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The cat's me-ow!

A report in the July 1 New England Journal of Medicine clearly identified the role of the bacterium R. henselae in cat-scratch disease and suggested that fleas may be responsible for infecting the animals. It also showed the value of a new blood test for diagnosing the disease.

Eighty-four percent of the patients in the study had R. henselae antibodies in their blood, as did 81 percent of their cats. The researchers also found evidence of the bacterium in fleas taken from two cats owned by one patient.

Sixty patients known to have cat-scratch disease were compared with 56 other cat owners. The study showed the patient group to be more likely than the control group to own a kitten, habe been bitten or scratched by a kitten, or have a kitten with fleas.

The disease is characterized by one or more swollen lymph nodes, generalized aching, loss of appetite, and (rarely) nausea and abdominal pain. Fever occurs in only about half the cases. A few of the patients in this study experienced brain involvement, with seizures and coma followed by complete recovery.

Usually, only one lymph node is involved, in the armpit or neck. Except for obvious infections of the skin or upper respiratory tract, cat-scratch disease is probably the most common cause of a single enlarged lymph node in a young person.

Treatment of the disease is usually unnecessary. Analgesics and bed rest are advised for those with fever, but otherwise most patients can continue normal activity during the weeks to a few months before the lymph node swelling fully subsides.

Antibiotics do not seem to shorten the duration of the disease or prevent the possibility of pus formation in the lymph node. Should formatioin occur, the pus usually is aspirated by needle, rather than by incision of the node, which may promote chronic drainage.

New EDA regulations require that bottled water meet the same standards as those for public water supplies. Moreover, they require clear identification of the source. For the product to be labeled as mineral water, it must come from a source "tapped at one or more bore holes or springs, originating from a geologically and physically protected underground water source." Spring water must come from an "underground formation from which water flows naturally to the surface and is collected at the spring itself or through a bore hole next to the point where the spring emerges."

Despite EPA standards, under-budgeted municipalities are often unable to correct deficiencies in their water supplies. Other problems, such as lead or plastic pipes in houses, can lead to contamination of tap water. In such circumstances, home purification may be advisable.

For answers to questions about water regulations, well water testing, and related matters, the EPA maintains a Safe Drinking Water Hotline: 800-426-4791. For a list of home water-treatment units and a free brochure, "Determining the Quality of Your Drinking Water," write to the National Sanitation Foundation International, P.O. Box 130140, Ann Arbor, MI 48113-0140.
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Title Annotation:cat-scratch disease
Publication:Medical Update
Date:Nov 1, 1993
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