Q: Can I get cat scratch disease from a healthy-looking cat?

Yes. Cats infected with Bartonella henselae typically show no signs of illness. They can appear perfectly healthy while carrying the bacteria and transmitting it to humans through scratches or bites.

# Cat Scratch Disease Bartonella henselae: Feline Vectors and Human Symptoms ## Key Takeaways - Cat Scratch Disease (CSD) is caused by *Bartonella henselae*, primarily transmitted to humans via scratches, bites, or flea feces from infected cats, particularly kittens and strays, who are usually asymptomatic carriers. - The hallmark human symptom is regional lymphadenopathy (swollen lymph nodes), often accompanied by fever, fatigue, and a skin lesion at the inoculation site; severe complications like neuroretinitis, endocarditis, and osteomyelitis can occur, especially in immunocompromised individuals. - Diagnosis in humans relies on clinical presentation, cat exposure history, and laboratory confirmation via serology (IFA for IgG/IgM antibodies) or PCR of clinical samples, though seronegative cases with positive PCR exist. - Feline infection is predominantly through infected cat fleas (*Ctenocephalides felis*), which acquire the bacteria from cat blood and shed it in their feces; effective, year-round flea control on pets is the most critical preventive measure for both animals and humans. - Treatment for uncomplicated CSD in immunocompetent individuals is often supportive and self-limiting, but antibiotics like azithromycin or doxycycline are indicated for severe or atypical manifestations, with combination therapy often used for serious complications like neuroretinitis or endocarditis. - Prevention strategies include rigorous flea control, prompt washing of wounds, avoiding rough play with cats, and caution with stray animals, especially for immunocompromised individuals, pregnant women, and children. --- **Owner Triage Summary:** [Cat](/knowledge/veterinary-medicine/clinical-methods/cat) scratch disease (CSD) is a bacterial infection caused by *[Bartonella henselae](/knowledge/bacteria/pet-bacteria/bartonella-henselae)*, transmitted to humans through a scratch, bite, or lick from an infected cat, often a kitten or stray. In humans, the most common sign is a swollen lymph node (lymphadenopathy), frequently accompanied by fever, fatigue, and a skin lesion at the inoculation site. While most immunocompetent individuals recover without specific treatment, the disease can cause severe complications like neuroretinitis (eye inflammation), endocarditis (heart infection), and bone or joint infections, especially in immunocompromised patients. If you or a family member develops a persistent swollen lymph node, fever, or vision changes after a cat scratch, seek medical evaluation promptly. For your cat, routine flea control and avoiding rough play are the best preventive measures. --- ## At a Glance: Feline Vector vs. Human Disease | Feature | Feline (Reservoir Host) | Human (Accidental Host) | | :--- | :--- | :--- | | **Role in Disease** | Asymptomatic reservoir; bacteria live in blood and are shed via fleas. | Dead-end host; infection occurs incidentally. | | **Primary Vector** | Cat flea (*Ctenocephalides felis*) [1]. | N/A (acquired via scratch, bite, or flea feces). | | **Typical Symptoms** | Usually none; rarely mild fever or transient illness. | Swollen lymph nodes, fever, fatigue, headache, skin lesion [2, 3, 4]. | | **Severe Complications** | Rare; can include endocarditis in cats, though uncommon. | Neuroretinitis, endocarditis, osteomyelitis, bacillary angiomatosis (especially in immunocompromised) [5, 6, 7, 8]. | | **Diagnosis** | Blood PCR, blood culture (difficult), serology. | Serology (IgG/IgM), PCR of lymph node aspirate or blood [9, 10, 11]. | | **Treatment** | Antibiotics (e.g., doxycycline) may clear bacteremia [12]. | Often self-limiting; antibiotics (azithromycin, doxycycline) for severe cases [7, 12]. | | **Prevention** | Flea control; declawing is not recommended. | Avoid rough play; wash scratches promptly; flea control on pets [1]. | --- ## Understanding the Pathogen and Its Feline Reservoir *Bartonella henselae* is a fastidious, facultative intracellular Gram-negative bacillus [2]. It is the primary etiologic agent of cat scratch disease in humans [8]. The domestic cat serves as the main reservoir host for this bacterium. Importantly, infected cats typically do not show signs of illness, making it difficult for owners to know their pet is a carrier. The bacteria reside within the cat's red blood cells and can be transmitted to other cats and to humans through various routes. The primary vector for transmission between cats is the cat flea (*Ctenocephalides felis*) [1]. Fleas acquire the bacteria when they feed on an infected cat's blood. The bacteria then multiply within the flea's gut and are excreted in its feces. When a cat scratches or bites, flea feces on the claws or in the mouth can be inoculated into a human's skin. This explains why CSD is often associated with kittens, as they are more likely to have fleas and engage in playful scratching and biting behaviours. It also clarifies why a person can contract the disease without a direct scratch, as contact with infected flea feces on a surface or another animal can be a source of infection [1, 5]. While cats are the primary reservoir, the cat flea can reside on other non-feline hosts, including dogs and other pet mammals. This means these animals can act as transient carriers of *B. henselae*, potentially transmitting the bacteria to humans even without direct feline contact [1]. A study highlighted that neuroretinitis, an ocular complication of CSD, can result from contact with infected fleas on family pets other than cats [1]. ### Prevalence and Epidemiology CSD is a worldwide zoonosis with a significant public health impact. The annual prevalence in the United States is estimated at 22,000 cases [13]. The prevalence of *B. henselae* infection in cat populations can be high. For instance, a study in Guayaquil, Ecuador, following a 2022 CSD outbreak, found that 14% of sampled stray and domestic cats were positive for *Bartonella* spp. carriage, with *B. henselae* being the most common species identified [2]. Seroprevalence in humans varies by exposure. A 1998 study found that all patients with CSD had IgG titers of 128 or higher, while 70% of healthy controls were seronegative [3]. However, a significant proportion of cat owners (28.6%) had antibodies, indicating past exposure without active disease [3]. More recent data from Malaysia (2015-2019) showed an *B. henselae* IgM seropositivity of 41.8% among suspected CSD patients, with an increasing trend each year, highlighting the ongoing public health concern [4]. --- ## Pathogenesis: From Scratch to Systemic Disease The pathogenesis of CSD begins with the inoculation of *B. henselae* into the human dermis through a break in the skin. The bacteria adhere to and invade endothelial cells and erythrocytes. The host's immune response, particularly the cell-mediated response, leads to the characteristic granulomatous inflammation and suppurative lymphadenopathy seen in affected lymph nodes. The typical incubation period is 3 to 14 days after the scratch or bite. The initial skin lesion, a small papule or pustule, may appear at the inoculation site. Within one to three weeks, regional lymphadenopathy develops, most commonly in the axillary (armpit), cervical (neck), or inguinal (groin) regions, depending on the location of the scratch [4]. The lymph nodes become enlarged, tender, and sometimes suppurative (forming pus). In most immunocompetent individuals, the infection is self-limiting, and the lymphadenopathy resolves within two to four months. However, in about 5-10% of cases, atypical or systemic manifestations occur. The bacteria can disseminate hematogenously to various organs, leading to complications such as neuroretinitis, endocarditis, osteomyelitis, hepatitis, and splenitis [5, 6, 7, 8]. Immunocompromised patients are at a significantly higher risk for severe and life-threatening complications, including bacillary angiomatosis and peliosis hepatis [5]. --- ## Human Symptoms: Recognizing CSD The clinical presentation of CSD can range from a mild, self-limiting illness to a severe, systemic disease. Recognizing the symptoms is crucial for timely diagnosis and treatment. ### Typical Presentation The classic and most common presentation of CSD is **regional lymphadenopathy**. This is the presence of swollen, tender lymph nodes near the site of the scratch or bite. Common locations include: - **Axillary (armpit):** Most common, often from a scratch on the arm or hand [4]. - **Cervical (neck):** Often from a scratch on the face or scalp. - **Inguinal (groin):** Can occur from a scratch on the leg or foot [5]. Other common symptoms include: - **Fever:** Often low-grade but can be high [2, 4]. - **Fatigue and Malaise:** A general feeling of being unwell. - **Headache:** A frequent complaint [14]. - **Skin Lesion:** A small papule, vesicle, or pustule at the inoculation site, which may appear before the lymph node swelling. A 2023 case report described a 29-year-old man with severe right inguinal pain, initially suspected to be an incarcerated hernia. He had been exposed to a kitten but denied any scratches or bites. Imaging and biopsy revealed right inguinal lymphadenitis, confirming CSD. This case underscores that CSD can present atypically and without a clear history of a scratch [5]. ### Atypical and Severe Manifestations When the infection disseminates, it can cause a variety of severe complications: - **Neuroretinitis:** This is one of the most common ocular manifestations of CSD [7, 8]. It involves inflammation of the optic nerve and the retina, leading to sudden, painless vision loss, optic disc edema, and the characteristic "macular star" exudate [7]. A case report detailed an 18-year-old female with isolated neuroretinitis and no systemic symptoms like fever or lymphadenopathy, highlighting that CSD must be considered in any unexplained case of neuroretinitis [7]. Another case involved a pediatric patient with both meningeal (brain) and ocular involvement, emphasizing the need for active screening for ocular complications in systemic CSD cases [8]. *B. henselae* neuroretinitis can also be associated with contact with non-feline pets, as fleas may reside on them [1]. - **Endocarditis:** *B. henselae* is a recognized cause of culture-negative infective endocarditis. It often occurs in patients with pre-existing heart valve lesions and a history of cat exposure [6]. A unique case report described a patient who developed CSD and then, six months later, developed mitral valve endocarditis, suggesting that CSD can be the primary infection that later leads to endocarditis in susceptible individuals [6]. - **Musculoskeletal Infections:** Osteomyelitis (bone infection) and arthritis can occur. A rare case of periprosthetic total knee infection caused by *B. henselae* was reported in a 65-year-old woman who developed acute knee pain three weeks after a cat scratch. The infection was undetectable by standard cultures and was only diagnosed via PCR analysis [15]. - **Other Systemic Involvement:** The infection can also affect the liver and spleen (hepatitis, splenitis), leading to abdominal pain and fever. In immunocompromised patients, *B. henselae* can cause **bacillary angiomatosis**, a condition characterized by proliferative blood vessel tumors in the skin and viscera, and **peliosis hepatis**, a condition involving blood-filled cysts in the liver [5]. - **Autoimmune Triggers:** There is evidence that *B. henselae* infection can trigger autoimmune conditions. A case report documented a 4-year-old boy who developed autoimmune thyroiditis (AIT) following a CSD infection. Notably, the AIT was fully reversible after the bacterial infection was treated and eliminated, suggesting a direct link between the pathogen and the autoimmune response [14]. --- ## Feline Vectors: The Cat's Role in Transmission The cat is the primary reservoir for *B. henselae*. Understanding the feline side of the equation is essential for veterinarians and pet owners to prevent zoonotic transmission. ### How Cats Become Infected and Transmit the Bacteria Cats become infected with *B. henselae* primarily through the bite of an infected cat flea. The flea ingests the bacteria when feeding on a bacteremic cat. Once infected, the flea sheds the bacteria in its feces for weeks to months. Cats can also become infected by ingesting infected fleas or flea feces during grooming. Transmission from cat to human occurs through: 1. **Scratches or Bites:** The most common route. Bacteria-laden flea feces on the cat's claws or in its mouth are inoculated into the skin [5]. 2. **Licks on Broken Skin:** A cat licking an open wound, scratch, or abrasion can transfer infected flea feces. 3. **Flea Feces Contact:** Direct contact with infected flea feces, for example, from a pet's fur or environment, can be a source of infection, even without a scratch [1]. ### Risk Factors for Feline Carriage - **Kittens:** Young cats, especially those under one year of age, are more likely to be bacteremic and are more likely to scratch and bite during play, making them a higher transmission risk [5]. - **Stray and Outdoor Cats:** These cats have a higher exposure to fleas and other vectors, increasing their risk of carrying *B. henselae*. A study in Ecuador found a high prevalence of *Bartonella* carriage in stray cats within an area that experienced a CSD outbreak [2]. - **Flea Infestation:** The presence of fleas on a cat is the single most important risk factor for *B. henselae* infection. Effective flea control is the cornerstone of prevention. ### Diagnosis of Feline Bartonellosis Diagnosing *B. henselae* infection in cats is challenging because they are typically asymptomatic. Diagnostic tests are not routinely recommended for healthy cats but may be considered in specific research or clinical scenarios. - **Blood Culture:** This is the gold standard but is difficult and slow because *B. henselae* is a fastidious, slow-growing organism. It requires specialized media and prolonged incubation (up to several weeks) [12]. - **PCR (Polymerase Chain Reaction):** This molecular test detects the bacterial DNA in a blood sample. It is more rapid and sensitive than culture. A study successfully used PCR to detect and genotype *B. henselae* from a cat's blood [12]. - **Serology:** Testing for antibodies against *B. henselae* in cats indicates exposure but not necessarily active infection. It is not a reliable indicator of current bacteremia or zoonotic risk. ### Treatment of Feline Bartonellosis Treatment of infected cats is controversial. Because the infection is usually asymptomatic and the risk of transmission to humans can be managed with flea control, treatment is not always recommended. However, in some cases, such as when a cat lives with an immunocompromised person, treatment may be considered to clear the bacteremia. Antibiotics such as doxycycline have been shown to eliminate *B. henselae* bacteremia in some cats. A case report documented that a cat's *B. henselae* infection was cleared within three months of doxycycline treatment [12]. However, antibiotic treatment is not always effective, and relapses can occur. The primary focus should always be on strict, year-round flea control. --- ## Diagnosis of Cat Scratch Disease in Humans Diagnosis of CSD in humans is based on a combination of clinical presentation, history of cat exposure, and laboratory testing. ### Clinical Suspicion A high index of suspicion is required, especially in patients presenting with regional lymphadenopathy and a history of contact with cats, particularly kittens. The presence of a characteristic skin lesion and fever further supports the diagnosis. However, as noted in several case reports, the absence of a known scratch does not rule out CSD [5]. ### Laboratory Confirmation Several laboratory tests can be used to confirm the diagnosis: - **Serology (IFA):** The indirect [immunofluorescence assay](/knowledge/diagnostics/molecular/immunofluorescence-assay) (IFA) is the most widely used serological test. It detects IgG and IgM antibodies against *B. henselae* [3, 4, 9, 16, 17, 18]. - **IgG Antibodies:** A single high titer (e.g., ≥1:256) or a four-fold rise in titer between acute and convalescent samples is considered diagnostic [3, 17]. - **IgM Antibodies:** Positive IgM antibodies indicate recent or active infection [16, 17, 18]. - **Limitations:** Serology has limitations, including false negatives in early infection (before antibodies develop) and false positives due to cross-reactivity with other *Bartonella* species [9, 10, 13]. A study in Japan found that 7.9% of patients with suspected CSD were seronegative but had *B. henselae* DNA detected by PCR, highlighting the risk of false-negative serology [10]. Additionally, the sensitivity of the test can vary depending on the bacterial strain used as the antigen. A case report described a patient who tested negative for the common Houston-1 strain but positive for a Japan-specific YH-01 strain [19]. - **PCR (Polymerase Chain Reaction):** This molecular test detects *B. henselae* DNA directly from clinical specimens, such as pus aspirated from a lymph node, a lymph node biopsy, or whole blood [9, 10, 11]. PCR is highly specific and can be more sensitive than serology, especially in the early stages of the disease [9, 10]. It is particularly useful for confirming the diagnosis in seronegative patients [10]. - **Immunofluorescence Detection (IFD):** This technique uses a monoclonal antibody to detect *B. henselae* directly in smears from lymph node biopsies. It is a rapid and specific test that can be used in conjunction with serology to improve diagnostic accuracy. A study found that the combination of IFD and IFA had a sensitivity of 97.4% if one of the two tests was positive [11]. - **Histopathology:** Examination of a lymph node biopsy can show characteristic granulomatous inflammation with stellate abscesses. Warthin-Starry silver staining can reveal the bacilli, but this is not always positive. This is often done to rule out other causes of lymphadenopathy, such as lymphoma or tuberculosis [14]. --- ## Evidence-Based Management and Treatment The management of CSD depends on the severity of the clinical presentation and the immune status of the patient. ### Treatment for Immunocompetent Patients For most immunocompetent patients with typical, uncomplicated CSD (regional lymphadenopathy without severe systemic symptoms), the disease is self-limiting. Supportive care, including analgesics for pain and fever, may be all that is needed. The lymphadenopathy typically resolves spontaneously within 2 to 4 months. The role of antibiotics in uncomplicated CSD is debated. Some studies suggest that antibiotics like azithromycin can shorten the duration of lymphadenopathy, but the effect is often modest. A case report of a child with CSD noted recovery after azithromycin therapy [12]. ### Treatment for Severe or Atypical Manifestations Antibiotic therapy is clearly indicated for patients with severe or atypical manifestations, including neuroretinitis, endocarditis, osteomyelitis, and for all immunocompromised patients. Commonly used antibiotic regimens include: - **Azithromycin:** Often used as a first-line agent for its good intracellular penetration and tolerability [12]. - **Doxycycline:** Frequently used, often in combination with rifampin for severe infections like neuroretinitis or endocarditis [7]. - **Combination Therapy:** For serious infections like neuroretinitis, a combination of doxycycline and rifampin is often recommended. For endocarditis, a prolonged course (weeks to months) of doxycycline and rifampin or gentamicin is typically required [6]. A case report of an 18-year-old with isolated neuroretinitis showed significant visual improvement after treatment with oral doxycycline combined with azithromycin and low-dose glucocorticoids [7]. This highlights the need for prompt and targeted treatment for ocular involvement. --- ## Prevention: Protecting Humans and Cats Prevention of CSD relies on a One Health approach that addresses both the feline reservoir and the human risk factors. ### For Pet Owners 1. **Flea Control is Paramount:** The most effective way to prevent *B. henselae* infection in cats and, consequently, in humans is rigorous, year-round flea control for all pets. This is the single most important preventive measure [1]. 2. **Avoid Rough Play:** Discourage kittens and cats from playfully scratching or biting. Use toys instead of hands or feet for play. 3. **Wash Scratches and Bites Promptly:** Immediately wash any cat scratch or bite with soap and running water. This can help remove the bacteria before they establish an infection. 4. **Avoid Stray Cats:** Do not handle or pet stray or feral cats, as they are more likely to be flea-infested and carry the bacteria. 5. **Immunocompromised Individuals:** People with weakened immune systems should take extra precautions. They should avoid contact with cats that have fleas and discuss the risks with their healthcare provider. Adopting a young kitten may not be advisable for these individuals. 6. **Declawing:** Declawing is a surgical amputation and is not recommended as a preventive measure for CSD. It is a painful procedure that can lead to behavioural and health problems in cats. The focus should be on flea control and appropriate play. ### For Veterinarians Veterinarians play a crucial role in educating clients about zoonotic diseases. Client education should include: - The importance of flea control for the health of the pet and the family. - The risks of CSD, especially for households with children and immunocompromised individuals. - The fact that healthy-looking cats can be carriers of *B. henselae*. - The recommendation to avoid rough play. --- ## Prognosis and Long-Term Outcomes The prognosis for CSD is generally excellent, especially for immunocompetent individuals. - **Typical CSD:** The disease is self-limiting, and symptoms usually resolve completely without any long-term sequelae. The lymphadenopathy may persist for several weeks but eventually subsides. - **Neuroretinitis:** With prompt antibiotic treatment, the visual prognosis is good, with most patients recovering significant vision over several months [7]. - **Endocarditis:** This is a serious complication with significant morbidity and mortality. It requires prolonged antibiotic therapy and often surgical intervention for valve repair or replacement [6]. - **Autoimmune Complications:** As seen in the case of autoimmune thyroiditis, the condition may be reversible if the underlying *B. henselae* infection is treated early and effectively [14]. --- ## Limitations and When to Contact a Veterinarian This article provides a comprehensive overview of CSD for educational purposes. It is not a substitute for professional veterinary or medical advice, diagnosis, or treatment. This information cannot predict the specific risk for any individual animal or person, nor can it account for all possible clinical variations. Breed-level or individual-animal susceptibility to *B. henselae* carriage is not well-defined and cannot be predicted from this information. **When to Contact a Veterinarian:** - If your cat has a severe flea infestation, your veterinarian can recommend safe and effective flea control products. - If your cat is showing any signs of illness, although rare with bartonellosis, a veterinary examination is always recommended. - To discuss the zoonotic risks of your pet, especially if a household member is immunocompromised or pregnant. **When to Seek Medical Attention (for Humans):** - If you develop a swollen lymph node, fever, or fatigue after a cat scratch or bite, especially if the symptoms persist for more than a few days. - **Emergency Red Flags:** Seek immediate medical care if you experience: - Sudden vision changes or vision loss. - Chest pain or shortness of breath. - Severe headache, confusion, or stiff neck. - High fever. - Severe pain or swelling in a joint or bone. --- ## Frequently Asked Questions ### 1. Can I get cat scratch disease from a healthy-looking cat? Yes. Cats infected with *Bartonella henselae* typically show no signs of illness. They can appear perfectly healthy while carrying the bacteria and transmitting it to humans through scratches or bites [2]. ### 2. How is cat scratch disease transmitted from cats to humans? The primary mode of transmission is through a scratch or bite from an infected cat. The bacteria are present in flea feces, which can be on the cat's claws or in its mouth. The bacteria enter the human body through the break in the skin [5]. ### 3. What are the first signs of cat scratch disease in a person? The first sign is often a small bump or blister at the site of the scratch. This is followed by swollen, tender lymph nodes near that area, usually within one to three weeks. Fever, fatigue, and headache may also occur [2, 4]. ### 4. Is cat scratch disease serious? For most healthy people, CSD is self-limiting and resolves without treatment. However, it can be serious, especially in immunocompromised individuals, leading to complications like neuroretinitis, endocarditis, and bone infections [5, 6, 7]. ### 5. How is cat scratch disease diagnosed in humans? Diagnosis is based on clinical signs, a history of cat exposure, and laboratory tests. Blood tests for antibodies (serology) and PCR tests on blood or lymph node samples are commonly used to confirm the infection [9, 10, 11]. ### 6. What is the treatment for cat scratch disease? Many cases require no specific treatment and resolve on their own. For more severe cases or for immunocompromised patients, antibiotics such as azithromycin or doxycycline are prescribed [7, 12]. ### 7. How can I prevent my cat from getting *Bartonella henselae*? The most effective prevention is strict, year-round flea control. Keeping your cat indoors and preventing exposure to stray animals can also reduce the risk of flea infestation and infection [1]. ### 8. Should I be worried about cat scratch disease if I am pregnant or have a weak immune system? Yes, you should take extra precautions. Immunocompromised individuals are at higher risk for severe complications. It is advisable to avoid contact with stray cats, ensure your own cat is on effective flea control, and discuss any concerns with your healthcare provider. --- ## Sources [1] [Not cat-scratch disease: Bartonella henselae neuroretinitis associated with non-feline pet mammals](https://www.semanticscholar.org/paper/88e369d29787f435fb80ccabb6f514a2a16a3044) [2] [First report of Bartonella henselae and Bartonella clarridgeiae carriage in stray cats from Ecuador and its link to a cat scratch disease outbreak in 2022.](https://www.semanticscholar.org/paper/828906cbdba8b53920b950ae0702e23ec0534e63) [3] [Seroprevalence of Antibodies to Bartonella henselae in Patients with Cat Scratch Disease and in Healthy Controls: Evaluation and Comparison of Two Commercial Serological Tests](https://www.semanticscholar.org/paper/82245b919c735daa9c524995a6eb7a55ad328c96) [4] [Seropositivity of Bartonella henselae Among Suspected Cat Scratch Disease Patients in Malaysia: A 5-Year Retrospective Study (2015-2019).](https://www.semanticscholar.org/paper/1ce8b5c4ef2fcc5b76854d285deaf6d464061f36) [5] [Cat Scratch Disease: An Unusual Case of Right Inguinal Lymphadenitis Due to Bartonella henselae](https://www.semanticscholar.org/paper/11ed1791c0690833b2115c89c5d7c33cbc16af4d) [6] [From cat scratch disease to endocarditis, the possible natural history of Bartonella henselae infection](https://www.semanticscholar.org/paper/a86020fdaaa2b81b7a8514c55a5cfc10b036916e) [7] [Cat-Scratch Disease Presenting as Isolated Neuroretinitis (Bartonella henselae): A Case Report.](https://pubmed.ncbi.nlm.nih.gov/41293337/) [8] [[Atypical cat scratch disease: Bartonella henselae ocular and meningeal involvement].](https://www.semanticscholar.org/paper/099d87b454d30f5853f9854e12d2393690a04dce) [9] [Serological and molecular detection of Bartonella henselae in specimens from patients with suspected cat scratch disease in Italy: A comparative study](https://www.semanticscholar.org/paper/044439e9dd19a79ae2c5fdf9ee753ee60d1024cc) [10] [Bartonella henselae DNA in Seronegative Patients with Cat-Scratch Disease](https://www.semanticscholar.org/paper/ef5868c57b43fb3dea697dfe1f9d760530b1bb46) [11] [Detection by Immunofluorescence Assay of Bartonella henselae in Lymph Nodes from Patients with Cat Scratch Disease](https://www.semanticscholar.org/paper/1cb0e9c2271730aa96aa639c0875e225351221ad) [12] [First isolation and genotyping of Bartonella henselae from a cat living with a patient with cat scratch disease in Southeast Europe](https://www.semanticscholar.org/paper/99c0cc2602279e2ee54f3fb731ecc13e1f00fece) [13] [Cat scratch disease: Pediatric case series for varying presentations of Bartonella henselae](https://www.semanticscholar.org/paper/8959df43079bd4eef6c9fd9a71bfccfea7c00981) [14] [Autoimmune Thyroiditis Induced by Bartonella henselae (Cat-Scratch Disease) Might Be Reversible](https://www.semanticscholar.org/paper/a473a7517ba9fff81212a08d262c415371ad45eb) [15] [Total Knee Bartonella henselae Infection: An Unusual Manifestation of Cat Scratch Disease: A Case Report.](https://www.semanticscholar.org/paper/7363d7de6df5a1055d88a53b07719c88e81f44b2) [16] [Exploring the seasonal and regional features of cat-scratch disease on the basis of anti-Bartonella henselae IgM/IgG positive rates in Japan.](https://www.semanticscholar.org/paper/c1cec1560b44744b7e79624fc8ac6084249bc392) [17] [Clinical utility of indirect fluorescent assay for IgA class antibodies against Bartonella henselae in serodiagnosis of cat scratch disease in its early stage.](https://www.semanticscholar.org/paper/c0df95e96c660746e1498410f124b0b8405d3317) [18] [[Bartonella henselae: Serological evidence in pediatric patients with clinical suspicion of cat scratch disease].](https://www.semanticscholar.org/paper/c7fb90488a98bfbc875d49f18d5527fbc4f5d678) [19] [A CASE OF CAT SCRATCH DISEASE DIAGNOSED BY INDIRECT FLUORESCENT ANTIBODY ASSAY OF IgM SPECIFIC FOR A JAPANESE STRAIN OF Bartonella henselae](https://www.semanticscholar.org/paper/6e9b06052eec7087d14923081c55792cc2460125) [20] [In silico analyses and design of chimeric proteins containing epitopes of Bartonella henselae antigens for the control of cat scratch disease](https://www.semanticscholar.org/paper/621fc5423beedf94e7cb702a26fd7875b8a4e72c) ## Related Clinical & Scientific Guides * [Heatstroke Emergency Triage: Cooling Guidelines and Organ Damage Triage](/knowledge/veterinary-medicine/emergency-zoonotic-care/heatstroke-emergency-triage-cooling-guidelines-and-organ-damage-triage) * [GDV Bloat Triage: Recognizing Stomach Torsion and Gastropexy Surgery](/knowledge/veterinary-medicine/emergency-zoonotic-care/gdv-bloat-triage-recognizing-stomach-torsion-and-gastropexy-surgery) * [Porcupine Quill Removal: Why You Should Never Cut Quills at Home](/knowledge/veterinary-medicine/emergency-zoonotic-care/porcupine-quill-removal-why-you-should-never-cut-quills-at-home)