Cat Scratch Fever: Causes, Symptoms, and Diagnosis

Cats: elegant, mysterious, and absolutely convinced your forearm is a climbing wall.
Most of the time, a scratch is just a scratchwash it, grumble, forgive the tiny tiger, move on.
But once in a while, that “oops, my bad” swipe comes with a surprise guest: a bacteria called
Bartonella henselae, which can trigger what most people call cat scratch fever
(also known as cat scratch disease).

The good news: in healthy people, cat scratch disease is usually mild and gets better on its own.
The more important news: it can look like other problems (and occasionally cause complications),
so knowing the classic pattern helps you decide when to call your healthcare provider instead of
just blaming the cat and moving on with your life.

What Is Cat Scratch Fever (Cat Scratch Disease)?

Cat scratch fever is an infection most often caused by Bartonella henselae.
People typically get it after a scratch or bite from a catespecially kittens.
The infection often starts near the skin injury and then shows up as swollen, tender lymph nodes
(those little immune-system “checkpoints” in your neck, armpits, groin, and elsewhere).

A common storyline goes like this:
you get a scratch, a small bump forms at the site, and a week or two later you notice a sore,
enlarged lymph node “downstream” from the scratch. Your body’s basically saying,
“Okay, teameveryone to the nearest lymph node, we’ve got a situation.”

Causes: How Cat Scratch Fever Happens

The Culprit: Bartonella henselae

The main cause of cat scratch disease is the bacterium Bartonella henselae.
Many cats carry it at some point and don’t look sick at all. So yesyour perfectly adorable,
apparently healthy cat can still be a carrier. (Cats are very good at this whole “I’m fine” thing.)

How Cats Get It (Hint: Fleas Are the Uninvited Middleman)

Cats often become infected through flea exposure. Fleas can carry Bartonella,
and the bacteria can be present in flea dirt (flea feces). When a cat scratches (or grooms),
that flea dirt can end up on claws or around the mouthsetting the stage for transmission.

How People Get It

Humans usually get infected when bacteria enters the body through:

• Scratches (the classic route).
• Bites (less common than scratches, but definitely a route).
• Cat saliva contacting broken skin (for example, licking an open wound).

Who’s More Likely to Get It?

Risk isn’t just about whether you own a catit’s about the combination of exposure and immune response.
Cat scratch disease shows up more often in children and teens, partly because kids are
more likely to play with cats in ways that end in scratches, and partly because it’s simply more common
in younger people.

People with weakened immune systems (for example, advanced HIV infection, certain cancer
treatments, or organ transplant medications) may be at higher risk for more severe or unusual forms of
Bartonella infection. In those cases, the “classic” pattern may not be the whole story, and medical care
becomes more urgent.

Symptoms: What Cat Scratch Fever Can Look Like

The Classic Trio

Many cases involve a recognizable combo:

• A small bump or blister near the scratch (often a papule or pustule).
  This can show up days after the injury.
• Swollen, tender lymph nodes near the area of the scratch (often 1–3 weeks later).
  Common sites include the armpit (after a hand/arm scratch), neck/jaw (after a face/scalp scratch),
  or groin (after a leg scratch).
• Low-grade fever and “generally blah” feelings.

Other Common Symptoms

People can also experience:

• Fatigue (the “why do I feel like I ran a marathon?” sensation)
• Headache
• Reduced appetite
• Muscle, joint, or body aches
• Occasional sore throat or mild flu-like symptoms

How Long Does It Last?

Symptoms can fade in weeks, but lymph nodes may stay enlarged for longersometimes for months.
Most healthy people recover without lasting problems, but the “timeline” can feel annoyingly slow,
especially if a lymph node stays tender or prominent.

When Symptoms Suggest Something More Than “Typical” Cat Scratch Disease

Cat scratch disease can sometimes involve other organs. This is less common, but it matters because it
can change the work-up and urgency. Signs that can point toward more complicated disease include:

• Eye symptoms (blurred vision, eye pain, sensitivity to light), which can be associated
  with eye involvement such as neuroretinitis.
• Severe headache, confusion, weakness, or seizure (possible nervous system involvement).
• Persistent high fever, significant abdominal pain, or weight loss.
• Bone pain that doesn’t make sense for your activity level.
• Symptoms in someone with immunocompromise, where Bartonella infections can look different
  and may be more serious.

Diagnosis: How Clinicians Figure Out If It’s Cat Scratch Fever

Step 1: A Good History (Yes, Your Cat Is Part of the Medical Record Today)

Diagnosis often starts with simple questions:
Did you have a cat scratch or bite? Was it a kitten? Did the cat lick a wound?
When did symptoms begin after the scratch?
The timing matters because cat scratch disease tends to follow a predictable sequence:
skin lesion first, swollen lymph nodes later.

Providers may also ask about:
flea exposure, outdoor/stray cat contact, recent travel, other animal exposures, and whether you have
conditions or medications that weaken immune defenses.

Step 2: Physical Exam (The Lymph Node Check You Can’t “Vibe” Your Way Out Of)

Clinicians will examine:

• The scratch or bite site (even if it’s already healing)
• Nearby lymph nodes for swelling, warmth, and tenderness
• Skin for other lesions or rashes
• Signs that suggest other diagnoses (for example, generalized lymph node swelling)

Step 3: Deciding If Testing Is Needed

Some cases are diagnosed clinicallymeaning the pattern is so classic that extensive testing isn’t always required.
But testing becomes more useful when:

• Symptoms are severe, atypical, or prolonged
• The person is immunocompromised
• Lymph nodes are very large, very painful, or appear to be forming pus (suppurating)
• The presentation could mimic another condition that requires a different approach (like certain cancers)

Common Tests Used

1) Blood Tests for Bartonella Antibodies (Serology)

Serology checks whether your immune system has made antibodies to Bartonella henselae.
It can support the diagnosis, but it’s not perfect:
antibodies may take time to rise, and some people may have antibodies without current illness.
Your clinician interprets results alongside symptoms and timingnot in isolation.

2) PCR Testing

PCR testing looks for bacterial DNA. It can be done on certain samples (for example, from a lymph node aspirate
in select situations). PCR can be especially helpful when the diagnosis is unclear, or when atypical disease is suspected.
Like any test, it has limitations and depends on sample quality and timing.

3) Imaging (Ultrasound or CT) When Needed

Imaging is not routine for every case. It may be used when:

• A lymph node is very large or suspected to have an abscess
• There’s abdominal pain or prolonged fever and a clinician wants to assess liver/spleen involvement
• Symptoms suggest complications outside the lymph nodes

4) Lymph Node Aspiration or Biopsy (Selective)

Most people do not need a biopsy. But if lymph nodes are persistently enlarged, atypical, or concerning for other
conditions, clinicians may consider aspiration or biopsy to rule out other causes and, in some cases, to test for Bartonella.

Conditions That Can Mimic Cat Scratch Fever

Because swollen lymph nodes and fever are a “greatest hits album” of many illnesses, healthcare providers may consider:

• Viral infections (such as EBV/mononucleosis)
• Other bacterial infections (including strep-related infections)
• Skin infections unrelated to Bartonella
• Toxoplasmosis (another infection sometimes linked with cats, but through different exposure routes)
• More serious causes of lymph node enlargement (including lymphoma or other cancers)

This doesn’t mean you should panic at every swollen node. It just explains why clinicians sometimes choose testing
not because cat scratch disease is always dangerous, but because your body has a limited number of ways to complain.

When to Seek Medical Care

Consider contacting a healthcare professional if you have:

• Swollen lymph nodes that are painful, growing, or not improving over time
• Fever that persists or is high
• Eye symptoms (blurred vision, eye pain)
• Neurologic symptoms (confusion, severe headache, weakness, seizures)
• Significant abdominal pain, unexplained weight loss, or night sweats
• Any symptoms after a cat scratch/bite if you have a weakened immune system

And yes: if the scratch looks increasingly red, warm, swollen, or drains pus, that can also suggest a more typical skin infection
(which is a different problem than cat scratch disease, but still worth medical attention).

Practical Prevention (Without Asking You to Break Up With Your Cat)

You don’t have to live in fear of your petjust stack the odds in your favor:

• Wash scratches and bites promptly with soap and water.
• Avoid letting cats lick open wounds.
• Use flea control for cats (especially if they go outdoors).
• If you’re immunocompromised, be extra cautious with rough playkittens are adorable, but also tiny chaos machines.

Experiences: What Cat Scratch Fever Often Feels Like in Real Life (500+ Words)

Medical descriptions are useful, but they can sound a little like a robot reading a grocery list:
“papule, lymphadenopathy, low-grade fever.” Real life is messierand funnierespecially when it starts with a cat
who swears the scratch was “an accident” while plotting the next one.

Here are experiences people commonly report (shared here as typical scenarios, not as a substitute for personal medical advice):

1) “It Was Just a Tiny Scratch… Until My Armpit Started Acting Like a Drama Queen”

A very common experience is that the scratch itself seems minor. It may heal quickly, and you forget about it.
Thenabout a week or two lateryou notice a tender lump in the armpit (if the scratch was on the hand or arm)
or along the jaw/neck (if the scratch was on the face or scalp). People often describe it as:
“It hurts when I move,” “It feels sore when I press it,” or “I thought I pulled a muscle, but… this is not a muscle.”
The surprise is the point: the lymph node swelling often feels disconnected from the scratch because of the delayed timing.

2) The “Flu-ish, But Not Quite Flu” Phase

Many people don’t feel violently sick. Instead, it’s the nagging kind of unwell:
fatigue, mild fever, low appetite, and a general sense that your body is running a bunch of background updates
without asking permission. Some folks say they’re fine in the morning, then feel wiped out by afternoon.
Others notice headaches or body aches that feel out of proportion to the small skin injury.

3) “The Bump at the Scratch Site Looked Weird, But I Assumed It Was Normal”

The initial skin lesion can be subtle: a little raised bump, a tiny blister, or a spot that looks like a bug bite.
Some people ignore it completelyespecially if they get scratched often.
In hindsight, they’ll say something like, “Oh yeah… there was a little bump there.”
It’s easy to miss because it may not be very painful, and it can appear before the lymph nodes swell.

4) The Emotional Side: Annoyed, Confused, and a Little Bit Betrayed

A weirdly universal experience is the emotional whiplash. People love their cats, but it’s hard not to feel mildly betrayed when:
(a) the cat caused the scratch, and (b) your immune system decides to make it a whole event.
Many people describe oscillating between “I’m fine, it’ll pass” and “Why is this lump still here?”
The drawn-out recoveryespecially lingering lymph node swellingcan be the most frustrating part.

5) The “Doctor Visit That Starts With ‘So Tell Me About Your Cat…’”

People are often surprised that a clinician will ask detailed questions about the cat:
kitten vs. adult, indoor vs. outdoor, flea exposure, bite vs. scratch, and timing.
Patients sometimes feel silly describing a scratch from “Mr. Whiskers,” but the history really matters.
When the story lines upscratch, small lesion, then nearby lymph node swellingit can feel oddly comforting to hear:
“This pattern fits cat scratch disease.” Not because it’s fun to be diagnosed, but because it’s reassuring to have a name for it.

6) A Note About “Atypical” Experiences

Some people don’t get the classic pattern. They may have prolonged fever, abdominal pain, or eye symptoms.
In those cases, the experience can be more stressfulmore tests, possibly imaging, and careful monitoring.
People with weakened immune systems may have a very different course and often need more urgent evaluation.
If you’re in that higher-risk group, the “wait it out” approach is not the movegetting medical guidance early is.

Bottom line: the lived experience of cat scratch fever is usually more annoying than alarmingbut it’s still a legitimate
illness. If symptoms are persistent, severe, or unusual, it’s smart (not dramatic) to get checked out.

Conclusion

Cat scratch fever is usually a self-limited infection caused by Bartonella henselae, most often after a scratch or bite
(or sometimes saliva exposure to broken skin). The hallmark is swollen, tender lymph nodes that appear after a typical delay,
often with mild fever and fatigue. Diagnosis is largely pattern-basedhistory, timing, and examsometimes supported by blood tests
or PCR when the case is unclear or more complicated.

If you’re generally healthy, the outlook is usually good. If symptoms are severe, persistent, involve the eyes or nervous system,
or occur in someone with a weakened immune system, it’s time to call a clinician. And yesyou can still love your cat.
Just maybe negotiate a non-aggression pact for your hands.