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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.


Erythema Nodosum

Inflammation of the skin that shows up as painful reddish tender lumps is called Erythema nodosum. This inflammation is usually located in a part of the fatty layer of skin (subcutaneous fat). The size of the lump could vary in size from 1 to 5 cm. The inflammation causes nodular swelling. The inflammation remains for about a week and then becomes flat leaving behind a bruised appearance. They usually show up on the shins (front portion of the legs, just below the knee). Erythema nodosum is a type of panniculitis, i.e. inflammation that can cause nodules below the surface of the skin. The condition is more common among youngsters aged between 12-20 years.


Erythema nodosum settles down on its own after a period of three to six weeks. It may leave behind a temporary bruised appearance or a chronic indentation in the part where the fatty layer has been injured. Though the condition is annoying and painful, the condition does not cause any damage to the internal organs of our body. In adults, the condition is more often seen in women than in men. In kids, it affects boys and girls equally. In a few people the trigger can be identified and in yet a few it cannot be identified. However identifying the trigger becomes very important as it needs to be treated.


Erythema nodosum causes

Erythema nodosum may show up on its own or may occur in association with other conditions. In about 30-50% of cases, the cause is unknown. However the common triggers that may cause Erythema nodosum include:



Erythema nodosum symptoms


  • Painful nodules are commonly seen on the shin and sometimes on the arms, thighs and trunk of the body. The nodule when it first appears is red, hot and firm to touch and becomes flat over a few days. It appears as bruise that is blue in color and later turns yellowish as it fades. A person may develop just a couple of nodules or much more.
  • Flu-like feeling before the appearance of lumps.
  • Aching joints and legs before the appearance of lumps. Ankle, knee and wrist joints are the most affected.
  • Loss of weight.
  • Symptoms may vary depending on the underlying trigger that caused the condition.

Erythema nodosum diagnosis


  • By means of physical examination
  • Biopsy of the affected area
  • Blood test to identify the trigger
  • Chest X-ray in case of TB or sarcoidosis induced condition
  • Throat swab

Erythema nodosum treatment


  • Cortisone injection
  • Oral cortisone
  • Anti-inflammatory drugs
  • Bed rest
  • Compression bandages
  • Cool wet compresses


Cervical Lymphadenitis

Cervical Lymphadenitis is inflammation in the lymph glands of the neck. This lymph gland enlargement is usually secondary to any viral or bacterial infections. This condition is often noticed with tonsillitis, pharyngitis or even dental infection. Cervical Lymphadenitis is commonly seen in children suffering from upper respiratory infection. Infections such as diphtheria, tuberculosis or wounds caused by cat-scratch disease or impetigo can bring on Cervical Lymphadenitis.


Symptoms of Cervical Lymphadenitis include pain and tenderness in the lymph glands of the neck. There might be cough, sore throat and fever. Often patients suffering from Cervical Lymphadenitis experience irritability and earache. In some cases, scalp infections or impetigo or dermatitis is noticed. Chest x-rays and skin tests are used to diagnose the cause for the swollen lymph nodes. The infected nodes are sometimes aspirated for further analysis. Biopsy might be done in some cases.


In most cases, Cervical Lymphadenitis does not need any treatment. Once the cause for the swollen lymph glands is identified, appropriate treatment is prescribed. Penicillin or dicloxacillin is often used.

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Bibliography / Reference

Collection of Pages - Last revised Date: August 21, 2019