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CASE REPORT Cat Scratch Disease (CSD) in a Veterinarian - A Case Report

*1Ranjini Manuel, 2Maria Elsa Mathews, 3Gowri Menon, 4Deepa CK, 5Sindhu OK and 6Deepa PM

1,2,3 M.V.Sc Scholar, 4 Assistant Professor, Department of Veterinary Parasitology, 5 Assistant Professor, Department of Veterinary Clinical Medicine, 6Assistant Professor and Head (i/c), Department of Veterinary Epidemiology and Preventive Medicine, College of Veterinary and Animal Sciences, Pookode-673576, Kerala, India.

Abstract Recently there is a boom in the overall number of cat cases in

veterinary hospitals and many are unaware about the zoonotic infections

that could be transmitted through cats. Cat scratch disease is an infectious zoonotic disease caused by Bartonella henselae belonging to the genus Bartonella . It is transmitted to man through a bite or a scratch of a cat. Incidence of cat scratch disease is considered very rare and there is limited cases reported. In the present report, a three months old stray Persian kitten *Corresponding Author: was presented to the TVCC, Pookode with pot-bellied appearance, alopecia and diarrhoea. The kitten was heavily infested with fleas. Kitten was treated Ranjini Manuel with selamectin spot on solution and was given medicated bath. A 24 year Email: [email protected] old female Veterinarian, who was attending the case accidentally, got

Received: 10/05/2019 scratch by the cat. It was reported that after six days she developed red Accepted: 02/06/2019 round raised lesions at the site of the scratches. Circumference of the lesions became wider and swollen as the days progressed, with intense itchiness, weakness and swollen lymph nodes. Diagnosis was based on the history, clinical signs and haematology. Patient responded positively to the treatment, lesions regressed and recovered uneventfully. However, the kitten died after a week due to feline panlekopenia which was confirmed by post-mortem. Thus, cat scratch disease is a rare zoonotic infection which

could be contracted by any person who is in close contact with the cats.

Therefore, it is advised that necessary precaution has to be taken while handling cats.

Keywords: Bartonella henselae, Cat scratch disease, Occupational hazard, Zoonotic infection.

1. Introduction The main mode of entry of organism is through Recently there is a boom in the cat industry. The flea bites. It can also be introduced into the cat’s body overall number of cat cases in veterinary hospitals and through flea dirt, when cat scratch’s or bites while other pet clinics are hiking. Many pet owners are grooming. The infected flea dirt can be adhered to the unaware about the zoonotic infections that could be nails or teeth. Thus on scratching, biting or on exposure transmitted through cats. Cat scratch disease (CSD) is of the saliva of the infected cat, the organism can enter one such infection that has a zoonotic potential and into other cats or humans. veterinarians by means of their occupation are more Clinical presentation of the disease can be exposed. It is caused by Bartonella henselae belonging initiated soon after the exposure to infected cats. In to the genus Bartonella . It has world-wide distribution. most of the cases there will be a papule formation at the Bartonellae are small (0.3 to 0.6 by 1.0 to 1.7 μm), inoculation site. This papule can progress to vesicle and pleomorphic, non-capsulated, non-sporing, and form crusty lesions within few days. Regional fastidious Gram negative rods. Bartonella quintana and lymphadenopathy is developed after a week or two. Bartonella henselae are fastidious organisms which are According to a study, 46 percent of the patients responsible for bacillary angiomatosis, trench fever, cat developed lymphadenopathy in upper extremities and scratch disease, and endocarditis (La Scola et al., 26 percent on neck region.75 percent of the patients 1999). The vector Ctenocephalides felis (cat flea) is developed anorexia and malaise. About 9 percent of the responsible for the transmission of the disease from cat patients had low- grade fever (Carithers et al., 1985). to cat or cat to human (Zangwill et al., 1993). Kittens Though it is a self- limiting disease characterised by younger than 1 year are more likely to harbour the fatigue, anorexia, skin eruptions at the inoculation site. organism and approximately more than 50% of the cats There are rare manifestations like meningoencephalitis, can have the infection and yet can be completely endocarditis and neuroretinitis, neurological disorders asymptomatic (Massei et al ., 2005). have also been reported in immunocompetent

Journal of Foodborne and Zoonotic Diseases | April-June, 2019 | Volume 07 | Issue 02 | Pages 09-11 © 2019 Jakraya Manuel et al…Cat Scratch Disease (CSD) in a Veterinarian - A Case Report individuals (Klotz et al., 2011). The emergence of the Haematology revealed elevated white blood cell count infection is noted in India but the disease is often and decreased platelet count. Since there is no gold underreported. standard test for confirmati on of the disease and culture takes longer turn-around time confirmation of the infection remained as a challenge. Patient was then 2. Case History, Diagnosis and Treatment treated with Tab. Doxycycline 100mg BID for 8 days, A 24-year-old female veterinarian developed Tab. Pantoprazole 40mg BID for 8 days, Tab. eruptions of blisters (Fig. 1) following scratch of the cat Deflazacort 6mg SID for 8 days , Tab. Atarax 25mg on her forearms. The cat was a three months old stray BID for 8 days. Oint ment Cosvate-GM (clobetasol Persian kitten which was brought to the TVCC of propionate, gentamicin and miconazole nitrate) for College of Veterinary and Animal Science, Po okode. external use. Following successful treatment, it was The kitten had severe flea infestation, diarrhoea and reported that even after complete healing of the scratch, was in poor health condition. The scratch was washed she developed red round raised lesions at the with soap solution immediately a nd required first aid inoculation site (Fig 3). was given.

Fig 1: Eruption of blisters over the scratch on forearm

The c ircumference of the lesions became wider as the days progressed with intense itchiness as depicted in Fig 2. Initially she was treated with regular first line antibiotic like Amoxicillin for 8 days. No improvement was reported.

Fig 3: Lesion a fter treatment - Day 21

3. Results and Discussion Bartonella henselae infection is one of the emerging vector-borne infection in India. Along with the cats securing their position in the pet world, the disease is also gaining its popularity. Due to its resemblance with other febrile illness , Cat scratch disease often goes un derreported or undiagnosed

Fig 2: Lesions progressing – Day 11 (Noden et al., 2014). It establishes an intra- erythrocytic and typically asymptomatic bacteraemia, She experienced weakness, intermittent although infections in incidental hosts may evoke headaches, fever and area around the lesions were discernible disease (Pullianinen and Dehio, 2012). The swollen and serous discharges were noticed. After a susceptible host contracts the disease more efficiently week axillary lymph nodes were swollen and painful to due to its long lasting erythrocytic bacteraemia which is touch, lesions started appearing in sites other than transmitted by the vectors. Vectors can be fleas inoculation site like, near the eye, elbow region, left leg (Ctenocephalides felis) or ixodid ticks (Cotte et al., ankle and thigh region. Further diagn osis was made 2008; Breitschwerdt, 2014). Bartonella spp multiply based on the characteristic clinical lesions of Cat inside the vector and transmission is by scratch/bite/ scratch disease, haematology and response to treatment. faeces of the vector (Pulliainen and Dehio, 2012). There is no established gold standard test for the

Journal of Foodborne and Zoonotic Diseases | April -June, 2019 | Volume 07 | Issue 02 | Pages 0 9-11 © 2019 Jakraya 10 Manuel et al…Cat Scratch Disease (CSD) in a Veterinarian - A Case Report infection, but polymerase chain reaction (PCR), 4. Conclusion immunofluorescent antibody assay (IFA) and ELISA Cat scratch fever is a rare zoonotic infection holds relevant for the clinical diagnosis, however a which can be contracted by a veterinarian or any person negative serological test does not rule out the disease who is in close contact with cats. It is an emerging (Hoey et al., 2009). vector-borne infection in India. The awareness Cat scratch disease is a self-limiting disease. In regarding this zoonotic infection are limited among the most of the cases it resolves within 2-6 weeks. pet owners, physicians and veterinarians. Since the Therefore if the infection is mild, antibiotic therapy is clinical illustration of the disease is evident, the not recommended. Physicians’ advice antibiotics only confirmation of the disease in a clinical setting is rarely when disease takes a long course. Acute cases are practiced. Therefore, the disease is often treated successfully treated with antibiotics like azithromycin, symptomatically. This increases the chances of doxycycline, rifampin, ciprofloxacin, underreporting and underdiagnosing of the infection. trimethoprim/sulfamethoxazole (Kordick et al., 1997; Rolain et al., 2004).

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Journal of Foodborne and Zoonotic Diseases | April-June, 2019 | Volume 07 | Issue 02 | Pages 09-11 © 2019 Jakraya 11