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Cat Scratch Disease

Cat scratch disease (CSD), also called Cat Scratch Fever, is a bacterial infection passed on to people from cats that are infected with Bartonella henselae bacteria, one of the most common bacteria in the world. The Bartonella genus encompasses at least 11 species out of which 4 cause infections in human. They are responsbile for diseases such as bacillary Angiomatosis.

When the cat infected with Bartonella henselae bacteria scratches or bites the person or saliva of an infected cat enters an open sore or wound of the person, the bacteria gets transmitted causing cat scratch disease. Cats are believed to contract these bacteria from infected fleas and nearly 40 percent of cats carry the bacteria at some time in their life span. When compared to adult cats, kittens are more prone to carry the bacteria and transmit the disease. Cat's sharp teeth result in deep puncture wounds which can get serious infections if left untreated.


Symptoms

The first symptoms of cat scratch disease surface after three to 14 days of coming into contact with the infected cat. Cat scratch disease can cause serious symptoms in people with impaired immune system such as cancer patients and HIV patients. The infection may be fatal and lead to inflammation of brain, spleen, liver, lungs, and bone marrow. Hence such cases require immediate medical attention and early treatment in case of suspicion.


  • Papular lesion of the skin, at the site of the injury
  • Swelling of lymph nodes near the bite. Most often lymph nodes located under arms, groin or neck are affected.
  • Tired feeling
  • Headaches
  • Low-grade fever
  • Loss of appetite
  • Weight loss

Diagnosis

It is difficult to establish the diagnosis of cat scratch disease as causative bacteria cannot be easily cultured from human lymph node samples. Therefore diagnosis is done based on the history of contact with a cat and the presence of a scratch or primary lesion of the skin, eye or mucous membrane. Serological test and epidemiological, histological findings are taken into consideration before conforming the diagnosis.


Treatment

Cat scratch disease is self limiting and usually regresses over few weeks. The condition does not require antibiotic treatment unless the patient is suffering from weakened immune system. Analgesics along with local heat application are recommended to relieve the pain of enlarged lymph nodes.


Prevention

Cat scratch disease is not contagious from person to person. The bacteria is transmitted only by the scratch or bite of an infected cat, most often kitten. Keep your pet cats free of fleas. Avoid rough play with the cats. Scratches from cat, if any, should be washed immediately and cats should not be allowed to lick open wounds.


CAT scan

Computed Axial Tomography (CAT scan) is a process of using computers to generate three dimensional images from a flat two dimensional X rays pictures through the 'slice' technique. Aided by computer, cross-sectional views are generated and if needed three dimensional images of the internal organs and structures of the body. In CAT scan the body is seen in 'slices' from the skin to the central part of the body. When all the levels (slices) are added together, a three dimensional picture of an organ is obtained. Together the cross sections give a very accurate picture of where the tumor is and how big or small it is. They also show how close the major body organs are to the area that needs to be treated or operated upon. A CAT scan can be used to define both the normal and abnormal structures the body. It also helps as an accurate guide in placement of instruments and treatments for undergoing procedures.


  • The head is examined for trauma injuries, such as blood clots or skull fractures.
  • Spine is studied for any infections and to check the anatomy of intervertebral discs and spinal cord.
  • Density of the bone in evaluating osteoporosis is also accurately measured by CAT scan.
  • CAT scans are used in the chest to identify tumors, cysts or infections.
  • CAT scans of the abdomen are helpful in defining body organ anatomy, including visualizing liver, gall bladder, pancreas, spleen, aorta, kidneys, uterus and ovaries. Also CAT scans help to verify the presence or absence of tumors, infection, abnormal anatomy or changes in the body from trauma.
  • CAT scans help to guide the radiologist in performing certain procedures such as biopsyand suspected cancers, removal of internal fluids for various tests.

Many of the procedures in CAT scan are minimally invasive. CAT scan is very low risk procedure. The amount of radiation in CAT scan is very minimal. Unlike MRI, CT scans can be done even if the patient has a pace maker or an internal cardioverter defibrillator devices implanted into the chest to help regulate the heart beat. CAT scan may pose a potential risk to the fetus during the first trimester of pregnancy. Sometimes in contrast studies using iodine-based, there may be itching, a rash, hives or a feeling of warmth throughout the body. But these reactions tend to go away quickly. Very rarely does a more serious reaction occur during intravenous contrast studies. This anaphylactic reaction results in severe hives and/or difficulty in breathing.


Benefits of CAT Scan


  • Diagnose muscle and bone disorders such as bone tumors and fractures
  • Pinpoint the location of tumor, infection and blood clot
  • Guide certain procedures in surgery
  • Detect and monitor diseases such as cancer or heart disease
  • Detect internal injuries and internal bleeding.

Toxoplasmosis

Often pregnant mothers are warned to keep away from cats for fear of Toxoplasmosis, which spreads to human through cat feces. This can lead to severe health issues for the unborn baby. As a cat ingests an infected small animal such as a rodent, the protozoa invade cells of the cat's intestine. The parasite undergoes several developmental changes to become infective and gets released into the environment in cat feces. This parasite can invade another animal or human, as it buries into skeletal muscles, heart muscles and the brain. It forms cysts, and can stay there throughout her entire life. It is quite rare for humans to get Toxoplasmosis as house cats are not allowed outside and do not carry this parasite; wild cats or those that live outside and hunt are most likely to host toxoplasmosis parasite.


How does Toxoplasmosis spread ?

Toxoplasmosis can spread through:

Food, especially uncooked meats, pork, lamb which may carry toxo cysts.


  • Directly from cat feces

  • From contaminated water, from soil or water with toxo from kitty litter or feces - feral cats or trash disposal may be responsible.

  • Blood transfusion

  • Organ transplantation

  • Mother-to-child transmission, congenital infections

Though the parasite is not infectious until 1 to 5 days after being excreted by an infected cat, it can survive in the environment or litter box for over a year.


Symptoms of Toxoplasmosis

Most infected with the parasite toxoplasmosis show no signs or symptoms. Approximately 10 to 20% of patients will develop flu-like symptoms that can last several weeks or more. Some develop swollen glands, such as in the neck - cervical lymph nodes. Confusion, lack of coordination, seizures, trouble breathing and blurred vision are some other signs of toxoplasmosis. These symptoms can last for a month or more and resolve on their own. Those with weakened immune system are at a risk of developing:


  • Brain inflammation, causing headaches, seizures, confusion and coma

  • Lung infection, which can cause cough, fever, shortness of breath

An infected fetus may exhibit symptoms mild or quite serious. It can lead to miscarriage, stillbirth or birth abnormalities including enlargement or smallness of head. Toxoplasmosis in an unborn baby can be life threatening for the baby soon after birth. It can also infect the baby's eyes and lead to temporary or permanent loss. While most newborns with congenital toxoplasmosis appear normal at birth, it can develop signs and symptoms as they age. Hence, it is important to check the baby's brain and eyes.


Causes

The parasite causing Toxoplasmosis is T.gondii, which survives in contaminated meat that is raw or not thoroughly cooked. Drinking contaminated water, or in some rare cases, blood transfusion or a transplanted organ can cause toxoplasmosis. The parasite exists in feces and mostly found in feces of cat. This means, it can be found in some unwashed produce contaminated with manure. Wash your produce thoroughly to prevent toxoplasmosis.

In the US, although the parasite is found in nearly all warm-blooded animals, cats are the only hosts. The parasite's eggs only reproduce sexually in cats. And interestingly, cats do not show any symptoms of toxoplasmosis, though they are hosts. Those humans who ingest the parasite become infected with toxoplasmosis. This happens, most likely, when cleaning out a litter box without washing hands properly afterward. Pregnant woman are at an increased risk of passing toxoplasmosis to their unborn child and hence, it is important to ask someone else to take care of cat litter box during pregnancy. Protect hands with gloves and change cat litter box daily. And remember, the parasite is not infectious until one to five days, after it is shed.


Risk factors

Toxoplasmosis, though can infect anybody, is more severe in people whose immune systems are weakened, such as those with HIV. The infection can particularly be worrisome in pregnant woman.

Diagnosis

To diagnose Toxoplasmosis clinically could be difficult. A swollen lymph node may be the key to diagnosis, and diagnosis can be made if blood sample is sent specifically for toxoplasmosis. The blood test looks for antibodies against Toxoplasmosis and this specific antibody can help clinicians estimate when the infection occurred. Other diagnosis, though less common, includes microscopic examination of tissues or body fluids for presence of this parasite. Toxoplasma DNA in amniotic fluid is used to determine if the fetus is infected.


Treatment

Most healthy people recover without any treatment. Pregnant women and infants are usually treated with drugs – a combination of pyrimethamine (Daraprim) and sulfadiazine. Pyrimethamine is also used to treat malaria. Sulfadiazine is an antibiotic. Alternate regimens are available for those with drug allergies. If the disease is persistent, and it involves the eyes or internal organs, or the patient is suffering from HIV or AIDS, they need to continue these medications for life.


Treatment for pregnant mothers

During pregnancy, the treatment is somewhat different. The course of treatment depends upon whether the unborn child is infected and if so, the severity of the infection. Most likely, an antibiotic is prescribed depending upon how far she is in pregnancy and to reduce the likelihood of transmission to the fetus. A combination of drugs is generally used during second or third trimesters. If her unborn baby has toxoplasmosis, then pyrimethamine and sulfadiazine may be considered as a treatment. However, these drugs do have significant side effects on the mother and fetus and are used only as a last resort. Potential side effects include bone marrow that helps produce blood cells and liver toxicity.


Prevention tips


  • Washing fresh produce of fruits and vegetables before consumption.

  • Making sure that meat is properly cooked by following safe kitchen practices especially when cooking meat - 70 degrees Celsius for 10 minutes to kill the parasite.

  • Washing utensils that are used to handle raw meat

  • Washing hands after cleaning cat litter.

  • Wearing gloves when gardening to avoid contact with feces in the soil.

  • Keeping outdoor sand boxes covered to keep out infected cats.

  • Avoid drinks that include un-pasteurized goat's milk and raw eggs.

  • Pregnant women should stay away from cat litter box and preferably can ask someone else to do the cleaning.

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Bibliography / Reference

Collection of Pages - Last revised Date: June 20, 2019