Cat Scratch Disease

Animal Bites and Rabies

Cat Scratch Disease | Johns Hopkins Medicine

Linkedin Pinterest

Animal bites and scratches, even when they are minor, can become infected and spread bacteria to other parts of the body.

Whether the bite is from a family pet or an animal in the wild, scratches and bites can carry disease. Cat scratches, even from a kitten, can carry “cat scratch disease,” a bacterial infection.

Other animals can transmit rabies and tetanus. Bites that break the skin are even more ly to become infected.

What is the care for animal bites?

For superficial bites from a familiar household pet that is immunized and in good health:

  • Wash the wound with soap and water under pressure from a faucet for at least 5 minutes, but do not scrub, as this may bruise the tissue. Apply an antiseptic lotion or cream.
  • Watch for signs of infection at the site, such as increased redness or pain, swelling, drainage, or if the person develops a fever. Call your healthcare provider right away if any of these symptoms happen.

For deeper bites or puncture wounds from any animal, or for any bite from a strange animal:

  • If the bite or scratch is bleeding, apply pressure to it with a clean bandage or towel to stop the bleeding.
  • Wash the wound with soap and water under pressure from a faucet for at least 5 minutes. Do not scrub as this may bruise the tissue.
  • Dry the wound and cover it with a sterile dressing. Do not use tape or butterfly bandages to close the wound as this could trap harmful bacteria in the wound.
  • Call your healthcare provider for guidance in reporting the attack and to determine whether additional treatment, such as antibiotics, a tetanus booster, or rabies vaccine is needed. This is especially important for bites on the face, hands, or feet, or for bites that cause deeper puncture wounds of the skin. It is also important for all cat bites that have a high incidence of infection. 
  • If possible, locate the animal that inflicted the wound. Some animals need to be captured, confined, and observed for rabies. Do not try to capture the animal yourself. Contact the nearest animal warden or animal control office in your area.
  • If the animal cannot be found or is a high-risk species (raccoon, skunk, or bat), or the animal attack was unprovoked, the victim may need a series of rabies shots and a dose of rabies immunoglobulin.

Call your healthcare provider for any flu- symptoms, such as a fever, headache, malaise, decreased appetite, or swollen glands following an animal bite.

What is rabies?

Rabies is a viral infection of certain warm-blooded animals and is caused by a virus in the Rhabdoviridae family. It attacks the nervous system and, once symptoms develop, is 100% fatal in animals, if left untreated.

In North America, rabies happens primarily in skunks, raccoons, foxes, coyotes, and bats. In some areas, these wild animals infect domestic cats, dogs, and livestock. In the U.S., cats are more ly than dogs to be rabid.

Individual states maintain information about animals that may carry rabies. It is best to check for region-specific information if you are unsure about a specific animal and have been bitten.

Travelers to developing countries, where vaccination of domestic animals is not routine, should talk with their healthcare provider about getting the rabies vaccine before traveling. 

How does rabies happen?

The rabies virus enters the body through a cut or scratch, or through mucous membranes (such as the lining of the mouth and eyes), and travels to the central nervous system. Once the infection is established in the brain, the virus travels down the nerves from the brain and multiplies in different organs.

The salivary glands are most important in the spread of rabies from one animal to another. When an infected animal bites another animal, the rabies virus is transmitted through the infected animal's saliva. Scratches by claws of rabid animals are also dangerous because these animals lick their claws.

What are the symptoms of rabies?

The incubation period in humans from the time of exposure to the onset of illness can range anywhere from 5 days to more than a year, although the average incubation period is about 2 months. The following are the most common symptoms of rabies. Symptoms may include:

Rabies: Stage 1Rabies: Stage 2
  • Initial period of vague symptoms, lasting 2 to 10 days
  • Vague symptoms may include, fever, headache, malaise, decreased appetite, or vomiting
  • Pain, itching, or numbness and tingling at the site of the wound
  • People often develop difficulty in swallowing (sometimes referred to as “foaming at the mouth”) due to the inability to swallow saliva. Even the sight of water may terrify the person.
  • Some people become agitated and disoriented, while others become paralyzed
  • Immediate death, or coma resulting in death from other complications, may result

The symptoms of rabies may look other conditions or medical problems. Always see your healthcare provider for a diagnosis.

How is rabies diagnosed?

In animals, the direct fluorescent antibody test (dFA) done on brain tissue is most often used to detect rabies. Within a few hours, diagnostic labs can determine whether an animal is rabid and provide this information to medical professionals. These results may save a person from undergoing treatment if the animal is not rabid.

In humans, a number of tests are necessary to confirm or rule out rabies, as no single test can be used to rule out the disease with certainty. Tests are done on samples of serum, saliva, and spinal fluid. Skin biopsies may also be taken from the nape of the neck.

What is the treatment for rabies?

Unfortunately, there is no known, effective treatment for rabies once symptoms of the disease appear. However, there are effective vaccines that provide immunity to rabies when administered soon after an exposure. It may also be used for protection before an exposure happens, for people such as veterinarians and animal handlers.

How can animal bites and rabies be prevented?

Being safe around animals, even your own pets, can help reduce the risk of animal bites. Some general guidelines for avoiding animal bites and rabies include the following:

  • Do not try to separate fighting animals.
  • Avoid strange and sick animals.
  • Leave animals alone when they are eating.
  • Keep pets on a leash when out in public.
  • Select family pets carefully.
  • Never leave a young child alone with a pet.
  • All domestic dogs and cats should be immunized against rabies and shots kept current.
  • Do not approach or play with wild animals of any kind, and be aware that domestic animals may also be infected with the rabies virus.
  • Supervise pets so they do not come into contact with wild animals. Call your local animal control agency to remove any stray animals.

What would my healthcare provider need to know about an animal bite?

If you or someone you know is bitten by an animal, remember these facts to report to your healthcare provider:

  • Location of the incident
  • Type of animal involved (domestic pet or wild animal)
  • Type of exposure (cut, scratch, licking of open wound)
  • Part of the body involved
  • Number of exposures
  • Whether or not the animal has been immunized against rabies
  • Whether or not the animal is sick or well; if “sick,” what symptoms were present in the animal
  • Whether or not the animal is available for testing or quarantine


UAMS creates guidelines for safe return to play for team sports

Cat Scratch Disease | Johns Hopkins Medicine

LITTLE ROCK, Ark. (News Release) — The University of Arkansas for Medical Sciences (UAMS) has developed guidelines to help high school and collegiate sports teams plan to safely resume activities during the COVID-19 pandemic.

The UAMS COVID19 Sports Committee that drafted the recommendations and considerations included experts from sports medicine, orthopaedic surgery, family medicine, pathology and infectious disease.

“Our experts developed these guidelines so teams across the state don’t have to start from scratch as they consider what a safe return to play might look ,” said Wesley Cox, M.D.

, committee chairman and chief of orthopaedics and sports medicine at UAMS Northwest Regional Campus.

“We also wanted to provide some basic expectations for all teams so they feel they can interact and compete with the peace of mind of knowing everyone is holding themselves to the same safety standards. Safe team sports makes for safe students and safe communities.”

Team sports have been suspended in Arkansas because of COVID-19, the disease caused by the new coronavirus. However, Gov. Asa Hutchinson and Nate Smith, M.D., Arkansas Department of Health director and state health officer, have said they plan to make an announcement about team sports in mid to late May.

Cox wants to help teams prepare for the possible resumption of gameplay.

The guidelines are a resource for teams, coaches, schools and team physicians, as well as student-athletes and their families. They aim to protect student-athletes, as well as staff, administrators and fans.

“We must all work together to safely return to sports,” said C. Lowry Barnes, M.D., committee member and chair of the UAMS Department of Orthopaedic Surgery.

“At stake is the health of our athletes, our communities, our economy, our state and our nation. As soon as it is safe to do so, we want athletics to resume.

To ensure continued safe play, we must remain diligent in reducing the risk of infection as much as possible.”

The guidelines include:

  • Education for coaches and staff
  • Quarantine and screening guidelines, plus what to do if a team member tests positive
  • Advice for pre-participation screening during physicals
  • Guidelines for home life and safe living situations for student-athletes to limit the potential for disease spread
  • Tips on team meals, transportation, on-field hydration
  • Equipment disinfection
  • Best staff and management practices, such as continuing to conduct meetings remotely when possible
  • Guidelines for locker rooms and training rooms
  • Recommendations on vaccinations

Furthermore, the guidelines encourage teams and student-athletes to be role models in safe infection control in their communities.

“For us all to get back to the activities we love, whether on or off the court, we must be the example and hold ourselves and our teammates and peers accountable for our actions,” Cox said. “We must be the ultimate teammate and assign the health of our teammates – and our communities – as our No. 1 priority.”

The full detailed guidelines are available on the UAMS website at and

School physicians and team physicians are encouraged to reach out to UAMS with questions and for additional recommendations at 479-966-4491 or 501-364-8336.

Copyright 2020 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.


Bartonella Species

Cat Scratch Disease | Johns Hopkins Medicine

— The first section of this topic is shown below —

  • Small fastidious intracellular pleomorphic Gram-negative bacilli.
    • Columbia, Brucella, BHI, and Trypticase soy-based agars (all 5% blood supplemented) and chocolate agar most frequently used solid media used for Bartonella isolation.
  • Bartonella has > 45 known species, more than 7 cause human disease: B. henselae, B. bacilliformis, B. quintana, B. vinsonii, B. grahamii, B. elizabethae and B. koehlerae.
    • Evolving nomenclature as subspecies classifications, e.g., Bartonella vinsonii subsp. yucatanensi.
  • Best seen with Warthin-Starry silver stain or a Brown-Hopps tissue gram stain.
  • The major reservoir of B. henselae is cats — 50% of cats are seropositive and transmit by saliva contact or scratching (“cat scratch fever” or catch scratch disease [CSD]).
  • Menu of diseases caused by Bartonella includes cat scratch disease, retinitis, trench fever, Carrión’s disease [Oroyo fever and verruga peruana], relapsing bacteremia, endocarditis, bacillary angiomatosis, and bacillary peliosis hepatitis.

— To view the remaining sections of this topic, please sign in or purchase a subscription —

  • Small fastidious intracellular pleomorphic Gram-negative bacilli.
    • Columbia, Brucella, BHI, and Trypticase soy-based agars (all 5% blood supplemented) and chocolate agar most frequently used solid media used for Bartonella isolation.
  • Bartonella has > 45 known species, more than 7 cause human disease: B. henselae, B. bacilliformis, B. quintana, B. vinsonii, B. grahamii, B. elizabethae and B. koehlerae.
    • Evolving nomenclature as subspecies classifications, e.g., Bartonella vinsonii subsp. yucatanensi.
  • Best seen with Warthin-Starry silver stain or a Brown-Hopps tissue gram stain.
  • The major reservoir of B. henselae is cats — 50% of cats are seropositive and transmit by saliva contact or scratching (“cat scratch fever” or catch scratch disease [CSD]).
  • Menu of diseases caused by Bartonella includes cat scratch disease, retinitis, trench fever, Carrión’s disease [Oroyo fever and verruga peruana], relapsing bacteremia, endocarditis, bacillary angiomatosis, and bacillary peliosis hepatitis.

There's more to see — the rest of this entry is available only to subscribers.

Auwaerter, Paul G, and John G Bartlett. “Bartonella Species.” Johns Hopkins ABX Guide, The Johns Hopkins University, 2019. Johns Hopkins Guide, Auwaerter PG, Bartlett JG. Bartonella Species. Johns Hopkins ABX Guide. The Johns Hopkins University; 2019. Accessed May 18, 2020.Auwaerter, P. G., & Bartlett, J. G. (2019). Bartonella Species. In Johns Hopkins ABX Guide. The Johns Hopkins University. Retrieved May 18, 2020, from PG, Bartlett JG. Bartonella Species [Internet]. In: Johns Hopkins ABX Guide. The Johns Hopkins University; 2019. [cited 2020 May 18]. Available from:* Article titles in AMA citation format should be in sentence-caseMLAAMAAPAVANCOUVERTY – ELECT1 – Bartonella SpeciesID – 540056A1 – Auwaerter,Paul,M.D.AU – Bartlett,John,M.D.Y1 – 2019/09/27/BT – Johns Hopkins ABX GuideUR – – The Johns Hopkins UniversityDB – Johns Hopkins GuideDP – Unbound MedicineER –


Cat Scratch Disease

Cat Scratch Disease | Johns Hopkins Medicine

Cat scratch disease is a bacterial infection that a person can get after being scratched, licked, or bitten by a cat or kitten.

In the United States, most cases happen in the fall and winter and usually affect kids, probably because they're more ly to play with cats and be bitten or scratched.

Bartonella henselae, the bacteria that cause this disease, live in infected cats' saliva but don't make the animals sick.  In fact, kittens or cats may carry the bacteria for months. Fleas spread the bacteria between cats.

Signs & Symptoms

The first sign of this infection is a blister or a small bump that develops several days after the scratch or bite and may resemble a bug bite. This blister or bump is called an inoculation lesion (a wound at the site where the bacteria enter the body). Lesions are most commonly found on the arms and hands, head, or scalp and usually are not painful.

Within a couple of weeks of a scratch or bite, one or more lymph nodes close to the area of the inoculation lesion will swell and become tender. (Lymph nodes are round or oval-shaped organs of the immune system that are often called glands.) For example, if the inoculation lesion is on the arm, the lymph nodes in the elbow or armpit will swell.

These swollen lymph nodes appear most often in the underarm or neck areas, although if the inoculation lesion is on the leg, the nodes in the groin will be affected. They range in size from about ½ inch to 2 inches in diameter and may be surrounded by a larger area of swelling under the skin. The skin over these swollen lymph nodes can become warm and red.

In most kids, swollen lymph nodes are the main symptom of the disease, and the illness often is mild. If kids have other general symptoms, they might include fever (usually less than 101°F or 38.3°C ), fatigue, loss of appetite, headache, rash, sore throat, and an overall ill feeling.

The swollen lymph nodes usually disappear within 2 to 4 months, although sometimes can last much longer. In rare cases, a person might develop other symptoms, including infections of the liver, spleen, bones, joints, or lungs, or a lingering high fever without other symptoms.

Diagnosis and Treatment

Doctors usually diagnose cat scratch disease a child's history of exposure to a cat or kitten and a physical examination. During the exam, the doctor will look for signs of a cat scratch or bite and swollen lymph nodes.

In some cases, doctors use laboratory tests to help make the diagnosis, including:

  • blood tests and cultures to rule out other causes of swollen lymph nodes
  • a blood test that is positive for cat scratch disease

Most cases do not need any special treatment. Antibiotics are sometimes used to treat a severe form of the disease. If your doctor has prescribed antibiotics, give them to your child on schedule and for as many days as prescribed.

Kids with cat scratch disease don't need to be isolated from other family members. Bed rest is not necessary, but can help if a child tires easily. If your child feels playing, encourage quiet play while being careful to avoid injuring swollen lymph nodes. To ease sore nodes, give your child nonprescription medicines acetaminophen or ibuprofen.


Cat scratch disease is not contagious from person to person. The bacteria are spread by the scratch or bite of an infected animal, most often a kitten. They also can spread if the animal's saliva (spit) comes in contact with a person's eye or through broken skin. Sometimes multiple cases happen in the same family, usually through contact with the same infected animal.

Having one episode of cat scratch disease usually makes people immune for the rest of their lives.


If you're concerned about cat scratch disease, you do not need to get rid of the family pet. The illness is not common and usually is mild, and a few steps can help limit your kids' chances of contracting it.

Teach kids to avoid stray or unfamiliar cats to reduce their exposure to sources of the bacteria. To lower the risk of getting the disease from a family pet or familiar cat, kids should avoid rough play to prevent being scratched or bitten. Have your family members wash their hands after handling or playing with a cat.

If your child is scratched by a pet, wash the injured area well with soap and water. Keeping the house and your pet free of fleas will reduce the risk that your cat could become infected with the bacteria in the first place.

If you suspect that someone caught cat scratch disease from your family pet, don't worry that your cat will have to be euthanized (put to sleep). Talk with your veterinarian about how to handle the problem.

When to Call the Doctor

Call the doctor whenever your child has swollen or painful lymph nodes in any area of the body. And always call your doctor if a child is bitten by an animal, especially if:

  • the bite or scratch was from a cat and the wound does not seem to be healing
  • an area of redness around the wound keeps expanding
  • the child develops a fever that lasts for a few days after receiving the scratch or bite

If your child has already been diagnosed with cat scratch disease, call the doctor if your child has a high fever, lots of pain in a lymph node, seems very sick, or develops new symptoms.

Reviewed by: Raluca Papadopol, MD

Date reviewed: December 2014


What causes cat scratch disease?

Cat scratch disease is caused by a bacterium carried in the cat saliva. The bacteria are passed from an infected cat to a human after the cat licks an open wound or bites or scratches human skin hard enough to break the surface of the skin.

Who is at risk for cat scratch disease?

Factors that can increase your risk for getting cat scratch disease include:

  • Being around cats on a routine basis, especially kittens that are more playful and apt to accidentally scratch you
  • Not cleaning scratches or bites from a cat as soon as you get them
  • Allowing a cat to lick any open wounds that you have
  • Being around a flea infestation

What are the symptoms of cat scratch disease?

These are the most common symptoms of cat scratch disease:

  • A cat bite or scratch that becomes reddened or swollen within a few days and does not heal or worsens over time
  • Painful or swollen glands, especially under the arms (if scratched on the arm or hand), or in the groin (if scratched on the foot or leg)
  • Flu- symptoms including headache, decreased appetite, fatigue, joint pain, or fever
  • Body rash

The symptoms of cat scratch disease may look other conditions or medical problems. Always see your healthcare provider for a diagnosis.

How is cat scratch disease diagnosed?

Diagnosis is a complete history, including a history of being scratched by a cat or kitten, a physical exam, and sometimes blood tests.

How is cat scratch disease treated?

Your healthcare provider will figure out the best treatment :

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

Treatment may include:

  • Antibiotics (to treat the infection)
  • Caring for the symptoms that result from the infection. In most cases, no antibiotics are needed, and the infection will clear on its own.

What are the complications of cat scratch fever?

Most healthy people don’t have complications from cat scratch fever. However, people whose immune systems are weak (such as those who have HIV/AIDS, are receiving chemotherapy, or have diabetes) can have complications such as:

  • Bacillary angiomatosis. A skin disorder characterized by red, elevated lesions surrounded by a scaly ring. This condition may become a more widespread disorder that involves internal organs. 
  • Parinaud's oculoglandular syndrome. A condition that involves a red, irritated and painful eye similar to conjunctivitis (pink eye), fever, and swollen lymph nodes in front of the ear on the same side

Can cat scratch disease be prevented?

Avoid being scratched or bitten by cats or kittens. If scratched or bitten, wash the area right away with soap and water. Do not allow cats to lick wounds you may have.

When should I call my healthcare provider?

If a cat scratch or bite becomes red or swollen and you develop flu- symptoms, including headache, decreased appetite, fatigue, joint pain, or fever, contact your healthcare provider.

Key points about cat scratch fever

  • Cat scratch disease is an infection caused by a bacterium in cat saliva.
  • The disease causes redness and swelling at the site of a cat scratch or bite, and flu- symptoms.
  • If you are scratched or bitten by a cat or kitten, it is important to promptly wash the area with soap and water.
  • Cat scratch disease can be treated by antibiotics.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.