Cats And Bartonella "The Cat Scratch Disease Bacteria" Information for Cat Owners Approximately 20% of healthy cats, living in the United States, are infected carriers of these dangerous Bartonella bacteria. Now you can stop the spread of Bartonella from cat to cat and cat to human with a simple blood test of your cat. FeBart Test The Bartonella test service provided exclusively by The National Veterinary Laboratory, Inc. Prepared by Dr. William D. Hardy, Jr. Director And Evelyn E. Zuckerman, B.S. Laboratory Supervisor National Veterinary Laboratory P.O. Box 239 Franklin Lakes, NJ 07417
In the 1970 s Ted Nugent had a hit song caled Cat Scratch Fever. Litle did he know how important the disease, Cat Scratch Disease or Bartonelosis would become. There are not many diseases that can claim to have a hit song written about them decades before the causative agent was identified.
Introduction Healthy cats can carry five members of the Bartonella bacteria family in their blood: Bartonella henselae, Bartonella clarridgeiae, Bartonella koehlerae, Bartonella elizabethae, and Bartonella weissii, which are transmitted between cats by fleas and ticks. The bacteria can be spread to people via cat scratches and bites, contact with fur, and probably rarely by infected fleas and ticks. Although most infected people do not become ill, Bartonella, transmitted from cats, can cause 22 human diseases. Bartonella Life Cycle
Bartonella are difficult to culture from the blood of infected cats. However, now there is a simple and accurate blood test, the FeBart Test developed by The National Veterinary Laboratory, to determine if cats are infected with these bacteria. Most infected cats remain infected for years and possibly for life. Although most cats are not infected, if your cat is found to be carrying these bacteria, your veterinarian can prescribe antibiotics to eliminate the infection. Cats Left Panel. Isolation of Bartonella from the blood of an infected kitten. More than 1,000 Bartonella per ml of blood was recovered (small gray dots- red arrows). Right Panel. Gram stain of the isolated Bartonella bacteria that tend to clump together (black arrows). Incidence of Infection: The incidence of Bartonella-infected cats varies in different geographic areas and depends on the average temperature and rainfall (humidity). About 20% of healthy cats in the U.S. are infected carriers. The highest infection rates occur in hot humid climates, which are conditions favorable for fleas and ticks: Southeast (28%), Hawaii (28%), Costal California (28%), Pacific Northwest (28%), South Central Plains (22%), Southwest (22%), Northeast and New England (17%), Midwest (9%), Alaska (9%), and Rocky Mountains-Great Plains (9%). 9% 17% 22% 28%
Incidence of Bartonella Infection in Healthy Cats by Zip Code 9 60% 75% To 8/1/04 8 24% Black= Low Yellow= Moderate Red= High 5 19% 6 48% 7 58% 4 35% 3 62% 1 st number of zip code 1 34% 0 29% 2 54% This figure showsthe National Veterinary Laboratory s prevalence of Bartonella infection in pet cats based on the first number of the zip code in each area of the United States. Worldwide Prevalence of Bartonella in Cats Low High Worldwide Prevalence of Bartonella Infection in Cats: The map above shows a summary of the worldwide prevalence of Bartonella infection in cats based on reports from the 4 th International Bartonella Conference, Uppsala, Sweden 2004 and a review of the scientific literature: USA- North- 20% South-60% France- 10-20% Hawaii- 89% Italy- 20-40% Canada- 20% Africa- 25% Caribbean- 70% Australia- 15-40% Sweden- South- 3%, North- 0% Philippines- 70% United Kingdom- 40% Indonesia- 55%
Cat Bartonella Diseases: Cat Bartonella possess pili which are hair-like structures found on the bacteria s surface. The pili cause Bartonella to stick to, and penetrate, red blood cells and the cells that make up the walls of capillaries. The ability to adhere to the cells of capillary walls leads to the wide and varied tissue specificity observed in cats, dogs, and people. Bartonella induce inflammatory reactions in many tisues throughout the infected animal s body. These tisues are: oral and respiratory mucosa, ocular tissues, the gastro-intestinal tissues, the skin, and organs such as the liver, spleen and lymph nodes. In fact, since capillaries are found in all tissues, all tissues are susceptible to the inflammatory effects of Bartonella. Inflammatory reactions often occur concurrently in multiple sites such as the oral and respiratory tissues, ocular and oral tissues, or in other combinations. Bartonella cause chronic insidious diseases such as inflammation of the eyes, the gums and oral cavity (a common condition of pet cats), enlarged lymph nodes, fevers, kidney disease, upper respiratory disease, and vague neurological signs in some cats. However, most infected cats are healthy carriers and go unnoticed by their owners. Although numerous micoorganisms cause inflammatory diseases, it appears that Bartonella is the cause of about 50% of the following conditions in pet cats: Bartonella-Induced Inflammatory Diseases of Cats Lymphoid System: Lymphadenopathy Oral: Gingivitis Stomatitis Oral Ulcers Submandibular lymphadenopathy Ocular: Uveitis Chorioretinitis Conjunctivitis Keratitis Respiratory: URI Rhinitis Sinusitis Heart: Endocarditis Valvulitis- vegetative Murmurs GI Tract: Infl. Bowel Disease- IBD Chronic Vomiting Chronic Diarrhea Musculoskeletal: Myositis Arthritis- polyarthritis CNS: Encephalitis Meningoencephalitis Seizures Aggression Major Organs: Liver: Bacillary peliosis hepatis Granulomatous hepatic syndrome Spleen: Splenic bacillary angiomatosis Granulomatous splenic syndrome Pancrease: Diabetes Mellitus? Skin: Bacillary Angiomatosis- Papule- chin acne Skin granuloma Pruritic rash Other: Fever of unknown originfebrile bacteremia
Cat Bartonella Diseases: Oral Diseases: Oral inflammatory diseases are the most common Bartonella diseases in cats. Gingivitis- Stomatitis- Oral Ulcers- inflammation of the gums inflammation of the mouth cavity ulcers in the mouth cavity Gingivitis Gingivitis Gingivitis Jan Corbishley, VT Oradell Animal Hospital Paramus, NJ Jan Corbishley, VT Oradell Animal Hospital Paramus, NJ Jan Corbishley, VT Oradell Animal Hospital Paramus, NJ Stomatitis Stomatitis Stomatitis Jan Corbishley, VT Oradell Animal Hospital Paramus, NJ Jan Corbishley, VT Oradell Animal Hospital Paramus, NJ Dr. Ben Colmery Dixboro Veterinary Dental Center Ann Arbor, MI
Gingivitis Gingivitis Oral Ulcers Dr. Joseph Chiosi Sayrebrook Veterinary Hospital Sayreville, NJ Dr. Stephen Schuchman Boulevard Pet Hospital Castro Valley, CA Jan Corbishley, VT Oradell Animal Hospital Paramus, NJ Gingivitis Gingivitis Gingivitis Jan Corbishley, VT Oradell Animal Hospital Paramus, NJ Jan Corbishley, VT Oradell Animal Hospital Paramus, NJ Jan Corbishley, VT Oradell Animal Hospital Paramus, NJ
Respiratory Diseases: Upper Respiratory Disease Rhinitis- inflammation of the nasal cavity Sinusitis- inflammation of the sinuses Upper Respiratory Disease Upper Respiratory Disease Jan Corbishley, VT Oradell Animal Hospital Paramus, NJ Jan Corbishley, VT Oradell Animal Hospital Paramus, NJ Rhinitis Dr. Larry Kantrowitz Oradell Animal Hospital Paramus, NJ
Ocular Diseases: ConjunctivitisUveitisChorioretinitisBlepharitisKeratitisCorneal Ulcers- inflammation of the conjunctiva inflammation of the iris inflammation of the retina and its blood vessels inflammation of the eyelids inflammation of the cornea ulcers of the cornea Conjunctivitis Dr. Jack Broadhurst Cat Health Clinic Pinehurst, North Carolina Blepharitis Dr. Jack Broadhurst Cat Health Clinic Pinehurst, North Carolina Conjunctivitis Dr. William D. Hardy, Jr. Henry Bergh Memorial Hospital of the ASPCA New York, New York Conjunctivitis Dr. Jack Broadhurst Cat Health Clinic Pinehurst, North Carolina Keratitis & Conjunctivitis Dr. Kerry L. Ketring All Animal Eye Clinic Cincinnati, Ohio www.allanimaleyeclinic.com
Uveitis Dr. Kerry L. Ketring All Animal Eye Clinic Cincinnati, Ohio www.allanimaleyeclinic.com Uveitis Dr. Kerry L. Ketring All Animal Eye Clinic Cincinnati, Ohio www.allanimaleyeclinic.com Uveitis & Chorioretinitis Dr. Kerry L. Ketring All Animal Eye Clinic Cincinnati, Ohio www.allanimaleyeclinic.com Corneal Ulcer Dr. Kerry L. Ketring All Animal Eye Clinic Cincinnati, Ohio www.allanimaleyeclinic.com
Chronic Diarrhea Intestinal Diseases: Inflammatory bowel disease Diarrhea (chronic) Vomiting (chronic) Other Diseases: Dr. Jack Broadhurst Cat Health Clinic Pinehurst, North Carolina Enlarged lymph nodes- lymphadenopathy Fever of unknown origin Liver diseasehepatitis Skin diseasespapules & dermatitis Heart diseasevalvular disease (murmurs) endocarditis Skin papule Dermatitis Dr. Kerry L. Ketring All Animal Eye Clinic Cincinnati, Ohio www.allanimaleyeclinic.com Skin papule Granuloma- ear Dr. Kerry L. Ketring All Animal Eye Clinic Cincinnati, Ohio www.allanimaleyeclinic.com
Treatment for at Bartonella Diseases: Treatment for Bartonella infection in healthy cats and for Bartonella-induced diseases in infected cats is very effective with the appropriate antibiotics that your veterinarian can prescribe. Below are a number of before and after treatment photographs that document the success of anti-bartonella therapy. Gingivitis: Oral Ulcers: Before Therapy Before Therapy After Therapy After Therapy
Upper Respiratory Disease: Before Therapy After Therapy Before Therapy After Therapy Conjunctivitis: Dr. Jack Broadhurst Cat Health Clinic Pinehurst, North Carolina Conjunctivitis/Uveitis: Before Therapy After Therapy Dr. Kerry L. Ketring All Animal Eye Clinic Cincinnati, Ohio www.allanimaleyeclinic.com
Corneal Ulcer/Uveitis: : Before Therapy After Therapy Dr. Kerry L. Ketring All Animal Eye Clinic Cincinnati, Ohio www.allanimaleyeclinic.com Skin Papule: Before Therapy After Therapy Gingivitis & Skin Papule in the same cat: Before Therapy After Therapy
Human Bartonella Diseases: Human Diseases Caused by Feline Bartonella There is an increasing awareness of the human diseases caused by Bartonella transmitted from cat s.ana r t i c l ee n t i t l e d Cu d d l ewi t hca r e a p p e a r e di nti mema g a z i n ei nt h efe b r u a r y2 3, 2004 edition which emphasized the danger to people of infections that can be obtained from their pets. Cat scratch disease (Bartonella diseases) was at the top of the list of diseases discussed. Time Magazine February 23, 2004 Although most infected people do not become ill, rarely, they may become very ill. Bartonella, transmitted from cats, can cause 22 human diseases: cat scratch disease, bacillary angiomatosis, bacillary peliosis, febrile bacteremia, heart diseases- (endocarditis & vegetative valvular disease), eye diseases- (uveitis, neuroretinitis, disciform keratitis), neurological disorders- (meningoencephalitis & AIDS encephalitis), musculoskeletal diseases(osteomyelitis, arthralgia, juvenile arthritis, & myositis), skin diseases-
(cutaneous rash- Henoch Schenlein purpura & cutaneous granuloma annulare), inflammatory bowel disease, mononucleosis-like syndrome, pulmonary infiltrates, lymphadenopathy (lymph node enlargement) and co-infection with Lyme disease. Cat Scratch Disease: The Tip of the Bartonella Iceberg 22,000 cases/year 2,000 hospitalizations CSD Bacillary Angiomatosis, Bacillary Peliosis Hepatis, Febrile Bacteremia, Endocarditis Endocarditis Lymphadenopathy, Encephalitis, Uveitis, Gingivitis/stomatitis, MononucleosisMononucleosis- like syndrome, Anemia, Granulomatous Hepatosplenic Syndrome, Retinitis & Optic nerve neuritis, Osteolytic Lesions, Pulmonary Granuloma, Disciform keratitis, AIDS Encephalopathy Encephalopathy Inflammatory bowel disease, CoCo-infection in Lyme Disease, Cutaneous rashrash- HenochHenoch-Schenlein purpura, Cutaneous granuloma annulare Human Disease Caused by Feline Bartonella Lymphoid System: Cat Scratch Diseaselymphadenopathy Ocular: Chorioretinitis Optic nerve neuritis Uveitis Disciform keratitis Conjunctivitis Parnaud s oculoglandular syndrome Orbital abscess Oral: Gingivitis/periodontitis Bacillary angiomatosis Respiratory: Pulmonary granuloma Pulmonary infiltrates Heart: Endocarditis Valvulitis- vegetative GI Tract: Inflammatory bowel disease Bacillary Angiomatosis CNS: Encephalitis Meningoencephalitis AIDS encephalopathy Major Organs: Liver: Bacillary peliosis hepatis Granulomatous hepatosplenic syndrome Spleen: Splenic bacillary angiomatosis Granulomatous hepatosplenic syndrome Kidney: Necrotizing glomerulonephritis S k in : Bacillary Angiomatosis Cutaneous rash- Henoch-Schenlein purpura Cutaneous granuloma annulare Other: Fever of unknown origin- febrile bacteremia Mononucleosis-like syndrome Chronic fatigue-like syndrome Co-infection in Lyme Disease
Kids and Kittens: Kittens are more likely than adult cats to transmit Bartonella to people, especially to children. Children often allow kittens to lick their face and to sleep with them. Boys play more roughly than girls with kittens and are more likely to be scratched or bitten and thus are more likely to develop cat scratch disease (CSD) more often than girls.
Cat Scratch Disease: Cat scratch disease develops in people a few weeks after transmission of Bartonella from cats. More than 22,000 cases occur each year, of which more than 2,000 people require hospitalization. Lymph nodes that drain the injury site become inflamed, enlarged, painful, and may develop an abscess, which may burst and drain. Severe cases may rarely progress to internal organ involvement, neurological complications, and coma. Antibiotics can shorten the clinical course, which usually lasts 6 to 8 weeks if untreated. Cat Scratch Disease is often used to denote all 24 Bartonella diseases in humans. Scratch and skin papule In a wife of a veterinarian Enlarged painful lymph nodes in the neck 17 year old boy- scratched by a kitten
Bacillary Angiomatosis (BA): BA is a skin condition where Bartonella infection causes red raised nodules, which may be mistaken for a certain skin tumor, Kaposi's sarcoma. BA can also involve major internal organs such as the liver and spleen. This disease occurs most often in immunosuppressed people such as those receiving chemotherapy, organ transplants or infected with HIV. Abdominal computer tomogram of a patient with bacillary peliosis hepatis caused by Bartonella henselae: Low density lesions (arrow) in the enlarges liver. (Koehler & Tappero, Clin Infect. Dis. 1993; 17:612-24). Top panels are Bartonella induces bacillary angiomatosis sores in HIV-infected patients. The bottom panels are Kaposi s sarcomas in HIV infected patients. NEJM 337: 1888, Dec. 25, 1997. Multiple subcutaneous nodules of bacillary angiomatosis (red arrows) in an HIV infected patient. The left eye has a Kaposi s sarcoma (KS) lesion (black arrow). Koehler and Tappero, Clin Infect. Dis. 1993; 17:612-24.
Neurological Disorders: Encephalopathy, encephalitis, aggression, status epilepticus, convulsions, and coma are some of the rare neurological disorders associated with Bartonella-infections, especially in children. I n c r e a s e d s i g n a l i n t en s i t y i n t h e pulvinar of left thalamus (arrow). One month after treatment: resolution of abnormal signal in left thalamus (arrow). MRI NE J Med. 338:112, Jan. 8, 1998. This case was an 11-year-old boy who lived with his parents and 2 kittens. He was admitted to the hospital due to seizures and was unconscious. The EMT found the boy confused, combative and unresponsive to verbal stimuli. He had been well until day of the seizure and there had been no fever, rash or lymphadenopathy. All blood culture specimens were sterile, however he had antibody to Bartonella henselae and was treated for c a t s c ra t c h d i s e a s e with antibiotics. He made a rapid and complete recovery. Status epilepticus: Armengol et al: J Pediatr 134: 635, 1999. Status epilepticus is defined as a repeated seizure or a seizure lasting at least 30 minutes. Six school age children in Virginia with cat scratch disease developed sequelae of status epilepticus after recovering from the classical cat scratch disease syndrome. A review of the hospital database revealed that 4 of 5 previously healthy children, who had developed status epilepticus, were positive for antibody to Bartonella henselae. This report shows that some people who recover from the classical cat scratch disease can develop various serious chronic Bartonella-induced diseases months after recovery from cat scratch disease.
Skin Lesions: Dermatitis, infection of the skin, induced by Bartonella is common in people. The reaction varies from a rash, blotchy red areas, raised red papules, nodules, granulomas, or dry appearing crater-like lesions. Papules Henoch-Schenlein Purpura Granulomas Rash Dry Crater Lesion Fever of Unknown Origin: Nodules o Bartonella-infections may cause persistent high fevers (104-105 F) where the physician is unable to diagnose the cause. The high fevers and flu-like signs may last 7 to 10 days and may recur several times.
Eye Disease: Some Bartonella-infected people develop generalized inflammations in the eye including the outer membranes, iris, retina and optic nerve. Conjunctivitis Conjunctivitis 10-year-old boy 12-year-old girl Parinaud s Oculoglandular Syndrome Parinaud s Oculoglandular Syndrome 13-year-old boy History of cat bite, 3 weeks prior Chorioretinitis NEJM 343:1459, Nov. 16, 2000. Female, adolescent History of cat bite Above 4 eye photos: Dr. Kerry L. Ketring All Animal Eye Clinic Cincinnati, Ohio www.allanimaleyeclinic.com
Infectious Mononucleosis-like Syndrome: A syndrome in 6 children, clinically identical to infectious mononucleosis, was recently found to be caused by Bartonella obtained from kittens. An Italian study published in 2000 described the clinical features of Bartonella henselae infections in 20 Italian children (14 males) within a 12-month period. All were positive for antibodies to Bartonella henselae. The mean age was 7 years 4 months with a range from 1 year 1 month to 14 years of age. All children but one had a history of contact with kittens. Clinical manifestations included regional lymph node enlargement in 14 patients, and an infectious mononucleosis-like syndrome in six children. In five patients a severe disorder was first suspected. Fever of unknown origin occurred in 2 children and multiple liver and spleen granulomas occurred in 1 child. Lesions of the bone suggested a bone tumor in one child whereas a marked enlargement of the lymph nodes in the groin suggested Burkitt lymphoma in another. This report again demonstrates the severe nature of Bartonella infections in some people, especially children. Invasive diagnostic procedures may be required before Bartonella infections are considered. Inflammatory Bowel Disease: There have been reports of Bartonella causing chronic inflammatory bowel disease in people. Abdominal Ultrasound: 13 year-old boy with fever for 3 weeks, bowel problems, and weight loss. The boy was not a cat owner but had contact with a fri e n d s kitten. Unknown to this boy, his friend had been hospitalized with cat scratch disease the month before. Top. Ileum- small intestines: Longitudinal view of terminal ileum- Increased thickness in the bowel wall (arrows). Bottom. Liver: Lucent focal Bartonella nodules in liver (arrows). Complications of Chronic Lyme Disease: Some people with chronic Lyme disease, that was refractory to therapy, were found to be coinfected with Bartonella derived from cats infested with Bartonella-infected ticks. The signs of disease in these people cleared after treatment for Bartonella infection. This finding is significant since it shows that ticks, as well as fleas, can transmit Bartonella.
What to Do? Test: Now cat owners can easily have their cats tested for Bartonella infection. Most infected cats show no sign of illness, yet some cats can carry as many as 1,000 bacteria in each milliliter (one-fifth of a teaspoonful) of blood. The Bartonella blood test requires only a small amount of blood, which can be drawn at the cat's yearly health checkup. The blood sample is then sent to a specialized reference laboratory, The National Veterinary Laboratory, Inc. Franklin Lakes, New Jersey, to perform the test. The test checks for antibody against the bacteria and high amounts of antibody signify infection. Treatment: If your cat is infected, your veterinarian will prescribe antibiotic therapy and intensive flea control for both your pet and your house. Flea control is very important since fleas can reinfect your cat after therapy. Antibiotic therapy can rid these bacteria from your cat and make it a safe pet once again. Should Healthy Cats Be Tested? We recommend that all healthy pet cats, especially those obtained as strays, from shelters or animal rescue organizations, and those that have had flea infestations, be tested for Bartonella infection. Strays and cats obtained from shelters and humane groups are more likely to have had flea infestations that transmit Bartonella. Kittens are more likely than older cats to transmit the bacteria because of their playful nature and their interactions with people, especially children. Interestingly, boys develop cat scratch disease more often than girls, probably because boys play more roughly, than girls, with kittens and thus are more likely to be scratched or bitten. It is especially important that cats owned by people with young children, people whose cats have had flea infestations at any time, and people who are immunosuppressed by chemotherapy, organ transplants, or HIV infection have their cats tested. At present, the cat scratch disease bacterium, Bartonella, is the most common disease organism transmitted from pet animals to people in the United States. We recommend that all kittens be tested for Bartonella before their first birthday.
The National Veterinary Laboratory The National Veterinary Laboratory is the oldest private veterinary laboratory in the United States. In 1972 we invented the first feline leukemia virus test, the FeLeuk Test. We have tested more than 1 million cats for the feline leukemia virus. It took 5 years to develop our Bartonella test and we tested more than 5,000 cats in order to verify its accuracy. Since the introduction of the FeBart Test, we have tested more than 87,000 cats for Bartonella. We have registered our Bartonella test, the FeBart Test, so that cat owners and veterinarians can identify the Bartonella test performed by The National Veterinary Laboratory. Revised May 2005 See your veterinarian for more information. He or she can protect your cat and your family from Bartonella. National Veterinary Laboratory P.O. Box 239, 1 Tice Road Franklin Lakes, NJ 07417 Copyright 1999 National Veterinary Laboratory