Maybe I am showing my age here, but I remember that old song, "Cat Scratch fever." I always thought it an odd title, and never knew that any such illness actually existed. Until last month, that is...
On September 28th, I had BPOs to do. It was afternoon, so I picked up my girls and hit the road. I got the 2 drive-bys done quickly, then headed out to BFE for the interior inspection. What a house! Absolutely beautiful log home. We hung out there for quite awhile so I could get enough pics for the bank. Then, we get into the car, back up, and the car doesn't feel right. I hop out, and see a flat tire. Great. But what is worse is my jack is broken and the donut spare won't come out of my trunk. We walk up the 1/4 mile driveway to the road, in a strange remote location, we say a quick prayer, and head to the neighboring house. the owner was not able to help us, but within a few minutes another neighbor came by, and by the time we jogged down the driveway, he had the car jacked up and was waiting for me to open the trunk. He refused payment and referred to us as his neighbors in Christ. Such a mundane task as changing a tire was a great witness for us!
Then we were on our way to the closest Wal-Mart to have the tire fixed. About halfway there (we're talking 30 miles to the closest one), my 11 year old started complaining about a headache. I gave her a Tylenol. By the time we got there, she said she hurt everywhere. I told her to let the Tylenol start working. During the hour we waited, she became noticeably ill, and her temperature shot up. I bought a thermometer, and her fever was at 103. By the time we finally got out of there and on the way home, I had also bought some Motrin and gave her one of those, as I was always told to leap-frog the 2 drugs for best effect. When we got home, she went straight to bed. She woke up 3 times in the night with her fever spiking and body aches. We assumed it was the flu, so I just treated her fever all weekend, and she slept most of it. I had no idea that this was just the beginning!
Monday, she was still sick, complaining of abdominal pains, shooting pains through her one hip and knee, and that fever that never would get lower than 101. I called in to work and took her to Urgent Care. the nurse practitioner thought it was a virus of some sort and told me to keep her on the meds as I had been, bring her back if she gets worse. Tuesday, she was back there, in worse pain. They thought appendicitus and Xrayed and ran blood work. No elevated white cell count, slightly enlarged liver, no sign of appendicitus, clean UA. The white cells that respond to bacteria were slightly high, so they assumed an infection of some sort was starting and put her on antibiotics. 2 days later, she was still no better, so I took her back. the third practitioner re-ran all the tests and all had the same results. She changed antibiotics and said they couldn't help her anymore, that if she wasn't better or got worse, to take her straight to the ER. Monday evening, I did that. It was a waste of 4 1/2 hours, as their attitude was that since it wasn't a life threatening emergency, we were wasting their time. they did run blood work and another UA, and said it was a virus. I asked if they could tell me what kind of virus causes a high fever for 11 days, and when could we expect to see an improvement. no answers to that. So I took her to a pediatrician the next day. She looked over all the prior labs and tests, said it was absolutely not a virus, and scheduled an abdominal ultrasound for the next day. We missed the appointment.
Later that day, Tuesday, afternoon, we were in the car going to pick up her sister, when she started screaming "it hurts!" The pains in her knee intensified to the point she couldn't stand it, so we picked up her sister, called my husband and our pastor, and headed back to Urgent care. She was not able to walk or move the leg at all. we sat with her for about an hour before that pain passed. then she started having kidney pain at the same unbearable level. This time, there was blood in her urine. The practitionaer, who was the first one to have seen her, called her pediatrician, and they had her admitted to the local hospital, where she spent 2 days getting her ultrasound, IV antibiotics, MRI of her spine (a neurologist found marked weakness and lack of relexes in that one leg) and blood work for a lot of things, including Bartonella, the bacteria that causes Cat Scratch Disease. After 2 days in the hospital, her fever was staying lower, but not gone, so they let her go home with more antibiotics. And we were to wait nearly a week for the test results. After 2 days, her fevers resumed at the high level, so we went back to the pediatrician. this time, it was decided she needed to go the Children's Hospital in St Louis, because they just weren't finding out what was wrong. an appointment was made with an infectious disease specialist. then all the original test results came in. everything was negative, including bartonella and tularemia (rabbit fever), so we were back at square one.
In St Louis, they ran tests for everything from HIV, various cancers, and all the animal borne illnesses, as well as for different parasites and tick fevers. Then they sent her down for a CT scan. Before we left the hospital, the doctors came in and showed us images from the scan- she had many lesions on her liver! I freaked out, but they said it was consistent with cat Scratch fever, which had been the pediatrician's most likely choice, in spite of the negative results. So they changed the antibiotic to one that is more effective with this illness, a double-course of it, and sent us home. Within 2 days, her fever was gone! It was still a few days before she felt well enough to go to school, as the extreme fatigue and body aches continued, but within her first week back, she had caught up on 3 weeks of missed schoolwork. I wish I could catch up on MY work that easily! The lab results finally came back in from St Louis- the test for bartonella was positive, so she did have Cat scratch fever. Turned out the original tests done here had been mistakenly done for a specific, rare type of the illness. the doctor had ordered the test for the more common type, but they did NOT run that one, and that is what she had...We go back to St Louis next week, to have the scan repeated and make sure her liver is healing as it should.
So, here is what I learned. Normally a scratch or bite is involved, and normally it gets infected or gets pimpl-like bumps around it. Normally there are swollen lymph glands. Those things never happened to my daughter. Sudden high fever and onset of body-aches is common, like the flu. Extreme fatigue occurs, appetite decreases (my little girl lost 15 pounds in 3 weeks). It usually takes at least a week for antibodies to build up that can show on blood tests. Normally the white cell count goes through the roof, but that never happened with my daughter, either. Most cats will carry the bacteria at some point in their lives, but they don't show symptoms of any illness. The bacteria can cause damage to liver, kidneys and other organs, occasionally can cause inflammation in the spine/nervous system and then there can be loss of reflexes, weakness and pain in a limb, and very rarely it can be fatal. Unless your hospital has a full lab, any blood test for the illness will probably have to be sent out and it will take several days to come back. It seems like this is a pretty common illness, but it affects people in different ways. In my daughter's case, it was pretty severe, but it couls have been worse...
And if it wasn't for that nagging feeling I had that it was more than a virus and SOMEBODY needed to figure it out, it would have gone on a lot longer and probably caused lasting damage. But I trust those instincts and really kept pushing people until we got to the bottom of it. Lots of support from my pastor's family and church, lots of prayers, and lots of people doing research for me all helped! My daughter is feeling well now, hasn't gained any weight back yet, but I'm sure that will come, in time.