Until recently the cause(s) of CSD and BA were unknown. Recently, however, attention has been focused on two organisms, Afipia felis and Bartonella henselae (old name, Rochalimaea henselae). A. felis has only been isolated in a very few laboratories, whereas B. henselae (or sometimes the closely related B. quintana) is frequently isolated from cases of both CSD and BA in North America.

The incidence of CSD in Europe is not known. In the USA, estimates range from 6000 to over 20000 cases each year, 2000 of which require hospitalisation. A survey of cat blood samples from San Francisco for evidence of B. henselae bacteraemia reported B. henselae in 25 out of 61 cats (41%). The authors have been unable to detect B. henselae by isolation or PCR in blood from just over 20 British cats.

Transmission of B. henselae between cats or cats and humans may be via cat fleas. A. felis, however, is probably acquired from the environment, particularly soil.

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