Babies-Kids and Kittens-The Hidden Danger-Dr. Don DeForge-Silver Sands Veterinary Center

     Dr. Don DeForge                   Silver Sands Veterinary Center                              21May2016

Babies, Kids, and Kittens

The Hidden Danger

Babies-Kids and Kittens-Cats--- A Hidden Danger

Parents are always concerned about injury to their baby or toddler.  Even as toddlers develop into small children parents protect and monitor every move that the young person makes.  The first step; the first "real" food; the first ice cream cone;  the first activity at gymnastics; the first swim; and even the first swing of a baseball bat-----parents are there watching; helping; and protecting!

In a past blog, I discussed the Zoonosis of Toxocariasis-an intestinal parasite of puppies, kittens, and adult companion animals that can parasitize children and adults.

The AVMA-The American Veterinary Medical Association recommends that veterinarians  take a proactive role in the prevention of zoonotic diseases.  Today, this blog will review the most up to date information from Dr. William Hardy at the National Veterinary Lab concerning the zoonosis of  Bartonella infection. Adults and children can be infected by cats or kittens that carry Bartonella.  

From the National Veterinary Lab:

Bartonella are Gram-negative, fastidious bacteria (approximately 20 species known to date) that are widespread in nature infecting many animal species from wild rodents, ruminants, pet animals, to humans. They are transmitted by arthropod vectors including fleas, ticks, biting flies, and lice from animal-to animal (intraspecies) and species to species (interspecies). Direct animal-to-animal transmission, without vectors, probably occurs rarely and is exemplified by the transmission from cats to humans via scratches, bites, and fur contact. 

Kids are very active and at times uncontrollable.  Kittens are the same.  You place a kitten and a youngster together and the chance of a cat scratch during play is very high. Energetic kids and kittens/cats can lead to reckless injury and potential transmission of the Bartonella bacterial disease from cat-kitten to child-adult.

From the National Veterinary Lab Newsletter-Evelyn E. Zuckerman, Editon: 

"It is still perplexing that veterinarians routinely test for feline retroviruses, FeLV and FIV, with an incidence of only 3.1% combined, where there is no therapy for either virus, and no zoonotic potential, but do not routinely test for Bartonella. Few veterinarians recommend routine testing for Bartonella, where the occurrence is about 35%, they cause far more disease, there is an excellent sterilizing response to antibiotic therapy, and where there is a significant zoonotic threat.

NEWSLETTER Let’s Get Serious About Bartonella! © Evelyn E. Zuckerman, Editor Spring 2013 Vol. 12, Number 2 In This Issue: 

Accumulating evidence demonstrates that Bartonella is endemic in cats and the zoonosis is being recognized as a “silent epidemic” in humans. In addition, the concern in the veterinary profession is lacking and the knowledge of the Bartonella diseases in the medical community could be better. 

Veterinarians: Responsibility: Cats are the major reservoir host for at least 6 Bartonella species and feline Bartonella cause inflammatory diseases in experimentally inoculated and in pet cats.Despite the ample published evidence for the past 20 years supporting these facts, there are web sites, chat rooms, and on line blogs that still present misleading and incorrect information. 

Fleas transmit Bartonella among cats and spring brings increased flea exposure. Thus veterinarians must become familiar with the published facts and “get serious about Bartonella” for their patient’s and for their client’s health. 

It is still perplexing that veterinarians routinely test for feline retroviruses, FeLV and FIV, with an incidence of only 3.1% combined, where there is no therapy for either virus, and no zoonotic potential, but do not routinely test for Bartonella. Few veterinarians recommend routine testing for Bartonella, where the occurrence is about 35% (Table 1), they cause far more disease, there is an excellent sterilizing response to antibiotic therapy, 13 and where there is a significant zoonotic threat. Table 1 Common Pathogens* in 7,484 Healthy Cats Pathogen No. Tested No. Infected % Infected FeLV IFA 7,484 84 1.1% FIV WB 7,484 147 2.0% Bartonella WB 7,484 2,604 35% *All tests performed by National Veterinary Laboratory Veterinarians who do not discuss Bartonella with their clients expose themselves to legal liability when one of their clients develops a Bartonella disease from one of their cats. Many veterinarians test for Bartonella when they are trying to determine the cause of an inflammatory disease, but will not routinely test healthy cats along with the routine retroviral tests and fecal examinations. As will be discussed later, most zoonotic spread of Bartonella to cat owners occurs from HEALTHY kittens under 1 year of age, the animals where early tests and vaccinations are routine. Fleas and Ticks: Cat fleas are responsible for the great majority of transmission of Bartonella among cats. Thus, flea control is essential for interrupting the transmission. To a lesser extent, ticks can also occasionally transmit Bartonella between cats but they are the more important vector for transmitting Bartonella to dogs. Dogs are much less a reservoir host for Bartonella than are cats. Cat Flea Dog ticks Cats and dogs that have been strays, feral, originated from shelters or rescue groups, and those living in multiple cat or dog households, (Table 2) are more likely to have had flea infestation and thus more likely to be infected. Table 2 Healthy Cat Risk Factors for Bartonella Infection Risk Factor No Tested % Infected Risk Factor (X) None 840 20% X CSD Household 1,057 57% 2.9X Strays 16,499 41% 2.1X Shelter 10,191 33% 1.7X Fleas: History of 9,072 48% 2.4X Current 3,510 45% 2.3X Multi Cat Hh 26,973 41% 2.1X Exposed to Bartonella + Cat 7,229 54% 2.7X Totals: 74,531 42% 2.1X Hh= household Many cats had multiple risk factors. 12 years of tests to 11-4-2011 These animals certainly warrant discussion with their owners regarding the feline disease potential and the zoonotic dangers. Feral Cats: As the pet populations increased after WWII, so did the stray dog and cat populations. This topic has been expertly researched and described by my long time scuba diving friend, Jim Sterba, in his excellent new book Nature Wars, published by Crown, New York about how wildlife comebacks turned backyards into battlegrounds (I highly recommend this book for veterinarians and animal lovers) www.jimsterba.com. Jim Sterba (left) & Dr. Hardy, Fiji 1983 Jim spent years researching all aspects of the closeness of contemporary people to wildlife and the joys and problems this has fostered. In the chapter entitled “Feral Felines,” Sterba chronicles the evolution of pet cats that evolved to shelter cats then to a feral lifestyle. This was due to the high percentage of shelter cats that had been euthanized over the years because of the low percentage of shelter adoptions. As we all know, the controversial policy of TNR- trapneuter-return has grown where the intent to lower the population of feral cats has met with Feeding feral cat colony TNR poster mixed results. Sterilized feral cats still pose dangers by carrying diseases, killing large numbers of wildlife, and their “colonies” can act as a dumping ground for fertile unwanted pet cats. Of course feral cats carry one of the highest Bartonella infection rates of all cats and they have been a source for numerous zoonotic transmissions to good hearted people who have tried to care for them. Many “shelter cats” originate as feral cats and adoptions pose a risk to the household members. In an urban feral cat study, conceived by Dr. Douglas Wyler, owner of the Whitestone Veterinary Care in Whitestone, NY, a suburb of New York City, we found that feral cats more frequently carry infectious microorganisms when compared to owned cats. Both Bartonella and FIV prevalence is elevated in these feral colonies sampled, Table 3. Table 3 Common Pathogens* in 102 Feral Cats Pathogen No. Infected % Infected FeLV IFA 1 0.9% FIV WB 9 9% Bartonella WB 50 49% *All tests performed by National Veterinary Laboratory The Bartonella infection incidence in healthy owned cats from this practice is only 18%. Since a large number of pet cats originate as adoptions of strays or feral cats, veterinarians should “get serious about Bartonella” and the public health dangers for their clients and themselves. Physicians: Many physicians are not thoroughly knowledgeable or are dismissive of the Bartonella diseases in their patients. Physicians must also “get serious about Bartonella” as it has been suggested that Bartonella is a silent epidemic. Bartonella is a stealth or chronic pathogen which makes detection and correlation with the clinical signs difficult for physicians. In addition, the zoonotic event, a cat scratch, bite, or tick bite, may have occurred weeks or months before the clinical signs begin. This long temporal interval can often negate consideration of this causative event by the patient or the physician. There has been continuing controversy that Bartonella do not fulfill Koch’s Postulates as the cause of cat disease despite numerous publications to the contrary, some 17 years ago.14-15 It has been known for some time that there are frontal and stealth pathogens.16 We wrote in our Summer 2005 NLV Newsletter, available at www.natvetlab.com, that the major difference is frontal pathogens are aggressive rapidly acting, whereas stealth pathogens are slow chronic mild inducers of disease, Table 4. Table 4 Frontal vs. Stealth Pathogenic Bacteria Frontal- (Aggressive): Stealth- (Slow-Mild): Incubation period: Short Long/ indeterminate Clinical sign: Acute Chronic Innate immune system: Engages Engages Multiplication: Rapid Slow Carrier state: Uncommon Common- shedding Sterilizing immunity: Induces Rarely induces Adaptive immunity: Engages Avoids or manipulates Bacterial Examples: Yersinia & Vibrio Bartonella & Helicobacter Adapted from: Merrell, D.S. & Falkow, S., Ref 16. In fact, a recent paper has suggested adding another criterion, the “postulate of comparative infectious disease causation” to the four venerable Koch’s Postulates for determination of a causative etiology of diseases by stealth pathogens. 17 In this regard, the proposed new postulate is not needed for Bartonella diseases of cats since there are ample publications that have fulfilled the original Koch’s Postulates for the Bartonella etiology of inflammatory diseases.1-12 We will again present our abstract from the 7th International Bartonella Meeting which summarizes the misconceptions that veterinarians and physicians have about Bartonella. We do this so that both professions can “take Bartonella seriously” in the spring when fleas transit Bartonella to cats and cats then transmit Bartonella to people. All Bartonella Diseases are not “Cat Scratch Disease”: Misconceptions about Bartonellosis. 7 th Intern. Conf. on Bartonella as Animal and Human Pathogens, 2012. Common misconceptions about cat scratch disease (CSD) are that: 1) fleas or flea dirt must be present on cats in order to transmit the bacteria to people, 2) there is no need to test or treat healthy cats, 3) CSD is the only Bartonella disease, and 4) CSD is a benign self-limiting disease. With the assistance of many of our veterinary clients, we were able to interview more than 500 people who had reported developing a Bartonella disease. These individuals had their cats tested for Bartonella at our laboratory after they were diagnosed with a Bartonella disease. We identified 283 people with a Bartonella disease who were diagnosed with the infection. 61% had developed classic CSD with fever, lymphadenopathy, malaise, and a papule. 23% developed CSD and sequelae consisting of chorioretinitis, cognitive dysfunction, psychoses, neurologic disorders, endocarditis, and hepatosplenomegaly. Finally, 16% developed only bartonellosis or sequelae with no classic CSD prodrome signs. 77% of the cases occurred in adults. 50% of the people developed chronic myalgia and arthralgia and 30% developed mental alterations including depression, cognitive dysfunctions, “brain fog,” and panic disorders. Classic CSD Prodrome “Brain fog” metaphor Cats that transmitted Bartonella were identified in 201 of the 283 cases or 71%. 97% of the cats were serologically WB positive for Bartonella infection, 65% were healthy, 49% were kittens under one year of age and 83% had no fleas or flea dirt on them at the time they transmitted the bacterium to people. The routes of infection were identified in 69% of the cases. Of these, 75% by scratches, 13% by bites or scratches, 5% by administering oral medication, and 31% by unknown routes. Thus healthy kittens, less than one year of age obtained as strays, from shelters or as feral cats, are the most likely to transmit Bartonella to people. The AAFP, CDC, and many academic websites do not recommend testing of healthy cats for Bartonella. Excluding the 40 veterinary professionals who had developed Bartonella diseases in this study 94% of the patients had NOT been informed of the zoonotic danger of feline Bartonella by their veterinarians before their illness occurred. In addition, 70% of the patients had difficulty in obtaining a diagnosis or had to urge or insist that their physician consider Bartonella as a possible cause of their illness. References: 1. Greene, CE, et al. Bartonella henselae infection in cats: evaluation during primary infection, treatment, and rechallenge infection. J Clin Microbiol 34:1682- 1685, 1996. 2. Guptill L, et al. Experimental infection of young specific pathogen-free cats with Bartonella henselae. J Infect Dis 176:206-216, 1997. 3. Kordick DL et al.: Clinical and pathologic evaluation of chronic Bartonella henselae or Bartonella clarridgeiae infection in cats. J Clin Microbiol 37:1536-1547, 1999. 4. O’Reilly, KL et al.: Acute clinical disease in cats following infection with a pathogenic strain of Bartonella henselae (LSU16). Infect Immun 67:3066- 3072, 1999. 5. Mikolajczyk MG, O'Reilly KL: Clinical disease in kittens inoculated with a pathogenic strain of Bartonella henselae. Am J Vet Res 61:375-379, 2000. 6. O’Reilly KL et al.: Passive antibody to Bartonella henselae protects against clinical disease following homologous challenge but does not prevent bacteremia in cats. Infect Immun 69:1880-1882, 2001. 7. Glaus, T., et al. Seroprevalence of Bartonella henselae infection and correlation with disease status in cats in Switzerland. J Clin Microbiol 35:2883, 1997. 8. Hardy, WD, Jr., Zuckerman, E, Corbishley, J. Seroprevalence of Bartonella-infection in healthy and diseased cats in the United States and Caribbean: Evidence for Bartonella-induced diseases in cats. International Conference of the American Society for Rickettsiology, Big Sky, MT, August 17-22, 2001. 9. Chomel, BB, et al. Fatal case of endocarditis associated with Bartonella henselae type I infection in a domestic cat. Clin Microbiol 41:5337-5339, 2003. 10. Ketring, KL, Zuckerman, EE & Hardy, WD, Jr. Bartonella: A new etiological agent of feline ocular diseases. JAAHA, 40: 6-12, 2004. 11. Varanat, M, et al. Recurrent osteomyelitis in a cat due to infection with Bartonella vinsonii subsp. berkhoffii genotype II. J Vet Intern Med 23:1273- 1277, 2009. 12. Sykes, JE, et al. Association between Bartonella infection and disease in pet cats. Abstract A1. Intern Conf on Bartonella as Medical & Veterinary Pathogens, Chester, UK, June 2009. 13. Hardy, W.D., JR., Zuckerman, E.E., Corbishley, J. et al. Successful therapy of Bartonella henselae bacteremic healthy pet cats. Annual Meeting, Infect. Dis. Soc. of America, New Orleans, Sept., 1996. 14. Koch R.: Uber bakteriologische Forschung Verhandlung des X Internationalen Medichinischen Congresses, Berlin, 1890, 1, 35. August Hirschwald, Berlin. (In German.) Xth International Congress of Medicine, Berlin, 1981. 15. Jacomo, V., Kelly, P.J. Raoult, D. Natural history of Bartonella infections (an exception to Koch’s Postulate). Cl. Diag. Lab. Immunol. 9: 8-18, 2002. 16. Merrell, D.S. and Falkow, S. Frontal and stealth attack strategies in microbial pathogenesis. Nature 430: 250-256, 2004. 17. Breitschwerdt, E.B., et al. Koch’s postulates and the pathogenesis of comparative infectious disease causation associated with Bartonella species. J Comp Path http:dx.doi.org/10,1016/j.jcpa.2012.12.003 1-11. Bartonella references can be obtained at: www.nlm.nih.gov/ or natvetlab.com ©National Veterinary Laboratory, Inc., 2013

National Veterinary Lab Recommendation concerning Bartonella Infection: 

1. Discuss the public health aspects of Bartonella infected cats with your clients. 

2. Recommend testing all cats in the household. 

3. Treat only those cats that are test positive. 

4. Recommend therapy evaluation tests 6 months after the end of therapy. 

5. If the owner refuses to test all cats in the household, note that refusal and date in your records. 

6. Implement stringent flea control for the household. 

Policy of Silver Sands Veterinary Center-DH DeForge, VMD: Bartonella a Serious Zoononsis-Public Health Protocol--

Any client, family member, or friend scratched or bitten by a Bartonella infected cat/kitten should be cautioned to call their physician/pediatrician immediately. Refer the Pediatrician-Physician to the National Veterinary Laboratory Website.  Give a copy of the Positive Feline Bartonella Test to your physician-pediatrician.  The Bartonella infected cat is treated according to National Veterinary Lab Guidelines with Azithromycin.  All cats in the household of the infected cat must be tested for Bartonella disease.

16th Anniversary of National Veterinary Lab Bartonella Screening Test

NEWSLETTER The FeBart® (Bartonella) Test is Sweet 16© Evelyn E. Zuckerman, Editor Fall 2015 Vol. 14, Number 4 In This Issue: On November 4, 2015 

I was again trying to decide on a subject for our 56th quarterly NVL Newsletter when it finally dawned on me that this very date was the 16th anniversary of our introduction of the FeBart® Test, a western blot (WB) serological test, for detection of Bartonella. Yes, 16 years ago the National Veterinary Laboratory was the first diagnostic laboratory to offer a routine Bartonella screening test. During these stimulating 16 years we have tested 338,393 cats and 9,381 dogs for Bartonella. In this Newsletter, I will recall our experiences, both good and bad, during these years. The most rewarding aspect has been the interactions with the thousands of veterinarians who utilized our services and taught us about the clinical aspects of Bartonella. 

William D. Hardy, Jr. V.M.D. Director and Owner National Veterinary Laboratory, Inc. Introduction: 

We began to study the zoonotic pathogen Bartonella shortly after its discovery in 1990.1 In 1995, after 5 years of research of comparison of culture isolation with serology, our data showed that the most accurate and reproducible test for detection of Bartonella infection in cats was the serologic detection of antibodies to the bacteria using the western blot (WB). The WB is the most specific (accurate) and sensitive serologic assay for the detection of many microorganisms. It is used in human medicine to confirm ELISA positive HIV screening tests, Lyme positive serology and several others. In veterinary medicine it is also used to confirm FIV ELISA positive serology. Detection of antibodies to an etiological agent is an amplification system when antibodies coexist with etiological agents as they do in FIV and Bartonella infections in cats. 

The National Veterinary Laboratory Inc. (NVL) is the oldest private veterinary diagnostic laboratory in the country. Dr. Hardy developed the first diagnostic test for FeLV infection in 1972 while at the Memorial Sloan Kettering Cancer Center, the IFA test for detection of FeLV antigens in cat leukocytes and platelets (FeLeuk® Test). He and his colleagues used the test to discover that FeLV is spread contagiously between cats. This discovery changed the paradigm that retroviruses were no longer thought to only be transmitted genetically (vertically). NVL was then established in 1973 to provide this inexpensive, practical, and accurate test for screening cats for this virus and led to programs that lowered the transmission among cats. The FeLeuk® Test remains the “Gold Standard” confirmatory screening test for detection of FeLV infection. 

Bartonella: During the early HIV retrovirus epidemic in the early 1990s, physicians in the many medical centers began to observe life-threatening cases of Bartonella infections in HIV infected patients. Since we had worked with feline retroviruses, and since Bartonella was known to be transmitted by cats, we began to study the occurrence of Bartonella in cats and developed IFA, ELISA and WB tests for Bartonella. It took more than 5 years, and tests of more than 5,000 cats, to develop and verify the accuracy of our diagnostic Bartonella tests. After thousands of comparative IFA, ELISA and western blot tests we chose the much more specific western blot (WB) as a screening test because, in our laboratory, it is more sensitive and more reproducible than the other Bartonella serological methods. 

FeBart® Bartonella Western Blot Test Happy Sweet 16th Birthday! The WB test can differentiate Bartonellainfected cats from cats that may react nonspecifically, or have cross-reactive antibodies, in IFA or ELISA tests, to Chlamydia or other microorganisms. The FeBart® test detects antibodies to as many as 14 Bartonella proteins and the test correlates well with infection or lack of infection in cats. 

With more that 4,000 Bartonella publications at present, there is ample evidence that Bartonella infection (updated paradigm) is not always self-limiting in people, that there are Bartonella tests available, and that Bartonella do cause inflammatory diseases in cats. 

 In fact, two of the academics who made many of the early negative statements regarding testing cats later developed their own commercial Bartonella tests. 

Veterinarians and Physicians Must Consider Bartonella as Important Pathogens- Updated Paradigm: After interacting with thousands of veterinarians during the past 16 years I still feel that many in our profession do not fully appreciate the importance of Bartonella in cats or in people. Likewise, after interviewing more that 500 people infected with Bartonella, it is clear that a substantial proportion of physicians do not know much about Bartonella or are dismissive of their clinical importance. Our findings, presented at the 7 th International Conference on Bartonella in 2012, support these conclusions. 

All Bartonella Diseases are not “Cat Scratch Disease:” Misconceptions about Bartonellosis. WD Hardy and EE Zuckerman, 7 th International Conference on Bartonella as Animal and Human Pathogens, Raleigh, NC, April 25-28, 2012. Common misconceptions about cat scratch disease (CSD) are that: 1) fleas or flea dirt must be present on cats in order to transmit the bacteria to people, 2) there is no need to test or treat healthy cats, 3) CSD is the only Bartonella disease, and 4) CSD is a benign self-limiting disease. With the assistance of many of our veterinary clients, we were able to interview more than 500 people who had reported developing a Bartonella disease. These individuals had their cats tested for Bartonella at our laboratory after they were diagnosed with a Bartonella disease. We identified 283 people with a Bartonella disease who were diagnosed with the infection. 61% had developed classic CSD with fever, lymphadenopathy, malaise, and a papule. 23% developed CSD and sequelae consisting of chorioretinitis, cognitive dysfunction, psychoses, neurologic disorders, endocarditis, and hepatosplenomegaly. 

Finally, 16% developed only bartonellosis or sequelae with no classic CSD prodrome signs. 77% of the cases occurred in adults. 50% of the people developed chronic myalgia and arthralgia and 30% developed mental alterations including depression, cognitive dysfunctions, “brain fog,” and panic disorders. Cats that transmitted Bartonella were identified in 201 of the 283 cases or 71%. 97% of the cats were serologically WB positive for Bartonella infection, 65% were healthy, 49% were kittens under one year of age and 83% had no fleas or flea dirt on them at the time they transmitted the bacterium to people. The routes of infection were identified in 69% of the cases. Of these, 75% by scratches, 13% by bites or scratches, 5% by administering oral medication, and 31% by unknown routes. Thus healthy kittens, less than one year of age obtained as strays, from shelters or as feral cats, are the most likely to transmit Bartonella to people. The AAFP, CDC, and many academic websites do not recommend the testing of healthy cats for Bartonella. Excluding the 40 veterinary professionals who had developed Bartonella diseases in this study 94% of the patients had NOT been informed of the zoonotic danger of feline Bartonella by their veterinarians before their illness occurred. 

In addition, 70% of the patients had difficulty in obtaining a diagnosis or had to urge or insist that their physician consider Bartonella as a possible cause of their illness. These physicians were unknowledgeable or were dismissive of Bartonella diseases. 

Veterinarians and physicians must become more aware of the correct Bartonella risks and diseases caused by feline derived Bartonella. Updated Bartonella Paradigm: (The Paradigm Shift) Cats: 1. Bartonella cause inflammatory disease in cats. 2. There are tests available for Bartonella. 3. There is therapy for Bartonella. 4. Serology can show current or past infection. Humans: 1. Bartonella cause CSD and severe diseases. 2. CSD occurs equally in children and adults. 3. CSD is not always self-limiting- treatment may be necessary. 4. Fleas do NOT have to be present on cats for zoonotic transmission to occur. 5. CDC still does not recommend testing cats. CDC Healthy Pets Healthy People Website: www.cdc.gov/healthypets/ The CDC has redesigned this website on October 2, 2015 with information about “diseases that can be spread from pets to people.” The director of the One Health Office in the CDC National Center for Emerging and Zoonotic Infectious Diseases said it is an excellent resource for practitioners and their clients. In the alphabetical list of diseases, Bartonella henselae and Cat Scratch Disease are listed with identical information given for both subjects. The information is outdated and inadequate considering there are more than 4,000 published articles on these subjects. Incorrectly, the website uses the term “CSD” as if it is the etiologic agent “Bartonella.” 

Although rare, CSD can cause people to have serious complications. CSD can affect the brain, eyes, heart, or other internal organs.” In another sentence concerning Bartonella in cats they state “Bartonella henselae infection may also develop in the mouth, urinary system, or eyes.” They probably mean that “inflammation or disease” may also develop. We know of no association of Bartonella with urinary system diseases. Under “Prevention,” there is no mention of testing cats for Bartonella infection and therapy. Under “Available Tests & Treatments” “People: Talk to your doctor about testing and treatments for CSD. CSD is typically not treated in otherwise healthy people.” Of course CSD is only the tip of the iceberg of Bartonella inflammatory disease in people (see our Newsletters on www.natvetlab.com). Under “Cats: Talk to your veterinarian about testing and treatments for your cat. Your veterinarian can tell you weather your cat requires testing or treatment.” Thus, the US national health site, the CDC, still does not give any concrete recommendation to assist cat owners and veterinarians to understand this dangerous zoonotic pathogen. In addition, the site leaves the reader with the impression that CSD is the most important Bartonella disease which is just not true. We hope that the CDC will quickly modify this outdated part of their website. **

We thank all of our clients for making these 16 years so productive** References: 1. Relman, DA. et al. The agent of bacillary angiomatosis: An approach to the identification of uncultured pathogens. N. Engl. J. Med. 323:1573, 1990. 2. Hardy, WD, Jr, Zuckerman, EE, Gold, JWM, Baron, P, Kiehn, TE, Polsky, B, and Armstrong, D. Immunogenic proteins of Bartonella henselae defined by western immunoblots with naturally infected cat sera. 95th General Meeting, American Society for Microbiology, Washington, D.C., May 21-25, 1995. 3. VIN.com Board: Vet-to-Vet; Folders: Intn Med., Feline; Zoonoses and Public Health. Various dates. 4. Regnery RL, Rooney JA, Johnson AM, et al. Experimentally induced Bartonella henselae infections followed by challenge exposure and antimicrobial therapy in cats. Am J Vet Res 1996; 57: 1714-9. Erratum in: Am J Vet Res. 58:803, 1997. 5. Tuzio, H., et al. Feline zoonoses guidelines from the American Association of Feline Practitioners. . J Feline Med Surg 7:243-274, 2005. 6. Hardy, W.D., JR., Zuckerman, E.E., Corbishley, J. et al. Successful therapy of Bartonella henselae bacteremic healthy pet cats. Annual Meeting, Infect. Dis. Soc. of America, New Orleans, Sept., 1996. 7. Hardy, WD, Jr., Zuckerman, E, Corbishley, J. Seroprevalence of Bartonella-infection in healthy and diseased cats in the United States and Caribbean: Evidence for Bartonella-induced diseases in cats. International Conference of the American Society for Rickettsiology, Big Sky, MT, August 17-22, 2001. 8. Hardy, WD, Jr., Zuckerman, EE, Corbishley, J, et al. Efficacy of high dose, long duration Doxycycline or Azithromycin treatment for Bartonella infections in pet cats. Internat Conf Am Soc for Rickettsiology, 2001. 9. Hardy, WD, Jr., Zuckerman, E., & Corbishley, J. Serological evidence that Bartonella cause gingivitis and stomatitis in cats. American Veterinary Dental Society Meeting, Savannah, GA, October 2002. 10. Ketring, KL, Zuckerman, EE & Hardy, WD, Jr. Bartonella: A new etiological agent of feline ocular diseases. JAAHA, 40: 6-12, 2004. 11. Hardy, WD, Jr., Zuckerman, E, Ketring, K, Fischer, C, Mineo, M. Bartonella-induced ocular inflammatory diseases of cats. Upsala J Med Sci, Suppl. 57: 37, 2005 12. Hardy, WD, Jr., and Zuckerman, EE. Human bartonellosis: diseases caused by feline Bartonella- 84 cases. 5th Intern. Conf. on Bartonella as Emerg. Pathogens. Pacific Grove, CA, September 2-7, 2006. 13. Hardy, WD, Jr., Zuckerman, EE, Petcher, SP and Raclyn, P. Atypical Bartonella-Associated Diseases of Cats and Dogs: Platelet and Pancreatic Disorders, 6 th International Conference on Bartonella as Medical and Veterinary Pathogens: Chester, UK, June 21-23, 2009. 14. Hardy, WD, Jr. and Zuckerman, EE. Bartonella: The Pet Cat-Human Connection. 1st Intern One Health Congress, Melbourne, Australia, February.14-16, 2011. 15. Pennisi, MG et al. Bartonella species infection in cats ABCD guidelines on prevention and management. J Feline Med Surg 15:563-569, 2013. References can be obtained at: www.nlm.nih.gov/ or natvetlab.com ©National Veterinary Laboratory, Inc., 2015

Special Tribute to William Hardy, Jr. VMD 

Dr. Hardy is to be congratulated for his development of the Feline Bartonella Western Blot Test and his investigation into the pathology that Bartonella causes in cats and people. 

Dr. Hardy's work is protecting cats from harm and enabling a serious zoonosis potential to be eliminated.  There is great need for the veterinarian to work with the physician for the continued control of this very serious zoonosis.  Thank you Dr. Hardy for persevering through great negativity and being steadfast in bringing valuable information to the veterinary profession and the human physician.  DH DeForge, VMD 21May2016

Dr. DeForge welcomes your comments concerning his blogs.  Write to: DonDeForge100@gmail.com

21May2016