From the BMJ

Beware of your neighbour's cat

Unilateral lymphadenopathy is commonly seen in general practice. Williams and colleagues (p 1199) describe a case of a 29 year old woman who presented with a painless swelling in the right groin. After biopsy, she was referred to a chest physician for suspected sarcoidosis despite having no systemic symptoms. Investigation found a raised IgM titre for Bartonella henselae, which is both sensitive and specific for cat scratch disease. The patient improved over time and, at final follow up, did recall being scratched in the groin by her neighbour's cat about a month before she became unwell.

-- Anonymous, May 17, 2002

Answers

Aggressive Pussies

-- Anonymous, May 17, 2002

Just what kind of bizarre (and illegal?) scenario can this woman have been in to be scratched in the groin by a cat?

-- Anonymous, May 17, 2002

Brings a whole different meaning to 'catnip'.

-- Anonymous, May 17, 2002

Phew, 24,000 cases of cat-scratch disease in the US eh? I thought that pigs were the favoured animal in Alabama.

Mind you, there are a lot worse things to be caught from animals than Bartonella wozzaname. Toxplasmosis, psittacosis, Lyme Disease and especially toxocariasis spring reaily to mind, and there are plenty more.

As they say, life is a sexually-transmitted fatal condition (copyright thought for the day).

-- Anonymous, May 17, 2002

I had sarcoidosis a few years back. Bilateral lymphadenopathy and all that. No cats were involved I am relieved to say. Haven't thought about the whole episode for a while now. Has anyone else had it? I've never met anyone. Quite uncommon I was told.

Sorry I'm messing about a sympatethic thread like this. Memory lane you see..

-- Anonymous, May 17, 2002

I have a question for you Dr. Bill ..... sorry to talk shop and all that. How often should you have tetanus boosters? And are they really essential? I don`t think I`ve had a booster since I was starting the seniors.

As for diseases that can be caught from animals, I guess it has to be part of the calculation you have to make when you decide to keep pets. I wonder how many parents stress, and check that their instructions have been followed, that their children wash their hands after playing with animals and before eating etc.

I`m a bit paranoid about these things, and probably wash my hands more times a day than anyone else I know! It`s just second nature to me. I also have one bench in the kitchen which is used for food preparation and food preparation only. Colour coded chopping boards too. I use bleach like it is going out of fashion, and have another small kitchen where I prepare the food for my cats and dogs.

Touch wood, I have never had a problem with `cat scratch fever` from any of my cats, but I did get scratched by a kitten when I was viewing a litter with a view to buying. I didn`t buy because the conditions the cats were kept in were disgraceful, and the scratch was red, sore and angry for a long time.

I try to minimise the possibility of being bitten by any cat, huge amounts of nasty bacteria in even the most pampered cats mouth. Generally speaking though, I think if you follow the basic rules of hygene, and keep your animals in good healthy shape, the risks should be very minimal.

-- Anonymous, May 17, 2002

Hi Galaxy, hope you are well and your monitor is still intact!

The recommended interval for tetanus boosters is a maximum of ten years, or sooner if you have an injury that could increase risk - they tend to dish it out in A&E departments as if they have shares in the manufacturer.

Although I'm sceptical about the science of some immunisations (eg cholera), tetanus is one I do keep up to date on. The bacterium, Clostridium tetani, is very widely found, and while infection is very rare, it carries a high mortality. A clinician is only supposed to see one in a lifetime's practice but I saw two in six months once which might bias me a little. Even though that was some time ago (in Banbury) they both survived, but it was touch and go.

If you're interested, the other immunisations I take very seriously are diphtheria, pertussis, polio, MMR and hepatitis A - I'd definitely keep up to date on hep A especially if going to the Med, SE Asia, Mexico etc.

I agree with all that you say about pets, the risks are minimal if you are sensible. I tend to think that cat scratch disease, being nearly always trivial, often goes unrecognised - but so what, if it's trivial? And there is epidemiological evidence that pet owners are on balance a happier, better adjusted, healthier and longer-living bunch than their counterparts. Just remember that the next time the computer is driving you up the wall!

-- Anonymous, May 18, 2002

Bill - I imagine that you are sick of being asked this but..... would you recommend the MMR jab in preference to the privately available seperate injections for measles, mumps and rubella.

-- Anonymous, May 18, 2002

Thanks for the information Dr. Bill. So my tetanus is only about forty years out of date then! Oops.....keep meaning to have it done, mostly because of the amount of gardening I do.

I`m pretty wussey when it comes to injections, so I kind of try and tailor our holidays to areas where I don`t need to have them! Mind you, from what you are saying, if you are doing any more than popping over to France you`d be well served to keep them all up to date.

Smug assed Pete, of course, is totally up to date on everything imaginable, with him `doing` Africa fairly regularly.(:o)

-- Anonymous, May 18, 2002

ps....I will have my tetanus done. Do they do it on sugar lumps yet? (:o)

-- Anonymous, May 18, 2002

Galaxy - hate to tell you this, but if memory serves tetanus was really painful!

-- Anonymous, May 18, 2002

Not as painful, of course, as contracting tetanus.... or being clawed in the groin by a cat.

-- Anonymous, May 18, 2002

Sorry folks I didn't manage to get online again until today.

SE: yes I would back MMR as a combined immunisation every time. I can spout the official line to order (and have done!) but I have no doubt it's correct. My kids had it as soon as it arrived, and I would do the same again. The after effects of all three conditions can be very bad news, and the suggestion that the combined version may cause problems is not worth the paper it's written on. Sadly, it's extremely easy to wind people up about imaginary risks "not yet proven", and the people that do so never have to stand accountable for the disease and death that their ego trips result in.

Galaxy: sorry it's not on a sugar lump, but neither should it be as painful as ADK suggests (I wonder if that could have been antitoxin, which you would get to give temporary cover after a really high risk injury like a deep penetrating dirty wound, and which can be a largish volume of fluid to get in intramuscularly). OK, sorry, take out the wimps at the back that have fainted, I was just trying to reassure Galaxy that it wouldn't be so bad.

Cap, gown, gloves...

-- Anonymous, May 20, 2002