Cat-scratch fever, also called cat-scratch disease, is a bacterial infection that happens after a person is scratched, bitten, or licked on broken skin by a cat that carries a germ called Bartonella henselae. The germ lives in the cat’s blood and saliva and can enter human skin through a small injury. After one to two weeks, a small bump or blister often appears at the scratch site, and then nearby lymph nodes (glands) become swollen and painful. Most cases are mild and get better on their own, but some people develop serious problems in the eyes, liver, spleen, brain, bones, or heart. NCBI+2Wikipedia+2
Other names for cat-scratch fever
Cat-scratch fever has several other medical names that describe the same or very similar disease. Common names include cat-scratch disease (CSD), felinosis, inoculation lymphoreticulosis, subacute regional lymphadenitis, and sometimes Teeny’s disease. “Cat-scratch disease” is the term most used by doctors and health agencies today. “Subacute regional lymphadenitis” describes the slow onset (“subacute”) and the swollen lymph nodes in one region of the body. These different names developed over time as doctors learned that all these patterns of illness were caused by Bartonella henselae spread from cats. Wikipedia+1
Types of cat-scratch fever
Doctors often divide cat-scratch fever into typical and atypical (unusual) forms. Typical cat-scratch disease mainly causes one or a few swollen, tender lymph nodes near the scratch or bite, with mild fever and tiredness. This is the most common form, especially in children, and usually goes away by itself over a few weeks to a few months. Atypical disease means the bacteria affect other organs such as the eye, liver, spleen, bones, brain, or heart and can cause serious complications that need closer medical care and sometimes hospital treatment. NCBI+2CDC+2
Another way to think about types is by organ involvement. There is ocular cat-scratch disease, which affects the eyes and can cause conditions such as Parinaud oculoglandular syndrome (a red, irritated eye with nearby lymph node swelling) or neuroretinitis (swelling of the optic nerve, sometimes with sudden vision changes). There is hepatosplenic cat-scratch disease, where the infection causes small abscesses (pockets of pus) in the liver and spleen and can lead to fever and abdominal pain. These forms are less common but important because they may look like other serious illnesses such as cancer or tuberculosis on scans. CDC+2CDC+2
There are also neurologic and cardiac types of cat-scratch fever. In the neurologic type, the infection may trigger brain irritation (encephalopathy), seizures, or other nerve problems. In the cardiac type, the germs can infect the heart valves and cause endocarditis, which can be life-threatening if not treated. These complications are rare, but they are more likely in people with weak immune systems or long-lasting infection. Recognizing these types helps doctors choose the right tests and decide when antibiotics and hospital care are needed. CDC+2CDC+2
Causes and risk factors of cat-scratch fever
1. Infection with Bartonella henselae
The true cause of cat-scratch fever is infection with the bacterium Bartonella henselae. This germ is a small, gram-negative bacterium that lives inside cells and grows slowly. It usually lives in the red blood cells of cats and in cat fleas. When the germ enters a person’s skin, it moves to nearby lymph nodes and triggers inflammation and swelling. Evidence from blood tests, tissue studies, and genetic tests shows that B. henselae is the main cause in most cases of cat-scratch disease worldwide. UpToDate+2AAFP+2
2. Scratch from an infected cat
Most people get cat-scratch fever after a scratch from a cat that carries Bartonella henselae. The cat’s claws may be contaminated with flea dirt (flea feces) that contains the bacteria or with the cat’s own saliva. When the cat scratches and breaks the skin, the germs can enter the wound. Even a small, playful scratch that barely bleeds can be enough to cause infection if the bacteria are present on the claw surface. Wikipedia+2AAFP+2
3. Bite from an infected cat
Cat bites can also transmit Bartonella henselae. A bite often injects saliva deep into the skin, which may carry a higher dose of bacteria than a scratch. Deep puncture wounds from cat teeth can trap germs under the skin and make it easier for them to reach the bloodstream and lymphatic system. People who are bitten on the hands or arms are at particular risk because these areas have many small lymph channels that lead to nearby lymph nodes. Wikipedia+2Cleveland Clinic+2
4. Cat licking broken skin or mucous membranes
Sometimes a cat does not scratch or bite but licks an open cut, scrape, or sore on a person’s skin. If the cat’s saliva contains Bartonella henselae, the bacteria can enter the body through the damaged skin. Licking around the eyes or mouth may also allow germs to reach the eye surface or oral mucosa. This can lead to eye involvement or regional lymph node swelling without a classic scratch mark. AAFP+2NCBI+2
5. Living with kittens or young cats
Kittens and young cats are more likely than older cats to carry Bartonella henselae in their blood. They often have heavier flea infestations and play more roughly, which leads to more scratches and bites. Studies show that households with kittens have a higher risk of cat-scratch disease, especially in children who handle the kittens frequently. Wikipedia+2CDC+2
6. Poor flea control in cats
Cat fleas (Ctenocephalides felis) spread Bartonella henselae between cats. The bacteria can live in flea gut contents and in flea dirt that collects on the cat’s fur. When a cat grooms itself, it may spread flea dirt onto its claws and mouth. People who live in homes or areas where cats have heavy flea infestations therefore face a higher risk of infection because there is more bacteria in the environment and on the animals. Wikipedia+2CDC+2
7. Rough play with cats
Playing roughly with cats, such as wrestling, grabbing, or letting them “rabbit kick” or claw the arms, increases the chance of skin breaks. Each extra scratch or bite is another possible entry point for Bartonella henselae. Children often play this way, which partly explains why they get cat-scratch disease more often than adults. ScienceDirect+2Cleveland Clinic+2
8. Not washing scratches and bites promptly
If a person does not wash a cat scratch or bite right away with soap and water, bacteria on the skin or claws stay in the wound longer. This gives Bartonella henselae more time to enter the body or multiply at the site. Public health advice for cat-scratch disease includes cleaning any cat-related wound quickly to lower the risk of infection, just as with other bite and scratch injuries. Virginia Department of Health+2Minnesota Department of Health+2
9. Owning multiple cats
Having several cats in the home increases the total number of possible exposures. If one cat has Bartonella henselae, it may infect other cats through fleas or fighting, and any of these cats could scratch or bite household members. Studies of Bartonella infections show higher seroprevalence (antibody levels) among cat owners and higher risk in multi-cat households. CDC+2AAFP+2
10. Outdoor cats or shelter cats
Cats that go outdoors, live in shelters, or live in crowded conditions are more likely to have fleas and to fight with other cats. This raises their chance of carrying Bartonella henselae. People who adopt such cats or care for outdoor colonies may have more frequent contact with infected animals, which raises human infection risk. CDC+2Virginia Department of Health+2
11. Dog scratches or bites (rare)
Although cats are the main source, Bartonella henselae infection has rarely been linked to dog scratches or bites. Dogs can carry the bacteria after contact with infected fleas or cats. Transmission from dogs seems much less common than from cats, but it may explain some cases where patients have typical cat-scratch disease symptoms but no cat contact. Wikipedia+2CDC+2
12. Tick exposure (possible but uncommon)
Some studies and case reports suggest ticks may occasionally transmit Bartonella henselae to humans. Ticks can carry several Bartonella species, and tick bites have been associated with Bartonella infection in some patients. However, the role of ticks in classic cat-scratch disease is still uncertain, and cats remain the main reservoir and source. AAFP+2UpToDate+2
13. Weakened immune system
People with weak immune systems, such as those with advanced HIV infection, cancer chemotherapy, organ transplants, or long-term high-dose steroids, are more likely to get severe or prolonged cat-scratch disease. In these patients, Bartonella henselae can spread more widely and cause serious problems in the liver, spleen, bones, or blood vessels. The weaker immune system makes it harder to clear the bacteria after a minor scratch or bite. CDC+2NCBI+2
14. Childhood and young age
Cat-scratch fever is seen more often in children and teenagers than in older adults. Young people spend more time playing closely with pets, may be scratched more often, and may pay less attention to wound cleaning. Large national studies in the United States show that most cases occur in people younger than 18 years. CDC+2Minnesota Department of Health+2
15. Living in warm, humid climates
Cat-scratch disease is more common in warm, humid areas where fleas thrive, such as the southern United States and similar climates. Fleas reproduce better in these conditions, which increases the likelihood that local cats carry Bartonella henselae. As a result, people living in such regions have more exposure to infected cats and more risk. CDC+2Minnesota Department of Health+2
16. Contact with stray or feral cats
Stray or feral cats often have heavy flea loads, poor health care, and frequent fighting injuries. These conditions increase their Bartonella infection rate, so scratches or bites from such cats carry higher risk. People who feed or rescue stray cats, or who work in animal shelters, may therefore have more opportunities for exposure to Bartonella henselae. CDC+2Virginia Department of Health+2
17. Delayed medical care after severe bites
Deep or multiple cat bites that are not examined by a health professional may become infected with many bacteria, including Bartonella henselae. If treatment is delayed, the local infection and lymph node swelling can become worse and last longer. While mild cat-scratch disease often needs only observation, severe or atypical cases may benefit from antibiotics when diagnosed in time. MSD Manuals+2UpToDate+2
18. Previous Bartonella exposure without immunity
Some people develop antibodies to Bartonella henselae after earlier exposure, but this may not give complete protection. Serologic surveys show that many cat owners have antibodies without clear illness, while others still develop typical cat-scratch disease later. This suggests that partial immunity may lower severity but not always prevent disease when new, high-dose exposure happens. CDC+2Wiley Online Library+2
19. Co-existing skin conditions or wounds
People with eczema, frequent skin picking, or many small cuts and scratches have more open areas that can be entry points for bacteria when they handle cats. If Bartonella henselae reaches deeper skin layers through these damaged areas, it may trigger local papules and nearby lymph node swelling even without a classic, remembered cat scratch. NCBI+2Wikipedia+2
20. Household crowding and poor hygiene
Crowded living conditions with many people and pets in a small space can make flea control harder and raise the number of close interactions with cats. Poor handwashing after touching pets or cleaning litter boxes may also increase the chance of bacteria spreading from cat fur or saliva to small skin injuries. Public health information on Bartonella infections stresses good hygiene and flea control in homes with cats to lower risk. Virginia Department of Health+2Minnesota Department of Health+2
Symptoms of cat-scratch fever
1. Skin bump or blister at the scratch site
One of the earliest signs is a small raised bump, blister, or pimple at the place where the cat scratched, bit, or licked broken skin. This lesion usually appears three to ten days after contact. It may be red and slightly itchy but is often not very painful. The skin bump shows where the bacteria first entered the body and often heals as the deeper lymph node swelling begins. Wikipedia+2CDC+2
2. Swollen, tender lymph nodes near the scratch
The classic symptom of cat-scratch disease is one or more swollen lymph nodes close to the scratch or bite, such as in the armpit, neck, jaw, or groin. These nodes may feel firm, painful, and warm to the touch, and they usually enlarge one to three weeks after infection. This swelling, called regional lymphadenitis, happens because the immune system is fighting the bacteria in the draining lymph nodes. NCBI+2Wikipedia+2
3. Low-grade fever
Many patients develop a mild fever, often less than 38.5°C (101.3°F). The fever may come and go over several days or weeks and is usually accompanied by feeling unwell. This low-grade fever reflects the body’s immune response to Bartonella henselae and is common in both typical and atypical cat-scratch disease. CDC+2Cleveland Clinic+2
4. Fatigue and feeling generally unwell
People with cat-scratch fever often feel tired, weak, or “run down.” They may have trouble doing usual activities or may need more rest. This general malaise is a non-specific symptom seen in many infections, but in cat-scratch disease it usually appears along with lymph node swelling and a history of cat contact. Wikipedia+2CDC+2
5. Headache
Headache is a frequent complaint in cat-scratch fever. It may be mild or moderate and can last for several days. In most cases it is part of the general viral-like feeling of illness, but in rare cases a very severe headache may signal more serious problems such as brain involvement (encephalitis), which needs urgent medical attention. Wikipedia+2CDC+2
6. Loss of appetite and weight loss
Some patients lose interest in food and may lose a small amount of weight during the illness. This often happens when fever, fatigue, and pain make eating less appealing. In children, parents may notice picky eating or reduced daily intake. These symptoms usually improve as the infection clears. Wikipedia+2Cleveland Clinic+2
7. Muscle aches and joint pains
Aches in the muscles and joints can occur, similar to what happens with viral infections like flu. People may feel sore in the back, arms, legs, or around the swollen lymph nodes. In some cases, cat-scratch disease can cause true arthritis with swollen, painful joints, but this is less common and usually improves with treatment. Wikipedia+2CDC+2
8. Prolonged lymph node swelling
Even after the fever and general illness have improved, the lymph nodes may stay enlarged for many weeks or even months. Sometimes the nodes become very large and may form soft areas filled with pus (suppurative lymphadenitis). These nodes can occasionally drain to the skin surface or may need needle aspiration to relieve pain and confirm the diagnosis. NCBI+2Merck Manuals+2
9. Eye redness and swelling (ocular involvement)
In ocular cat-scratch disease, one eye may become red, sore, and watery, often with nearby lymph node swelling in front of the ear. This pattern is called Parinaud oculoglandular syndrome. Some patients develop neuroretinitis, where the optic nerve at the back of the eye becomes swollen and vision becomes blurred. These eye problems are uncommon but important because they can affect sight. CDC+2NCBI+2
10. Abdominal pain or liver and spleen problems
Some people, especially children, develop fever and pain in the upper abdomen due to small abscesses in the liver or spleen. Ultrasound or CT scans may show multiple small lesions in these organs. This hepatosplenic form may look like cancer or other infections, so doctors often order detailed imaging and blood tests to find the cause. CDC+2CDC+2
11. Rash or generalized skin eruptions
In addition to the local bump at the scratch site, some patients develop more widespread skin rashes. These may look like small red spots or patches on the body. Although not specific to cat-scratch disease, they reflect the body’s immune reaction to the infection and are more often seen in atypical or systemic forms. Cleveland Clinic+2NCBI+2
12. Neurologic symptoms (confusion, seizures)
A small number of patients develop brain-related symptoms such as confusion, irritability, or seizures. This condition, called cat-scratch encephalopathy, usually appears several weeks after the initial infection. It is thought to result from inflammation in the brain triggered by the infection and often requires hospital care, but most patients recover fully. CDC+2NCBI+2
13. Bone pain or limping
Cat-scratch disease can occasionally infect bones, causing osteomyelitis. Patients may have localized bone pain, tenderness over a limb, or limping in children. Imaging may show bone lesions. Although rare, bone involvement is an important atypical form and must be distinguished from tumors or other bone infections. CDC+2CDC+2
14. Heart-related symptoms (shortness of breath, chest pain)
In very rare cases, Bartonella henselae can infect heart valves and cause endocarditis, especially in people with pre-existing heart disease or weak immune systems. Symptoms may include fever that does not go away, shortness of breath, chest discomfort, or signs of heart failure. This complication needs urgent specialist care and long-term antibiotics. CDC+2UpToDate+2
15. Long-lasting or recurrent fever
Some people experience prolonged or recurrent fevers without clear cause until cat-scratch disease is diagnosed. This can happen in atypical forms with liver, spleen, or bone involvement, where the usual local lymph node signs may be less obvious. In such cases, doctors often look carefully for a history of cat exposure and order targeted tests for Bartonella henselae. CDC+2CDC+2
Diagnostic tests for cat-scratch fever
Doctors diagnose cat-scratch disease using a mix of history, physical examination, and tests. Often, the diagnosis is made clinically when a person has typical symptoms and cat exposure, and tests are used to confirm unclear or severe cases. CDC+2NCBI+2
Physical exam tests
1. General physical examination and vital signs
The first “test” is a careful physical examination. The doctor checks temperature, heart rate, breathing rate, and blood pressure and looks for signs of infection such as fever or rapid pulse. They also examine the whole body for rashes, swelling, and signs of illness. This broad view helps decide whether cat-scratch disease is likely and whether the person is mildly ill or has a more serious condition needing urgent care. NCBI+2MSD Manuals+2
2. Inspection of the skin for a scratch papule
The doctor looks carefully at the skin, especially near any remembered cat scratch, bite, or lick site. They search for a small papule (bump) or pustule (bump with pus) that marks where Bartonella henselae entered. Finding this typical lesion supports the diagnosis because it usually appears days before the lymph nodes swell. The size, redness, and healing stage are noted and compared with the time since cat contact. CDC+2Wikipedia+2
3. Palpation of lymph nodes
The doctor uses their fingers to feel (palpate) lymph nodes in the neck, armpits, elbows, and groin. They check the size, tenderness, firmness, and whether the nodes are freely movable or fixed. In cat-scratch disease, the nodes near the scratch are usually enlarged, tender, and mobile. This physical test helps distinguish typical cat-scratch lymphadenitis from other causes such as lymphoma or metastatic cancer, which often feel harder and more fixed. NCBI+2Merck Manuals+2
4. Eye and ear examination
If a patient has red eye, eye pain, or vision changes, the doctor examines the eye with a light and sometimes with an ophthalmoscope to view the retina and optic nerve. They also check lymph nodes in front of the ear and near the jaw. This exam looks for signs of Parinaud oculoglandular syndrome or neuroretinitis related to cat-scratch disease. Such findings guide the choice of further tests and urgent eye care. CDC+2NCBI+2
5. Abdominal examination
In patients with prolonged fever or abdominal pain, the doctor gently presses on the abdomen to feel for enlargement of the liver or spleen. Tenderness or fullness in the upper abdomen may suggest hepatosplenic cat-scratch disease, where small abscesses form in these organs. This simple exam helps decide whether imaging tests like ultrasound or CT scans are needed. CDC+2CDC+2
Manual tests
6. Range-of-motion test of nearby joints
If lymph nodes near a joint (such as the armpit or groin) are swollen and painful, the doctor may gently move the nearby shoulder, arm, or leg to check range of motion and pain level. Limited movement or severe pain may suggest significant inflammation or abscess formation. This helps assess how much the swollen nodes affect function and whether drainage or stronger treatment may be needed. NCBI+2MSD Manuals+2
7. Bedside neurologic examination
When a patient has headache, confusion, seizures, or weakness, the doctor performs a manual neurologic exam. This includes checking mental state, eye movements, strength, reflexes, sensation, and coordination. Abnormal findings may indicate brain or nerve involvement from cat-scratch disease, such as encephalopathy or neuropathy, and prompt urgent imaging or electrodiagnostic studies. CDC+2NCBI+2
8. Pain and functional impact assessment
The clinician may ask the patient to rate pain in swollen lymph nodes or affected areas and to describe how it affects daily activities like lifting objects, walking, or sleeping. While this is not a lab test, it is a structured clinical assessment that guides decisions about pain control, possible drainage of nodes, and the intensity of follow-up. It also helps monitor improvement over time. NCBI+2MSD Manuals+2
Lab and pathological tests
9. Complete blood count (CBC)
A CBC measures white blood cells, red blood cells, and platelets. In cat-scratch disease, results may be normal or show mild changes such as slight white blood cell elevation or anemia, especially in long-lasting or systemic cases. While CBC does not prove the diagnosis, it helps rule out other serious causes of lymph node swelling, such as leukemia or other infections, and provides a baseline for monitoring. NCBI+2AAFP+2
10. Inflammation markers (ESR and CRP)
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are blood tests that measure inflammation. They are often elevated in cat-scratch disease, especially in hepatosplenic or bone involvement. However, these markers are non-specific and can be raised in many infections or inflammatory conditions. They are useful as supportive evidence and for tracking treatment response but cannot alone confirm the diagnosis. NCBI+2AAFP+2
11. Bartonella henselae serology (IgG and IgM)
Serologic tests look for antibodies (IgG and IgM) against Bartonella henselae in the blood, usually by indirect immunofluorescence assay (IFA) or enzyme immunoassay (EIA). A high or rising antibody level supports the diagnosis of cat-scratch disease, especially when combined with compatible symptoms and cat exposure. Serology is widely used but not perfect: some patients with typical disease may have negative tests, and some healthy cat owners may have positive tests from past exposure. CDC+2Wiley Online Library+2
12. Bartonella henselae PCR testing
Polymerase chain reaction (PCR) testing detects Bartonella henselae DNA in blood, lymph node tissue, or other specimens. PCR can be highly specific and, when combined with histology and serology, improves diagnostic accuracy. However, sensitivity varies (for example, 30–60% in lymph node samples alone) and the test may be available only in specialized laboratories. PCR is especially helpful in atypical cases or when tissue is already being sampled for other reasons. Medscape+2PMC+2
13. Blood cultures
Blood cultures are used to grow bacteria from the bloodstream. Bartonella henselae is slow-growing and difficult to culture, so positive blood cultures are uncommon in typical cat-scratch disease but may occur in more severe forms, such as endocarditis. When Bartonella infection of heart valves or widespread infection is suspected, blood cultures are taken and held longer than usual (often more than 21 days) to allow growth. CDC+2UpToDate+2
14. Liver function tests
In patients with suspected liver or spleen involvement, doctors check liver enzymes such as AST, ALT, alkaline phosphatase, and bilirubin. Mild to moderate elevations may be seen in hepatosplenic cat-scratch disease. These lab changes are non-specific but, together with imaging showing liver or spleen lesions, they support the diagnosis and help monitor recovery. CDC+2CDC+2
15. Lymph node biopsy with histology
If the diagnosis is uncertain or there is concern about cancer or other causes of lymphadenopathy, a lymph node biopsy may be performed. Pathologists examine the tissue under a microscope. Cat-scratch disease typically shows granulomas with central areas of pus (suppurative granulomas). Special stains such as Warthin–Starry silver stain and immunohistochemistry can highlight Bartonella organisms. This test can confirm cat-scratch disease and help rule out other infections or malignancies. Merck Manuals+2CDC+2
Electrodiagnostic tests
16. Electrocardiogram (ECG)
When heart involvement is suspected, an electrocardiogram is performed to measure the heart’s electrical activity. It can show rhythm changes, conduction problems, or signs of heart strain that may occur in endocarditis or myocarditis related to Bartonella infection. While ECG does not diagnose cat-scratch disease by itself, it is important for detecting cardiac complications that may require urgent treatment. UpToDate+2CDC+2
17. Electroencephalogram (EEG)
In patients with seizures or confusion due to suspected cat-scratch encephalopathy, an EEG records the brain’s electrical activity. It may show abnormal wave patterns that support the presence of brain irritation or inflammation. EEG findings, together with neurologic exam and brain imaging, help doctors confirm that neurologic symptoms are real and guide decisions about anti-seizure treatment and further testing. CDC+2NCBI+2
Imaging tests
18. Ultrasound of lymph nodes, liver, or spleen
Ultrasound uses sound waves to create pictures of internal structures. It can show enlarged lymph nodes, fluid collections, or abscesses that may be present in cat-scratch disease. In hepatosplenic forms, ultrasound can reveal multiple small lesions in the liver or spleen. This test is painless, has no radiation, and is often the first imaging study chosen for children with prolonged fever and suspected organ involvement. CDC+2CDC+2
19. CT scan of chest, abdomen, or affected regions
Computed tomography (CT) scans use X-rays to create detailed cross-sectional images. CT can detect deep lymph nodes, liver and spleen abscesses, bone lesions, or other organ involvement that might not be visible on physical exam or ultrasound. In complex or atypical cat-scratch disease, CT helps doctors map the extent of infection and rule out cancer or other serious conditions with similar imaging findings. CDC+2CDC+2
20. MRI or CT of brain and eyes
If neurologic symptoms or eye problems are present, MRI or CT scans of the brain and orbits (eye sockets) may be performed. MRI is especially good at showing inflammation in the brain, optic nerve, or retina, such as in neuroretinitis or encephalitis. These images, combined with history of cat exposure and positive serology or PCR for Bartonella henselae, help confirm that cat-scratch disease is the cause of the neurologic or ocular findings. CDC+2UpToDate+2
Non-pharmacological (non-drug) treatments
1. Rest and activity pacing
Rest helps the body focus energy on fighting Bartonella henselae instead of heavy physical work or intense exercise. Simple activities like walking around the house are fine, but sports, long runs, or heavy lifting can worsen fatigue and fever. Pacing means doing small tasks, taking breaks, then doing more only if you feel well. This gentle pattern supports the immune system and avoids over-stress on the heart and lungs while swollen lymph nodes and fever are present.
2. Adequate hydration (drinking enough fluids)
Fever, sweating, and poor appetite can make you lose fluid. Drinking water, oral rehydration solutions, clear soups, or herbal teas keeps blood volume stable and helps the kidneys clear toxins and inflammation by-products. Good hydration can reduce headache and light-headedness that often come with fever. In children, checking that they pass urine regularly and that the mouth is moist is a simple way to monitor hydration at home while recovering from cat-scratch disease.
3. Local warm compress over painful lymph nodes
Applying a warm, damp cloth over the tender, swollen lymph node for 10–15 minutes several times a day can gently improve blood flow and comfort. Heat relaxes nearby muscles, which reduces pain and stiffness. It may also speed resorption of inflammatory fluid around the node. This simple home measure is often suggested as first-line symptom control in mild cat-scratch disease, together with oral pain relief if needed. Compresses should be warm, not hot, to avoid burns.
4. Gentle limb elevation
When lymph nodes in the armpit or groin are swollen, raising the arm or leg on a pillow can help lymphatic drainage. Gravity helps fluid move away from the inflamed node, which may reduce pressure and discomfort. For example, a person with axillary (armpit) nodes can rest with the arm supported on cushions above chest level while sitting or lying. This is a common supportive strategy in lymphatic conditions and is safe when used together with medical monitoring.
5. Careful skin and wound hygiene at the scratch site
The first papule or small blister where the cat scratched or bit is the entry point for Bartonella henselae. Washing the area immediately and then at least once daily with mild soap and running water helps remove bacteria and flea dirt from the skin. Keeping the area clean and dry reduces the risk of secondary bacterial infection by other germs such as Staphylococcus and Streptococcus, which can complicate cat bites and scratches.
6. Avoiding further trauma and scratching of the lesion
Itching around the papule or scab is common and may tempt patients to scratch. Scratching breaks the skin barrier again and can push bacteria deeper or introduce new germs from under the fingernails. Using trimmed nails, cotton gloves for children at night, and distraction techniques can help. A small clean bandage may be used if the child keeps picking at the spot, as long as the dressing is changed daily.
7. Hand-washing after handling cats
Regular hand-washing with soap and water after playing with a cat removes flea dirt, cat saliva, and bacteria from the hands before they can reach broken skin, the eyes, or the mouth. Hand hygiene is one of the centerpieces of prevention and also reduces re-exposure while the person is still recovering. For families, teaching children to wash hands after playtime with pets is a simple but powerful routine.
8. Environmental flea control for the cat and home
Because Bartonella henselae spreads among cats through cat fleas (Ctenocephalides felis), controlling fleas reduces bacterial load in the cat and lowers the chance of future human infection. Veterinarians recommend approved flea control products, regular combing, washing bedding, and frequent vacuuming of carpets and furniture. This is not a direct treatment for the sick person, but it prevents new scratches from highly contaminated claws and is strongly recommended in public health guidance.
9. Sleep optimization and stress reduction
Sleep is essential for immune regulation and antibody production. Poor sleep and chronic stress can weaken infection control and prolong recovery time. Creating a quiet, dark room, avoiding screens before bed, and using relaxation methods such as slow breathing or meditation can improve sleep quality. In children, a predictable evening routine and comfort from caregivers reduce anxiety about swollen nodes or fever and support healing.
10. Gentle range-of-motion exercises
Painful nodes in the armpit, neck, or groin can make people hold the joint stiffly, which may cause secondary muscle tightness. Once fever is settling, very gentle shoulder, neck, or hip movements within pain-free limits can keep joints flexible and maintain blood flow. These should never be forced or done if they worsen pain or cause dizziness, but when well tolerated they reduce stiffness from guarding.
11. Cool compresses for fever and headache
Some people prefer cool, damp cloths on the forehead or back of the neck when fever is high. Cool compresses do not cure the infection but can make the person feel more comfortable and may slightly lower skin temperature. They are often used alongside oral fluids and rest, especially when trying to delay or reduce the dose of pain medicines in small children or people who are sensitive to drugs.
12. Symptom diaries and self-monitoring
Keeping a simple diary of temperature, pain level, node size, and any new symptoms helps both the patient and doctor see if the illness is improving or getting worse. In cat-scratch disease, most uncomplicated cases improve over 2–4 weeks; persistent or rapidly worsening findings can be a warning sign of complications such as liver, eye, or brain involvement that need urgent medical review.
13. Psychological support and reassurance
Large, visible lymph nodes in the neck or armpit can be frightening, and some patients fear cancer. Calm explanation that cat-scratch disease is usually benign and self-limited helps reduce anxiety. For children, simple stories and age-appropriate explanations can improve cooperation with examinations and procedures such as blood tests or ultrasound. In immunocompromised patients, psychological support can help them cope with worry about more serious complications.
14. School or work adjustments
Short-term adjustments like reduced hours, lighter duties, or skipping sports can prevent over-fatigue while fever and tenderness are present. For children, a note to teachers explaining that the child may be tired or sore can prevent misunderstandings. These practical changes allow the immune system to recover while maintaining social contact, which supports mental health.
15. Avoiding alcohol and smoking
Alcohol and smoking both stress the immune system and harm blood vessels. During any acute infection, including cat-scratch disease, avoiding these substances may help the body fight bacteria more effectively and reduces the risk of interactions with medicines like antibiotics or painkillers that can affect the liver or stomach.
16. Sun protection for photosensitive patients on antibiotics
Some antibiotics used for Bartonella, such as doxycycline and certain fluoroquinolones, can make the skin more sensitive to sunlight and cause sunburn. Wearing broad-brimmed hats, long sleeves, and using sunscreen reduces this risk. In sunny climates, this is important even for short outdoor trips. Sun protection is part of safe non-drug care whenever photosensitizing medications are used.
17. Use of supportive devices (slings or soft supports)
If swollen axillary lymph nodes make arm movement painful, a simple short-term arm sling can rest the area and reduce tension on tender tissues. The sling should be used only for a limited time each day to avoid stiffness. A physiotherapist or clinician can show how to use it safely. This is a comfort measure rather than a cure but can greatly improve day-to-day functioning for some patients.
18. Cool, loose clothing
Wearing loose cotton clothing and avoiding tight collars, bras, or waistbands around swollen nodes reduces rubbing and mechanical irritation. Breathable fabrics also help control sweating during fever and may reduce skin breakdown or secondary bacterial infection over the lymph node area.
19. Veterinary evaluation of the cat
Taking the cat to a veterinarian for assessment and flea control helps break the flea–cat–human transmission cycle. Vets may perform blood tests for Bartonella where available and advise on indoor housing and flea treatments. This does not directly treat the already infected person, but it reduces recurrent exposure in families with multiple cats or immunocompromised members.
20. Education of family members and caregivers
Teaching everyone in the household about gentle play with cats, prompt washing of scratches, and the importance of not allowing cats to lick open wounds greatly reduces spread. Clear education is part of public health guidance for cat-scratch disease and is especially important in homes with young children, elderly people, or those with weakened immunity.
Drug treatments –
Antibiotic use in cat-scratch disease is controversial. Many uncomplicated cases in healthy people recover without antibiotics. Antibiotics are more often used when lymph node pain is severe, disease is prolonged, or when there are atypical or disseminated complications, particularly in immunocompromised patients. Always follow specialist infectious-disease advice.
1. Azithromycin
Azithromycin is a macrolide antibiotic often considered first-line when antibiotics are chosen for typical cat-scratch disease. A randomized trial showed that a 5-day course (500 mg on day 1, then 250 mg daily for 4 days in adults) reduced lymph node size faster than placebo, although it did not change long-term outcomes. Azithromycin works by blocking bacterial protein synthesis and has good intracellular penetration, which is helpful for Bartonella. Common side effects include nausea, diarrhea, and, rarely, heart rhythm problems; the FDA label highlights the risk of QT prolongation.
2. Doxycycline
Doxycycline is a tetracycline-class antibiotic used for more severe or atypical Bartonella infections, such as neuroretinitis (eye involvement) or central nervous system disease, often in combination with rifampin. It inhibits bacterial protein synthesis and penetrates tissues well. Typical adult regimens for serious Bartonella infections use 100 mg twice daily, but exact dose and duration must be individualized by specialists. Common side effects include photosensitivity, esophageal irritation, and stomach upset; pregnancy and young children require special caution.
3. Rifampin (rifampicin)
Rifampin is a rifamycin-class antibiotic that blocks bacterial RNA synthesis. It is often combined with doxycycline or macrolides for severe Bartonella disease, especially central nervous system or endocarditis, because of good tissue penetration and synergy. Adult doses for serious infections are commonly around 300–600 mg twice daily, adjusted for weight and liver function. Rifampin strongly induces liver enzymes, which can reduce the effect of many other drugs, including some antivirals and contraceptive pills. It can cause orange discoloration of body fluids and carries a risk of liver injury, as highlighted in FDA labeling.
4. Erythromycin
Erythromycin is another macrolide antibiotic historically used to treat Bartonella infections and bacillary angiomatosis. It inhibits bacterial protein synthesis and is generally given several times daily due to a shorter half-life. For Bartonella, dosing and duration are tailored to severity and organ involvement. Gastrointestinal side effects (nausea, abdominal pain, diarrhea) are common, and drug interactions via CYP3A4 must be considered. Although less commonly used now than azithromycin or clarithromycin, it remains an option in some settings.
5. Clarithromycin
Clarithromycin is a macrolide similar to azithromycin that shows in-vitro and clinical activity against Bartonella henselae. It interferes with bacterial protein synthesis and is often dosed twice daily in adults. Clarithromycin may be used as an alternative when azithromycin is not suitable, sometimes in combination with rifampin for complicated infections. Side effects include taste disturbance, gastrointestinal upset, and potential QT prolongation; the FDA label also warns about drug interactions, especially with statins and anti-arrhythmic drugs.
6. Trimethoprim–sulfamethoxazole (co-trimoxazole, TMP-SMX)
TMP-SMX is a combination antibiotic (a sulfonamide plus trimethoprim) that blocks bacterial folate metabolism. It is active against many gram-negative organisms and is sometimes used as an alternative for Bartonella, particularly in mixed infections or in patients who cannot take macrolides or tetracyclines. Typical adult oral doses for other infections are one double-strength tablet (160/800 mg) twice daily, but appropriate use for cat-scratch disease must be guided by a doctor. Side effects include allergic rashes, photosensitivity, kidney effects, and bone-marrow suppression, described in FDA product labeling.
7. Gentamicin
Gentamicin is an aminoglycoside antibiotic used mainly intravenously for severe systemic Bartonella infections, such as endocarditis, often combined with doxycycline or a β-lactam. It binds bacterial ribosomes and is rapidly bactericidal but must be carefully dosed by weight and kidney function due to risks of kidney damage and hearing loss. Courses are usually short (for example, 1–2 weeks) as part of a longer combination regimen. FDA labeling stresses the need for drug-level monitoring and careful assessment of renal function.
8. Ciprofloxacin
Ciprofloxacin is a fluoroquinolone antibiotic with activity against various gram-negative bacteria and some intracellular pathogens. In vitro and clinical reports suggest that fluoroquinolones have activity against Bartonella, and ciprofloxacin may be considered as a second-line or adjunct treatment in selected severe cases, especially when other options cannot be used. Adult dosing typically ranges around 500–750 mg orally twice daily for serious infections, adjusted by renal function. Side effects include tendon problems, neuropathy, CNS effects, and QT prolongation, all emphasized in FDA boxed warnings.
9. Ceftriaxone
Ceftriaxone is a third-generation cephalosporin β-lactam antibiotic often given by IV or IM injection. It is not first-line for uncomplicated cat-scratch disease but may be part of combination regimens for severe disseminated Bartonella infections, including endocarditis, based on small series and expert recommendations. Ceftriaxone interferes with bacterial cell wall synthesis. It is commonly dosed once daily in adults for other serious infections; dosing for Bartonella is individualized. Side effects include allergic reactions, biliary sludging, diarrhea, and, rarely, blood abnormalities as described in FDA labeling.
10. Amoxicillin–clavulanate (Augmentin)
Amoxicillin–clavulanate combines a penicillin-class antibiotic (amoxicillin) with a β-lactamase inhibitor (clavulanate). It is not highly active against Bartonella henselae itself but is widely used to prevent or treat mixed bacterial infections following cat bites or deep scratches, which can involve Pasteurella, streptococci, and anaerobes. Adult dosing for bite prophylaxis commonly uses 875/125 mg twice daily, but regimens are tailored to indication and kidney function. Side effects include diarrhea, allergic reactions, and, occasionally, liver injury; these are clearly noted in FDA labeling.
11. Ibuprofen
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and fever associated with cat-scratch disease. It does not treat the bacteria but makes patients more comfortable while the immune system clears the infection. Typical over-the-counter adult doses are 200–400 mg every 4–6 hours, with a maximum daily dose specified on the label. Side effects include stomach irritation, ulcer risk, kidney strain, and, with long-term high-dose use, increased cardiovascular risk, which are highlighted in FDA warnings.
12. Acetaminophen (paracetamol)
Acetaminophen is a widely used pain reliever and fever reducer with fewer stomach side effects than NSAIDs. It is helpful for headaches, muscle pains, and fever in cat-scratch disease and can be used alone or alternated with ibuprofen under medical advice. It has no direct antibacterial effect. Adult dosing usually should not exceed 4,000 mg per day, and labels now stress avoiding multiple products that contain acetaminophen to reduce the risk of liver damage.
13. Naproxen
Naproxen is another NSAID with a longer duration of action than ibuprofen, sometimes used for persistent lymph node pain. It reduces prostaglandin production and thus helps decrease inflammation and tenderness. Adult dosing schedules vary by brand and formulation; typical total daily doses range from 500–1,000 mg in divided doses, following label and prescriber instructions. Side effects and warnings are similar to other NSAIDs: risk of GI bleeding, kidney damage, and cardiovascular events, especially at higher doses or with long-term use.
14. Tramadol (with great caution)
Tramadol is an opioid-like pain reliever reserved for severe pain that is not controlled by acetaminophen or NSAIDs, and only under strict medical supervision. It acts on opioid receptors and also affects serotonin and norepinephrine pathways. Because of risks of dependence, overdose, seizures, and serotonin syndrome, recent FDA labeling carries strong warnings. Doses and duration must be minimized; in many cat-scratch cases it is not needed at all.
15. Prednisone (steroid – only for selected complications)
Prednisone is a corticosteroid that suppresses inflammation and immune activity. It is not routine treatment for typical cat-scratch disease but has been used, together with antibiotics, in serious complications such as neuroretinitis or severe inflammatory reactions, under specialist supervision. Because steroids can worsen infections if misused, dosing, tapering, and duration must be carefully controlled, and they should never be started without clear medical indication.
16. Doxycycline plus rifampin combination
For severe systemic Bartonella infections (for example, involving the brain, heart valves, or liver), experts often recommend combination therapy with doxycycline and rifampin because of their complementary penetration and bactericidal activity. Regimens can last several weeks to months, especially in endocarditis. Side effects include those of both drugs (photosensitivity, GI upset, liver toxicity, drug interactions) and therefore require close monitoring with blood tests and specialist follow-up.
17. Azithromycin plus rifampin
In some severe or refractory Bartonella cases, azithromycin is combined with rifampin to enhance intracellular killing and reduce the chance of resistance, based on laboratory and clinical experience. This combination is not usually needed for uncomplicated cat-scratch disease but may be considered in complicated cases. Both drugs share risks of liver toxicity and drug interactions, so liver function and co-medications must be reviewed carefully.
18. Doxycycline plus gentamicin
For Bartonella endocarditis and some serious systemic infections, guidelines support combinations of doxycycline with a short course of gentamicin, especially during the initial high-bacterial-load phase. Gentamicin adds rapid bactericidal activity but increases the risk of kidney and ear toxicity, so it is usually given for only 1–2 weeks with close monitoring. Afterward, doxycycline (with or without another agent) may continue for a longer period to eradicate bacteria.
19. Antiretroviral therapy in HIV-positive patients
In people with AIDS and Bartonella-related conditions such as bacillary angiomatosis or peliosis, effective antiretroviral therapy is essential to restore immune function and prevent relapses. These drugs are not specific to cat-scratch disease but are crucial background therapy when Bartonella infection occurs in the setting of advanced HIV. Regimens are highly individualized, and careful attention to drug–drug interactions with Bartonella antibiotics is required.
20. Other supportive medications (anti-nausea, anti-itch)
During treatment, doctors may prescribe anti-nausea medicines for patients who cannot tolerate antibiotics, or topical agents and oral antihistamines for itching around the scratch site. These drugs do not treat Bartonella directly but improve comfort and adherence to therapy. Choices depend on age, other diseases, and drug interactions, and must follow standard prescribing information and local guidelines.
Dietary molecular supplements
Evidence for supplements in cat-scratch disease specifically is very limited. Most data relate to general immune function or other infections. Always discuss supplements with a clinician, especially if taking prescription medicines.
1. Vitamin D
Vitamin D is a fat-soluble vitamin that supports bone health and modulates both innate and adaptive immunity. Low vitamin D status is linked to increased risk of several infections and autoimmune diseases. Typical maintenance doses for adults often range from 600–2,000 IU per day, but higher doses may be used short-term under medical supervision in deficiency. Vitamin D helps immune cells produce antimicrobial peptides and regulate inflammatory responses. Too much vitamin D can cause high calcium levels and kidney damage, so dosing must not exceed medical advice.
2. Zinc
Zinc is an essential trace mineral involved in hundreds of enzymes, DNA repair, and immune cell function. Supplementation has been shown to modestly shorten the duration of common colds and other viral illnesses when taken early, although results are mixed. Typical short-term immune-support doses for adults are around 15–30 mg elemental zinc daily; very high doses (>75–100 mg/day) can cause copper deficiency and other side effects. Zinc may support overall immune resilience during infections like cat-scratch disease but is not a substitute for medical treatment.
3. Vitamin C (ascorbic acid)
Vitamin C is a water-soluble antioxidant that helps protect cells from oxidative stress and supports neutrophil function and collagen synthesis. It may slightly shorten the duration of common cold symptoms in some people, though it does not prevent most infections. Typical supplemental doses range from 200–1,000 mg per day, with higher doses potentially causing diarrhea or stomach upset. For cat-scratch disease, vitamin C can be viewed as a general immune-support nutrient within a balanced diet rich in fruits and vegetables.
4. Omega-3 fatty acids (fish oil)
Omega-3 fatty acids from fish oil (EPA and DHA) have anti-inflammatory effects by altering cell membrane composition and eicosanoid production. They may help modulate excessive inflammation and support cardiovascular health. While not specific for Bartonella, omega-3s may improve overall recovery and well-being in people with chronic inflammatory states. Typical supplemental doses for general health often range around 250–1,000 mg combined EPA/DHA daily, but higher doses may increase bleeding risk and should be discussed with a clinician, especially in patients on anticoagulants.
5. Probiotics
Probiotic supplements contain live beneficial bacteria that can help maintain a healthy gut microbiome, which is closely linked to immune function. Antibiotics used for Bartonella can disrupt gut flora and cause diarrhea; probiotics may reduce antibiotic-associated diarrhea and support mucosal immunity. Strains such as Lactobacillus and Bifidobacterium are commonly studied. Doses are often expressed in billions of colony-forming units (CFU) per day. People with severe immune compromise or central venous catheters should only use probiotics under specialist guidance, as rare bloodstream infections have been reported.
6. Selenium
Selenium is a trace element important for antioxidant enzymes (selenoproteins) and immune modulation. Deficiency can impair immune responses to infections. Supplementation in low-selenium areas may enhance antiviral defense and reduce oxidative stress. Typical supplemental doses are 50–100 mcg per day; chronic very high intake can cause hair loss, nail changes, and neurologic symptoms. Selenium’s potential role in bacterial infections is indirect, through general immune support rather than specific anti-Bartonella activity.
7. B-complex vitamins
B vitamins (particularly B6, B9/folate, and B12) are central to energy metabolism, red blood cell formation, and immune cell function. Inadequate intake can lead to fatigue and weakened immune responses. A balanced B-complex supplement providing roughly 100% of daily recommended intake may support overall resilience during infection and recovery. Extremely high doses of certain B vitamins (like B6) can cause side effects such as nerve damage, so megadoses should be avoided without medical supervision.
8. N-acetylcysteine (NAC)
NAC is a precursor to glutathione, a key intracellular antioxidant. It has mucolytic properties and is used medically for acetaminophen overdose and some chronic lung diseases. As a supplement, NAC may support detoxification and modulate inflammatory responses by replenishing glutathione stores. Typical supplemental doses range from 600–1,200 mg per day. Side effects include nausea and, rarely, allergic-type reactions. Evidence in bacterial infections includes improved oxidative balance rather than direct antibacterial effects.
9. Curcumin (from turmeric)
Curcumin is a polyphenol from turmeric with anti-inflammatory and antioxidant properties. It modulates several molecular targets involved in inflammation and may help reduce pain and swelling in general inflammatory conditions. Bioavailability can be low, so many products combine curcumin with piperine or use enhanced formulations. Typical supplemental doses range from 500–1,000 mg daily of curcuminoids. It may thin the blood slightly and interact with some medications, so caution is needed before combining with anticoagulants or high-dose NSAIDs.
10. Quercetin
Quercetin is a plant flavonoid found in onions, apples, and berries, with antioxidant and anti-inflammatory effects. It can modulate immune cell signaling and stabilize mast cells, which may help with allergy-type symptoms. As a supplement, doses of 250–1,000 mg per day have been used in research on respiratory infections. Evidence is still emerging, and there are no specific data for cat-scratch disease, so quercetin should be considered an optional supportive nutrient, not a core therapy.
Immune-boosting / regenerative / stem-cell–related drugs
For cat-scratch disease, there are no standard “stem cell drugs” or specific regenerative medicines used in routine care. The options below are general immune-modulating or hematologic therapies sometimes relevant in severe or underlying immune problems, and they must only be used in specialist settings.
1. Intravenous immunoglobulin (IVIG)
IVIG is a pooled antibody product given by infusion to support or modify the immune response in certain immune deficiencies and autoimmune conditions. It supplies a broad range of antibodies and can neutralize pathogens or dampen autoantibodies. Dosing is weight-based and carefully individualized; side effects include headache, infusion reactions, and, rarely, thrombosis. IVIG is not a standard treatment for uncomplicated cat-scratch disease but may be considered in complex immune-related situations under specialist care.
2. Granulocyte colony-stimulating factor (G-CSF, filgrastim)
G-CSF is a growth factor that stimulates the bone marrow to produce more neutrophils. It is used in neutropenia due to chemotherapy or bone-marrow disorders, helping reduce the risk of severe bacterial infections. Dosing depends on indication and weight, and is monitored with blood counts. Typical side effects include bone pain and, rarely, spleen enlargement. In cat-scratch disease, G-CSF is not routine therapy but might be relevant if the patient has severe underlying neutropenia plus a Bartonella infection.
3. Interferon-γ
Interferon-γ is an immune signaling protein used in some chronic granulomatous disease and atypical mycobacterial infections to enhance macrophage function. It modulates intracellular killing of pathogens but carries risks of flu-like symptoms, liver enzyme elevation, and other side effects. It is not standard for cat-scratch disease and would only be considered in very specific immune defects in consultation with immunology specialists.
4. Hematopoietic stem-cell transplantation (HSCT)
HSCT replaces diseased bone marrow with healthy stem cells in conditions like severe primary immunodeficiencies or hematologic cancers. It can indirectly improve the ability to fight infections, including Bartonella, but is a major procedure with high risk and complex conditioning regimens. HSCT is never performed solely for cat-scratch disease; it is mentioned here only as an example of a regenerative therapy that can change infection risk in patients with serious underlying blood disorders.
5. Nutritional “immune support” under dietitian supervision
In some chronic or complicated infections, dietitians may prescribe specialized high-protein, micronutrient-rich oral formulas to support tissue repair and immune function. These are not drugs in the strict sense, but medically supervised nutrition support strategies that can be crucial for healing in undernourished patients. Calorie and protein targets are calculated individually, and formulas may be enriched with omega-3s, vitamins, and trace elements.
6. Future experimental therapies
Research is exploring cell-based and biologic therapies that modulate host immunity to intracellular bacteria, but these remain experimental and are not standard care for cat-scratch disease. Clinical trials may investigate ways to boost specific immune pathways or repair tissue damage after severe infection. Participation in such trials is tightly regulated, and decisions must be made with specialist teams and ethics approval.
Surgical and interventional procedures
1. Needle aspiration of a fluctuant lymph node
When a lymph node becomes very swollen, painful, and filled with pus (suppurative lymphadenitis), a doctor may use a needle and syringe to aspirate some of the pus under local anesthesia. This can relieve pain quickly and may reduce the risk of spontaneous rupture, while also allowing samples for culture or PCR testing. Needle aspiration is less invasive than open surgery and is often recommended before considering incision and drainage.
2. Incision and drainage of an abscessed node
If needle aspiration is not possible or fails, a surgeon may make a small incision over the node to drain pus and insert a temporary drain. This is usually done under anesthesia in sterile conditions. The aim is to control local infection, relieve pain, and prevent spreading infection to nearby tissues. It is reserved for clearly fluctuant nodes or when less invasive measures have not worked.
3. Excisional biopsy of persistent lymphadenopathy
In some patients, a lymph node remains enlarged for months or has features that raise concern for lymphoma, tuberculosis, or other diseases. In these cases, surgeons may remove the node completely for detailed histopathology. This procedure both provides a firm diagnosis and, sometimes, symptom relief. It is performed under local or general anesthesia depending on location and patient factors.
4. Surgical management of Bartonella endocarditis
In rare cases, Bartonella can infect heart valves, causing endocarditis. When valves are severely damaged or heart failure develops, cardiac surgeons may need to repair or replace the affected valve in addition to long courses of antibiotics. The goals are to eradicate infection and restore normal blood flow. These operations are major procedures requiring intensive care and close follow-up.
5. Neurosurgical or ophthalmic procedures for severe complications
Very rarely, cat-scratch disease can cause brain abscesses or severe eye complications. In such situations, neurosurgeons may drain abscesses, and ophthalmologists may perform procedures to manage retinal detachment or vitreous hemorrhage. These interventions are highly specialized and are always combined with targeted antibiotic therapy.
Key prevention strategies
Control fleas on cats using veterinarian-approved products, flea combs, and regular cleaning of the home environment.
Keep cats indoors as much as possible so they are less exposed to fleas and wild animals that may carry Bartonella.
Avoid rough play with cats, especially kittens, that might lead to scratches or bites. Teach children to play gently and never tease cats.
Wash any cat scratch or bite immediately with soap and running water, and apply a clean bandage if needed.
Do not let cats lick open wounds or broken skin, including eczema, cuts, or surgical sites.
Immunocompromised people should avoid young stray cats and consider adopting older, healthy indoor cats instead.
Practice regular hand hygiene after handling cats, cleaning litter boxes, or gardening where cats roam.
Educate children and caregivers about signs of cat-scratch disease and when to seek medical care if fever or big lymph nodes appear.
Avoid adopting or handling cats with heavy flea infestations until they have been treated and cleaned by a veterinarian.
Maintain general health with vaccines, good nutrition, adequate sleep, and regular medical check-ups to keep the immune system strong, especially in people with chronic diseases.
When to see a doctor
You should see a doctor promptly if you or your child:
Develops a tender, swollen lymph node near a cat scratch or bite along with fever, especially lasting more than a few days.
Has very large, red, or extremely painful nodes, or nodes that feel soft and fluctuant like a fluid-filled sac (possible abscess).
Experiences persistent fever, weight loss, night sweats, or extreme fatigue, which may signal more serious infection or another disease such as lymphoma or tuberculosis.
Notices eye symptoms such as blurred vision, dark spots, or pain with eye movement, which could indicate neuroretinitis or other ocular complications.
Develops severe headache, confusion, seizures, or weakness, suggesting possible nervous-system involvement that needs urgent imaging and specialist review.
Has chest pain, shortness of breath, or new heart murmurs, which may be signs of endocarditis or heart involvement.
Is pregnant, very young, elderly, or immunocompromised (for example, HIV, cancer therapy, transplant, long-term steroids) and develops any symptoms after a cat scratch or bite.
In emergencies (trouble breathing, seizures, sudden vision loss, confusion, or chest pain), seek emergency medical care immediately.
What to eat and what to avoid
Eat a balanced, nutrient-dense diet with fruits, vegetables, whole grains, legumes, lean protein, and healthy fats to provide vitamins, minerals, and energy that support immune and tissue repair functions.
Include protein-rich foods (fish, eggs, lentils, beans, tofu, lean meats) to help build antibodies and repair tissues affected by inflammation.
Choose vitamin C–rich foods like citrus fruits, guava, kiwi, berries, and leafy greens to support collagen formation and immune cell activity.
Include zinc-containing foods such as meat, poultry, pumpkin seeds, lentils, and chickpeas, which contribute to immune function alongside or instead of supplements.
Stay well hydrated with water, oral rehydration solutions, broths, and herbal teas to counter fever and decreased appetite. Avoid very sugary beverages, which can cause blood sugar spikes and may worsen fatigue.
Limit processed and fried foods high in trans fats, refined sugars, and salt, as they can promote inflammation and provide little nutritional value during recovery.
Avoid alcohol during illness and antibiotic therapy, because it can strain the liver, worsen dehydration, and interact with many drugs, including rifampin, doxycycline, and acetaminophen.
Be cautious with caffeine (strong tea, coffee, energy drinks) if you are already dehydrated or anxious, as it can increase heart rate and interfere with sleep, both of which may slow recovery.
Avoid raw or undercooked animal products (raw eggs, undercooked meat, unpasteurized milk) that can introduce other infections while your immune system is busy fighting Bartonella.
Consider small, frequent meals if appetite is low, focusing on easy-to-digest foods like soups, soft rice, yogurt, and bananas, to maintain energy without overloading the digestive system.
Frequently asked questions
1. Is cat-scratch fever always serious?
No. In most healthy people, cat-scratch disease is mild and self-limited. A small papule appears at the scratch site, followed by swollen lymph nodes and low-grade fever that usually resolve over weeks without complications. However, serious disease can occur, especially in immunocompromised patients, children, or when organs like the eye, brain, or heart are involved, so medical assessment is still important.
2. Do all people scratched by cats get cat-scratch disease?
No. Many cat scratches heal without any systemic illness. Infection depends on whether the cat is carrying Bartonella henselae, the presence of flea contamination, and factors such as the depth of the scratch and the person’s immune status. Immediate washing of the wound may reduce the risk further.
3. Can indoor cats cause cat-scratch disease?
Yes, but the risk is generally lower if indoor cats are free of fleas, kept healthy, and do not interact with stray animals. Kittens, especially with flea infestations, are more likely to carry Bartonella in their blood and transmit it through scratches.
4. Do I always need antibiotics for cat-scratch disease?
Not always. Many uncomplicated cases resolve without antibiotics, and some guidelines suggest conservative management with symptomatic care alone in immunocompetent patients. Antibiotics like azithromycin may speed reduction in lymph node size and are more strongly considered in severe, prolonged, or atypical cases or in immunocompromised patients. Your doctor will decide based on your overall situation.
5. How long does cat-scratch disease usually last?
The initial papule appears within days of the scratch, and lymph node swelling typically starts 1–3 weeks later. Lymph nodes can remain enlarged for several weeks to a few months, even after fever and general symptoms have resolved.
6. Can cat-scratch disease come back?
Re-infection is possible if you are scratched again by a cat carrying Bartonella henselae, especially if flea control is poor. However, long-term relapse from the same episode in immunocompetent people is uncommon. Preventive measures with flea control and careful handling of cats are important to lower recurrence risk.
7. Is cat-scratch fever contagious from person to person?
There is no strong evidence that cat-scratch disease spreads directly from person to person by casual contact, coughing, or kissing. The main source is an infected cat and its flea environment. However, general hygiene (hand-washing, not sharing personal items with open wounds) is still recommended.
8. Can I keep my cat if I have cat-scratch fever?
Most people can safely keep their cats. The focus is on treating the human illness, controlling fleas, and avoiding further scratches or bites. Immunocompromised individuals should discuss pet ownership with their clinicians and veterinarians, but permanent removal of the cat is not routinely required.
9. Are there vaccines for cat-scratch disease?
At present, there is no approved human vaccine against Bartonella henselae. Prevention depends on flea control, safe cat handling, and prompt wound care. Research into vaccines for Bartonella and related bacteria is ongoing, but nothing is yet available for routine use.
10. Can cat-scratch disease cause eye problems?
Yes. A well-known complication is neuroretinitis, where the optic nerve and retina become inflamed, leading to blurred vision or visual field defects. This usually requires urgent specialist evaluation, eye imaging, and combined antibiotic and sometimes steroid therapy. Any new visual changes in someone with cat-scratch disease should be treated as an emergency.
11. What about cat-scratch disease in pregnant people?
Data are limited, but any infection with fever during pregnancy should be evaluated carefully, as high fevers and systemic infection may affect both mother and fetus. Many standard Bartonella antibiotics (such as doxycycline) have pregnancy restrictions, so obstetric and infectious-disease specialists are needed to choose safe options and monitor closely.
12. Does cat-scratch disease mean my cat is “dirty” or badly cared for?
Not necessarily. Even well-cared-for cats can carry Bartonella henselae, especially if they were exposed to fleas earlier in life. The condition is common worldwide wherever cats and fleas are present. Responsible flea control, regular veterinary check-ups, and gentle handling greatly reduce but cannot completely eliminate risk.
13. How is cat-scratch disease diagnosed?
Diagnosis usually relies on clinical history (cat exposure and scratch), examination of characteristic lymphadenopathy, and exclusion of other causes. Supporting tests may include serology for Bartonella antibodies, PCR on tissue or blood, and sometimes lymph node biopsy when the diagnosis is uncertain or malignancy must be excluded.
14. Can other animals cause similar infections?
Yes. Dogs and other animals can carry related Bartonella species and may occasionally cause similar syndromes, although cats are the most common source for classic cat-scratch disease. Ticks and other arthropods can sometimes transmit Bartonella as well, so clinicians consider a broad list of possible exposures in unexplained lymphadenitis or fever.
15. What is the long-term outlook?
For most healthy people, the long-term prognosis is excellent, with complete recovery and no lasting problems once the infection has cleared. Rarely, people with severe complications (such as endocarditis, brain involvement, or serious eye disease) may have residual heart, neurologic, or visual deficits. Early recognition, appropriate antibiotics when indicated, and close follow-up improve outcomes in these severe cases.
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.
