat CSD, but they protect against other infections that could further weaken the body while it is dealing with Bartonella. Staying up to date with vaccinations is part of general immune protection.Avoiding corticosteroids unless absolutely necessary
Steroids like prednisone can strongly suppress the immune system. Some case reports describe worsening of Bartonella infections with steroids alone. So in most CSD cases, steroids are avoided unless there is another clear indication and an experienced specialist is involved.No routine use of biologic immunomodulators
Modern biologic drugs that block TNF-α or other immune pathways are sometimes associated with opportunistic infections, including Bartonella. They are not used to treat CSD and may actually increase risk when used for other diseases.Stem-cell therapies only in research settings
There is no approved stem-cell treatment for CSD. Experimental stem-cell approaches belong in carefully controlled clinical trials for other conditions. Using unregulated “stem cell” injections or infusions for infection is risky and not evidence-based.Physiologic “immune support” through nutrition, sleep, and management of chronic illness
The most realistic “immune boosting” strategy is keeping chronic conditions (like diabetes or HIV) well controlled, eating a nutrient-dense diet, sleeping well, and avoiding smoking and heavy alcohol. These factors have strong evidence for supporting immune health overall.
Surgeries and invasive procedures
Most people with cat scratch disease never need surgery. Surgery is reserved for complications or for very large, persistent, or destructive lesions.
1. Needle aspiration of suppurative lymph nodes
As mentioned above, when a lymph node becomes very large and filled with pus, a doctor may insert a sterile needle and withdraw the pus. This procedure is done under local anesthesia, sometimes with ultrasound guidance. It reduces pressure and pain, may speed healing, and provides material for laboratory tests. It is done to avoid rupture of the node through the skin and to rule out other causes such as tuberculosis or cancer.
2. Incision and drainage of lymph nodes or abscesses
If needle aspiration is not enough or the node has already formed a large abscess, a small surgical cut may be needed to drain thick pus and remove dead tissue. The area is numbed, opened, irrigated, and sometimes packed with gauze. The purpose is to control local infection, relieve pain, and allow faster healing. This is done when imaging or examination shows a well-formed abscess or when the node is close to rupturing.
3. Excision (removal) of a chronically abnormal lymph node
Rarely, if a lymph node remains enlarged for many months despite appropriate antibiotic therapy, or if doctors are concerned about lymphoma or other diagnoses, they may surgically remove the whole node. The removed tissue is examined under a microscope and may be tested for Bartonella and other organisms. The main purpose is diagnosis and to ensure there is no underlying cancer; sometimes removal also helps symptoms in chronic cases.
4. Ocular surgery (for serious eye complications)
Cat scratch disease can, rarely, cause eye problems such as neuroretinitis or choroiditis. Most cases respond to antibiotics and sometimes steroids under specialist care, but severe complications (like retinal detachment or dense vitreous hemorrhage) might require retinal surgery such as vitrectomy. The purpose is to preserve vision and treat structural damage to the eye caused by inflammation. These surgeries are performed by ophthalmic surgeons.
5. Valve replacement surgery in Bartonella endocarditis
Bartonella can infect heart valves (endocarditis), usually in people with pre-existing valve disease or weakened immunity. In these cases, prolonged combination antibiotic therapy is required, and many patients also need surgical replacement of the damaged valve because vegetations and scarring can cause heart failure. The surgery removes the infected valve and replaces it with a mechanical or tissue valve to restore normal blood flow.
Prevention strategies
Avoid rough play with cats, especially kittens – Try not to let cats bite or scratch your skin during play.
Wash scratches and bites promptly with soap and water – This reduces the number of bacteria entering the skin.
Use flea control on cats as advised by a veterinarian – Controlling fleas reduces Bartonella spread among cats and lowers human risk.
Do not let cats lick open wounds or broken skin – Saliva may contain bacteria; clean the area if this happens.
Teach children how to handle cats gently – Children under 15 are at highest risk, so gentle handling and avoiding teasing are important.
Wash hands after touching cats, litter, or bedding – Simple handwashing removes flea dirt and bacteria.
Keep cats indoors when possible – Indoor cats are less likely to pick up fleas and Bartonella outdoors.
Avoid adopting stray cats or kittens if you are immunocompromised – People with HIV, transplant recipients, or those on biologic drugs should discuss pet choices with their doctor.
Seek veterinary care if your cat is very sick or flea-infested – Treating the animal reduces risk to the household.
Maintain your own health (vaccines, chronic disease control) – Better general health makes severe CSD less likely.
When to see a doctor
You should see a doctor promptly if:
You develop a red bump at a scratch site followed by swollen, tender lymph nodes near that area, especially if it lasts more than 1–2 weeks.
You have fever, chills, night sweats, or feel very unwell.
The lymph node becomes very large, very painful, or seems full of fluid or pus.
You or your child has eye symptoms (blurry vision, eye pain, floaters) after a cat scratch.
You have headache, confusion, seizures, or weakness, which could suggest nervous system involvement.
You have shortness of breath, chest pain, or new heart murmur, which could suggest heart infection.
You are pregnant, have HIV, have a transplant, are on chemotherapy or biologic drugs, or have another immune problem and think you may have CSD.
Emergency care is needed if there are symptoms like severe breathing difficulty, sudden confusion, or severe eye pain with vision loss.
What to eat and what to avoid
Helpful to eat:
Plenty of water and clear fluids – To prevent dehydration from fever and poor intake.
Fruits rich in vitamin C (oranges, guava, berries) – Support immune function and antioxidant defenses.
Vegetables of many colors – Provide vitamins, minerals, and plant compounds that help immune cells work properly.
Lean proteins (fish, eggs, beans, lentils, lean meat) – Supply amino acids needed to make antibodies and repair tissues.
Whole grains (brown rice, oats, whole-wheat bread) – Provide steady energy and fiber for gut health.
Better to limit or avoid:
Excessive sugary drinks and sweets – They provide “empty” calories and may worsen inflammation and blood sugar control.
Highly processed fast food with trans-fats – These foods can promote low-grade inflammation and do not support healing.
Heavy alcohol use – Weakens immune function and can interact with antibiotics or pain medicines.
Very salty packaged snacks – Can worsen dehydration and sometimes increase blood pressure.
Herbal products that claim to “cure infection” without evidence – Some may interact with antibiotics or harm the liver; always ask your doctor before using them.
Frequently asked questions
1. Is cat scratch disease always serious?
No. In most healthy children and adults, cat scratch disease is mild and self-limited. People often get a small bump at the scratch site followed by swollen, tender lymph nodes, mild fever, and tiredness. These symptoms usually improve over weeks to a few months even without antibiotics. However, because rare but serious complications can occur, especially in people with weak immune systems, you should still see a doctor for proper diagnosis and follow-up.
2. Do all patients with cat scratch disease need antibiotics?
No. Some guidelines are cautious and suggest that typical, uncomplicated CSD in healthy people may not require antibiotics, as the disease usually resolves on its own. However, a small randomized trial showed azithromycin can speed the reduction of lymph node size. Doctors often use antibiotics if the nodes are very painful, the disease is severe, lasts long, or the patient is immunocompromised.
3. Can I catch cat scratch disease from every cat scratch?
No. Only some cats carry Bartonella henselae, and infection usually requires flea contamination on the cat’s claws or fur. Many scratches, especially from healthy indoor cats on flea control, will not cause CSD. But you cannot tell by looking at the cat, so it is always wise to clean scratches and watch for symptoms.
4. Can I still keep my cat if I had cat scratch disease?
In most cases, yes. You generally do not need to get rid of your cat. The focus is on preventing new infections: using flea control, avoiding rough play, and not letting the cat lick open wounds. People with very weak immunity should discuss pet safety with their doctor and veterinarian.
5. Is cat scratch disease contagious from person to person?
No routine person-to-person spread has been shown. CSD is considered a zoonosis (animal-to-human infection). Family members may get infected if they are scratched by the same infected cat, but not by sharing food or by casual contact with the sick person.
6. How long do swollen lymph nodes last?
Lymph node swelling from cat scratch disease often lasts one to several months, even after other symptoms improve. Nodes usually shrink slowly over time. If a node stays large, becomes very hard, or remains painful beyond this period, your doctor may order more tests or consider biopsy.
7. Can cat scratch disease affect the eyes?
Yes. In some patients, especially children and young adults, Bartonella can cause eye problems such as neuroretinitis, which leads to blurred vision and special findings on eye examination. This is serious and needs rapid evaluation by an ophthalmologist and an infectious disease specialist, usually with antibiotics and sometimes steroids.
8. What about cat scratch disease and the brain or nervous system?
Rarely, CSD can involve the brain or nerves, causing encephalopathy (brain inflammation), seizures, or peripheral nerve problems. These complications require hospital care, brain imaging, and often strong antibiotics like doxycycline plus rifampin. Any patient with CSD who develops confusion, severe headache, or seizures should seek emergency care immediately.
9. How is cat scratch disease diagnosed?
Doctors usually rely on a combination of history (cat exposure), typical skin lesion, regional lymph node swelling, blood tests for Bartonella antibodies, and sometimes imaging or biopsy. There is no single blood test that is perfect, so clinical judgment is very important.
10. Can I prevent cat scratch disease by giving my cat antibiotics?
No. Giving antibiotics to healthy cats to try to prevent CSD is not recommended. It may not clear the bacteria completely and can promote resistance. Flea control and safe handling are much more important and safer prevention tools.
11. Does cat scratch disease come back after treatment?
Most people have a single episode and recover completely. Rarely, especially in immunocompromised patients, infection can recur or persist, leading to ongoing or new complications. Following your doctor’s advice and completing the full antibiotic course (if prescribed) helps reduce this risk.
12. Are there long-term effects of cat scratch disease?
In uncomplicated cases, long-term effects are unusual. Swollen nodes gradually shrink, and most people return to normal health. In the small number of patients who develop eye, brain, or heart involvement, there can be lasting problems such as vision loss or heart valve damage, which may require ongoing care.
13. Can pregnant women get cat scratch disease?
Yes, pregnant women can get CSD, but typical cases in otherwise healthy pregnant women are often mild. Data are limited, so pregnant patients should be assessed carefully. Some antibiotics (like doxycycline) are usually avoided during pregnancy, so doctors choose safer options such as certain macrolides when needed.
14. Which doctor should I see for cat scratch disease?
Many people can be managed by their primary care doctor or pediatrician. However, if the disease is severe, complicated, or you have a weak immune system, your doctor may involve an infectious disease specialist. For eye involvement, you should see an ophthalmologist; for suspected endocarditis, a cardiologist and cardiac surgeon may also be involved.
15. Is there a vaccine against cat scratch disease for humans?
At present, there is no human vaccine against Bartonella henselae or cat scratch disease. Prevention relies on flea control in cats, careful handling, good wound care, and general immune health.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: November 13, 2025.
