In 2019, a cat bit an 85-year-old woman, but she was unaware of the need for post-exposure prophylaxis rabies vaccination. Unfortunately, she later developed symptoms consistent with rabies, including anxiety, hydrophobia, aerophobia and ultimately succumbed to the disease. Prior to this case, a man also died of rabies following a cat bite. According to the patient’s relatives, he was bitten on the leg by a cat but did not seek medical attention or receive an anti-rabies vaccine. Following his death, widespread panic ensued in his hometown. Around the same time, dozens of individuals who had also been bitten by the same cat visited Sukraraj Tropical and Infectious Disease Hospital (STIDH) to receive post-exposure prophylaxis rabies vaccinations.

Several cat-mediated rabies cases have also been reported globally. Of 18 human rabies cases surfaced between 2006 and 2019 in Europe, two were caused by cats. The number was 197 from 2010 to 2021 in the EU countries. In our northern neighbour, China, reportedly 5 percent of human rabies cases are from cats. According to a 14-year trend analysis of animal bite cases conducted by the Sukraraj hospital from 2000 to 2014, cat bites were the third most common reason for post-exposure prophylaxis (PEP) vaccination visits, following dog and monkey bites. Cat bites accounted for only 1 percent of all animal bite cases recorded during that period. However, in recent months, cat bite incidents have become increasingly common in Nepal, accounting for nearly half of all animal bite cases. This raises concerns about a potential risk of rabies transmission or even an outbreak.

The number of cat bite cases could be shooting up due to a growing tendency to adopt cats as pets or increased human-cat interactions in Nepal. It is also probable that, in the past, people were less likely to seek post-exposure prophylaxis vaccination following cat bites due to limited awareness about the potential risk of rabies transmission from cats.

When a cat bites, its sharp and slender teeth can easily puncture one’s skin, creating small but deep wounds. Many cat bite victims visit our outpatient department with such wounds, particularly on the fingers. This contrasts with dog bites, which typically result in larger wounds with excessive bleeding. In Nepal, there is a common perception that only deep and bleeding wounds require medical attention, including administration of the anti-rabies vaccine. As a result, cat bites, which often cause relatively small but deep puncture wounds with minimal bleeding, may be overlooked or considered insignificant.

Such a misconception can lead individuals to forgo necessary post-exposure prophylaxis vaccination, increasing the risk of rabies infection. Moreover, several bacteria, including highly pathogenic ones such as Pasteurella multocida, are commonly associated with cat bites. This bacterium can cause localised infections such as cellulitis, and in severe cases, may lead to life-threatening conditions like septicemia (bacteria entering the bloodstream).

Clinically, the bite wound is often swollen, red and painful. In our outpatient department, several cat bite victims have reported these symptoms. However, septicemia following cat bites remains underreported in Nepal, perhaps due to limited research and insufficient clinical attention to the history of cat bite exposure.

Cat scratches are another common reason for hospital visits, as individuals often seek medical advice due to potential complications. One such concern is Cat-Scratch Disease (CSD), caused by the bacterium Bartonella henselae, which is present in the saliva of infected cats. Transmission can occur when a cat licks an open wound or when it bites or scratches hard enough to break the skin barrier. The scratch area typically becomes reddened and swollen within a few days. Swollen lymph nodes, particularly under the arms (if scratched on the arm or hand), or in the groin (if scratched on the foot or leg), are common. Other signs and symptoms of CSD may include flu-like symptoms such as headache, fatigue, decreased appetite, joint pain, fever, scab or blister filled with pus (at the scratch site). It can, however, be effectively treated with the available antibiotics. We occasionally observe cases of CSD in our OPD, meaning CSD may be more common than we previously thought. However, scientific data on CSD in Nepal remain scarce.

Given the increasing close interaction between humans and cats in recent years, there is also a risk of transmission of other infectious diseases from cats to humans. Notably, toxoplasmosis is a significant zoonotic disease associated with close contact with cats. It affects pregnant women with weakened immune systems. A study published in 1998 reported an overall prevalence of 55.4 percent for antibodies against toxoplasmosis among pregnant women in Nepal, indicating a significant exposure to this disease.

If a woman acquires the infection during pregnancy—particularly in the first trimester—it can result in severe illness or congenital abnormalities in the infant, including birth defects and long-term developmental complications. However, the mother may remain asymptomatic or experience only mild, flu-like symptoms, making the infection difficult to detect. Therefore, doctors routinely include toxoplasmosis screening as part of antenatal (ANC) checkups to identify and manage the infection early. Toxoplasma gondii parasite, the causative agent of toxoplasmosis, is commonly found in cats and is observed in up to 50 percent of cats, particularly free-roaming ones, that have antibodies indicating prior infection. However, cats shed Toxoplasma gondii oocysts only once in their lifetime, usually for 3-10 days following ingestion of tissue cysts.

To sum up, cat bite cases and the need for anti-rabies vaccination were previously uncommon in Nepal. Although I have observed only two cat-mediated rabies cases over the past two and a half decades, the rapid rise of cat bite incidents in recent months, prompting an increased risk of rabies virus transmission from cats to humans, cannot be ignored. Awareness of cat-mediated rabies among cat owners through public education initiatives must be conducted to mitigate the risk. Moreover, research is needed to identify locally circulating bacterial pathogens in cats to help guide health care providers in providing timely and appropriate treatment. The recent sudden surge in cat bites or scratches in communities should serve as a wake-up call for the country.