5-92
Follow-up Actions
Wound Care: Keep clean and dry.
Consultation Criteria: Report any case to local health authority immediately. Refer for expert care if
available.
Evacuation: Evacuate when stable and body fluid precautions can be followed.
Zoonotic Disease Considerations
Principal Animal Hosts: Cattle, sheep, goats, and horses
Clinical Disease in Animals: Incubation period is 3-7 days (Range = 1 to >14 days). The peracute form
in ruminants has a rapid onset and is fatal, with signs of dyspnea, ataxia, collapse, or convulsions. The
acute form in ruminants begins with a rapid increase in body temperature (up to 107°F/41.5°C) and a period
of excitement followed by depression, stupor, ataxia, convulsions and death. There may be bleeding from
orifices. DO NOT NECROPSY any animal showing this sign. The chronic form is characterized by localized,
subcutaneous, edematous swelling of the ventral neck, thorax and shoulders. In horses the disease is acute,
with signs of fever, chills, colic, anorexia, and swelling of the animal’s ventrum, with death in 2-3 days. Swine
may die acutely without showing signs, or having a rapid swelling of the throat.
Probable Mode of Transmission: Occupational exposure (wool sorter’s disease), foodborne in Africa, Asia
and Russia
Known Distribution: Worldwide, associated with chalky soil.
NOTE: See also CBR: Inhalational Anthrax
ID: Bartonellosis
(Cat Scratch Disease, Trench Fever, Oroya Fever)
COL Naomi Aronson, MC, USA & MAJ Daniel Schissel, MC, USAIntroduction: There are several Bartonella bacterial species that cause different illnesses. Bartonella bacil-
liformis causes Oroya fever, a febrile anemia and chronic skin eruption (verruga peruana) in a limited area of
mountain communities in Peru, Ecuador and Colombia. It is thought to be transmitted by the bite of a sand y.
Bartonella quintana, transmitted by body lice, causes trench fever, a febrile illness that which can recur years
later. Bartonella henselae is inoculated by cat scratch or bite and causes lymphadenitis and variable fever 3-10
days after cat exposure.
Subjective: Symptoms
S. American Bartonella (Oroya fever): Fever, which can persist up to 6 weeks; pallor; weakness; chills;
muscle/joint aches. After 2-20 weeks, crops of painless, red, 2-4 mm skin lesions can be seen, mainly on head
and extremities.
Trench fever: Headache; fever (episodic fever of 3-5 days duration - can have fever relapses up to 10 years
later); back/leg ache; shin pain; transient rash (maculopapular).
Cat scratch disease: Papule at inoculation site; regional adenopathy that can suppurate; nodes subside in
2-5 months without treatment.
Focused History: Have you traveled in the past month to Peru, Ecuador or Colombia? (where Bartonellosis is
endemic) Have you been around anyone with lice or poor body hygiene? (trench fever exposure) Have you
been scratched or bitten by a cat? (cat scratch disease exposure). Do you have a new skin rash or sore?
(Look for the verrucous lesion of S. American Bartonellosis and the crusted papule at the inoculation site of
cat scratch.) Do you have any swollen or sore lymph nodes? (In cat scratch disease you can see uctuant,
red, regional adenopathy.)
Objective: Signs
Using Basic Tools:
Oroya fever: Fever (up to 105°F) begins early and may persist for weeks, skin pallor and slight jaundice.
After several weeks, crops of persistent, 2-4 mm, red to purple skin nodules appear on the exposed parts of
the body.
Trench fever: Fever (up to 105°F) lasting 4-5 days, recurs in paroxysms for 3-6 weeks. In the immunocompro-