Pt with history of a scratch by cat 8days back.was given post-exposure prophylaxis im anti-rabies vaccine upto 3rd dose(7th day).pt did not receive anti-rabies immunoglobulin against advice.was treated with antibiotics,anti-inflammatory following scratch.came back on 8th day with painful,tense swelling of fore-arm nd arm with restricted mobility of elbow-jt nd blisters as can be seen over dorsum of hand nd h/o did. Ot give h/o diabetes.daignosis nd rx please.thnk u

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There is no definitive role of anti rabies vaccine in in cat scratch or bite. So not taking immunoglobulin does not seem to be the cause. It is spreading cellulitis, taking aggressive form with development of blisters. As stated above, medications for Bartonella infection (cat scratch disease) must have been given - Azithromycin or Doxycycline. Tight glycemic control, ulcer care, analgesics and i.v. antibiotics must be started now. Surgical treatment in form of debridement or fasciotomy as required. Inj. TT. Aggressive treatment should be done to prevent further spread

Dear colleague I defer at one point that ARV has definitie role in prevention of rabies in case of cat bite or scratch also according to WHO and national rabies control programme. Rest of the management mentioned by you is excellent.

It's a case of cellulitis because of secondary infections Do blood glucose monitoring and treat DM accordingly . Blood glucose levels should control for quick recovery Start broadspecrum antibiotics + metrnidazole+ amikacin parentrally as per dose and schedule According severity and responses to treatment continue all measures Local applications of ointments for mixed infections Keep affected arm elevated till swelling reduced

Dr Lohitaksh has a point. It is 'horse sense' to think when cat scrathes - CSD; AND WHEN RAT SCRATCHES (!) - PLAUGE!. IN FACT ANTICIPATION IS THE RULE WHEN A CAT SRATCHES AS TREATMENT WITH AZITHRO OR DOXY TAKES CARE OF PROPHILACTIC TREATMENT AS WELL AS ANTIBIOTIC COVERAGE ROUTINELY. WHAIT antibiotic is used is not known. The fact that the pt developed probably localised pus is a proof enough that the prophylactic antibiotic used is ineffective. CSD-- whether it is the present problem or sec.infection following cratch is the issue. Now whether it is just sratch or a deep bite is also important as the former causes erysepalas and latter causes Celulitis / compatmental syndrome the later requires immediate surgical intervention whereas former doesnit need any surgical intervention. So there is "no rule oh thumb". Treatment should be as per disgnosis- here- whether it is- erysepalas or cellulitis or compartmental syndrome. Weiding scalpel thoughtlessly should be eshwed . Now coming back to CSD , it is easy and harmless to treat than proving the disease the later requires either s PCR or FTA test. For a ademic discussion of CSD OR NO CSD- 1) FEVER IS MUST, AS THE NAME ITSELF IS ' CAT SCRATCH FEVER '. THE ANTIBIOTIC COVER CAN be presumed to have madked the fever which is reported to be not there by the doc who posted. If such/ so effefctive why the infection progressed? so some confusion about fever. 2) regional lymph adenopathy not lympangitis is ghe hallmark of CSD. The point is never addressed.but presence of sec infection makes this point irrelevant. 3) single blster is usually formed at the Site of bite. E xistance of group of blisters both at dorsum and elbove and if seen the pic closely some papuo- vesicles in between the two makes it unlikely CSD as the cause of blister. 4) It is very much correct that the sumptoms of CST start after 1 or 2 weeks following scratch. Here a distinction is to be made between onset of symptoms and the time of second visit of the pt. When pt came again the infection assumed serious proportions implying that 'symptoms started much earlier but pt found it convenient ro report after a week here. No orthragia is reported as presumed to support diagnosis of CSD. That much about CSD LET CUROFIANS MAKE IT A RULE OF THUMB, THAT NEXT TIME THE CAT IS PLEASED TO BITE UR NEAR OR DEAR , TREAT PROPHYLACTICALLY WITH A TT ( not I.G / vaccine of rabies) and a course of azithro or doxy. (And pray GOD against CSD!).

Is antirabies indicated in scratch? It more so looks infection due to scratch with Cellulitis.. Antibiotics/ Anti-inflammatory/ Limb elevation will work.

No role of anti-rabies in this case!

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I will adress only the blister part which I feel ' orphoned' This is eczematisation, - dermatitis medicamentosa, probably a ' pain balm' or so, prescribed/ self medication. Avoid the offender. Treat with cold compress. Attend to more important things suggested.

Can be cat scratch disease due to bartonella infection as the symptoms started some 8 days after the scratch. Vesicles, arthralgia, lymphangitis and relative absence of fever support dx. Please add azithromycin or doxycyline if not previously prescribed.

Cellulitis. I hope the cat is being monitored. Scratched cases need the same treatment due to constant licking of paws by the cat. Always te remote chance of residual saliva.


Features are suggestive of cellulitis/compartment syndrome? Treat with inj b lactam. Do look for blood sugar levels

Res mam, no role of rabies vaccination or HRIG is needed for domestic cat scratch, second he had developed cellulitis of upper arm with? Compartment syndrome so can go for necrotizing fascitis. Third coming to treatment part limb elevation, iv antibiotics like cefaperazone+sulbactum, amikacin, metronidazole with oral doxy. Blood sugar control by insulin, mgso4 dressing, don't puncture blisters, monitor tlc & rft with urine output & acetone.

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