Cat Scratch Disease

There is nothing scarier to a parent than while their child is sick with a disease they had never even heard of. Up until December 2006, I thought Cat Scratch Fever was just a Ted Nugent song. Then my 3 year old daughter was brought to the ER with swollen lymph nodes and a fever of 103. All from one tiny bit mark on her arm.

It all started with a kitten named Vaca, she looked like a tiny cow and, our children loved her. Our baby however, was convinced Vaca lived to serve her as a playmate. She dressed her up, drug her around the house and basically abused her in the ways only a toddler can. Each time the cat scratched her or defended itself my husband and I would respond with a “well, that’s what you get for hurting the kitty…” We naturally assumed that she would learn a lesson from the pain and learn to treat the cat better. Little did we know that the lesson would last about 6 months and cost us tens of thousands of dollars in medical bills.
Cat scratch fever is a bacterial infection that typically causes swelling of the lymph nodes. It usually results from the scratch, lick, or bite of a cat — more than 90% of people with the illness have had some kind of contact with cats, often with kittens. About 40% to 50% of cats carry B. henselae at some time in their lives. Cats that carry B. henselae do not show any signs of illness; therefore, you cannot tell which cats can spread the disease to you. It is thought that fleas spread the bacteria between cats; however, there is no evidence that fleas can transmit the disease to humans. Once a cat is infected, the bacterium lives in the animal's saliva. Kittens or cats may carry the bacteria for months. Cats less than a year old are more likely to be infected.
The Emergency Room visit consisted of a doctor convinced Eva, our 3 year old, had a terrible case of Strep Throat. When the test came back negative, he then proceeded to call it a virus and told us to follow up with her pediatrician Monday morning, (children never get deathly ill during office hours!) Armed with nothing but Motrin, I bought my lethargic toddler home and pushed fluid and piggybacks fever reducing medications until 8 am Monday morning.
Arriving at the office, the staff who has known my child her entire life, jumped to attention. My normally talkative and (for lack of a nicer word) inquisitive child was clinging to me, still swollen, still febrile. The doctor saw her immediately and she was then transported to the Children’s Hospital in Hartford, CT. It was there they noticed the scratch and bite mark on her arm. Through a blood test they were able to establish the bacterium in her blood.
Normally it takes a couple of weeks for a scratch or bite to cause one or more lymph nodes close to the area to swell and become tender. (Lymph nodes are organs of the immune system that are often called glands.) These swollen lymph nodes appear most often in the underarm or neck areas. They normally 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 may become warm and red, and occasionally the lymph nodes drain pus.
I say normally because, within three days of her first symptoms, one of Eva’s lymph nodes had swollen to a size of a plum on her neck. Within ten days, a head formed on the lymph node, (similar to the biggest pimple you have ever seen). We had been seeing the doctor once a week to monitor the nodes. From day one, the doctor had also put her on Zithromax. By week 2, she was taking a full dose of the antibiotics everyday. If you are not familiar with the medication that is also called a Z-pack, traditionally it is taken in a full dose on day one and half doses for 4 to 5 days following. My 3 year old was taking the full dose and continued to do so for over 130 days.
Twenty-one days in, Eva ruptured the giant pustule on her neck in her sleep. The smell alone was horrifying. We went back to the doctor only to be sent to the lab for more blood work and return to the doctor to find out what should have been good news. While there was an inordinately high level of the bacteria still in her blood, they believed the rupture meant the end of the worst. They bandaged her neck and put her on a secondary antibiotic (Bactrim) to take in conjunction with the Zithromax. We went home feeling a sense of peace that this was almost over.
Thirty-three days in, a second pustule began on her face in front of her left ear. They are no longer calling it Cat Scratch Fever but a rarer strain of the same illness called Parinaud Oculoglandular Syndrome. Apparently, in atypical cases of cat scratch fever she could get even sicker, with no clear sign of the end. No one thought to tell us that a person may develop infections of the liver, spleen, bones, joints, or lungs, or a reoccurring high fever without any other symptoms. She had gotten an eye infection known as Parinaud Oculoglandular Syndrome. That she could have developed inflammation of the brain or seizures, although this is rare.
Obviously we brought her back to doctor, after all it was Tuesday and we went every Tuesday. He, as frustrated as we were, introduced the option of surgery to drain the pustule before it exploded like the previous one. Our question was if we allow the surgery, will that be the end of this? Our baby has now been on antibiotics for over 40 days. I have left my job because the daycare will not allow her to attend with a disease they are not familiar with. While Cat Scratch Fever is not contagious, they were concerned with her risks of higher infections.
April 17, 2007, 138 days in, Eva went to the Children’s Hospital for her surgery. It took less than an hour and she came through like a trooper. It had been our tradition that after every doctor visit she was allowed to go to McDonalds for a small fry, her first words after the surgery was “do I get my fries now?” The hospital staff loved her. Most importantly, we may have been done with all of this.
Seven days post surgery, 138 days of Zithromax, Bactrim, and Arythromyicin, Eva had no visible symptoms, no pustules, and the swelling was gone, as was the fever. It was gone. Our final visit to the doctor included champagne. While we still needed to be aware of her contact with cats, she was healthy again. She will always has the bacterium in her blood but, it is so much less parts per million, that she can lead a completely normal life.
If you're concerned about cat scratch disease, you do not need to get rid of the family pet. The disease is relatively rare and usually much less than what happened to Eva. A few simple steps can go a long way toward limiting your child's chances of contracting the disease.
Teaching your children to avoid stray or unfamiliar cats can 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 with any pets so they can avoid being scratched or bitten. Have your family members wash their hands after handling or playing with a cat. Regular flea checks for your pets are also advisable.
Take it from me, telling your child “That’ll teach ya” doesn’t pay off.