Cat Scratch Research Articles

Detection of Bartonella sp. in ticks and their small mammal hosts in mangrove forests of Peninsular Malaysia.

Bacteria of the genus Bartonella have been known as emerging zoonotic pathogens for several human diseases including cat scratch disease, Carrion's disease and trench fever. Numerous species of small mammals have been reported to play a role as a suitable reservoir to many pathogenic Bartonella. These infections are thought to be transmitted through blood-feeding arthropod vectors such as ticks, fleas and lice. The purpose of this study is to detect the presence of Bartonella species from tick samples collected from small mammals in mangrove forests of Peninsular Malaysia. Herein, 38 individual ticks and their small mammals host were evaluated for the presence of Bartonella DNA by conventional PCR targeting the 16S rRNA intergenic spacer region (ITS) and partial sequencing of 460 bp from this locususing Bartonella genus-specific primers. Two tick individuals from Dermacentor auratus and Haemaphysalis hystricis collected from Rattus tiomanicus (host), were PCR-positive for Bartonella DNA amplification. No Bartonella amplification was possible in other tick species (Amblyomma sp.). Phylogenetic analysis of ITS fragments demonstrated that the sequences from ticks were closely related to Bartonella phoceensis, a species that has been reported from black rats (Rattus rattus) in Australia. This is the first report of a Bartonella bacteria detected in ticks from small mammals in Malaysia. Further research should be warranted to investigate the transmission of Bartonella and the potential impact of this zoonotic pathogen in animals and humans as this mangrove ecosystem is significant for local economy and tourism.

Unusual radiological features on diffusion-weighted imaging in myelin oligodendrocyte glycoprotein-associated disease

We report an unusual radiological appearance in a patient with myelin oligodendrocyte glycoprotein-associated disease (MOGAD).1 A 53-year-old Caucasian man presented with a 2-week history of pain on eye movements and...

Atypical Manifestations of Cat-scratch Disease, United States, 2005–2014

The Pediatric Infectious Disease Journal: January 2021 - Volume 40 - Issue 1 - p 48 doi: 10.1097/INF.0000000000002953

Experience of Cat Scratch Disease (CSD) in Rawalpindi, Pakistan – Could Physician's vigilance help in detection and case management?

Background: Cat scratch disease, caused by Bartonella henselae is more likely found in young cats, transmitted to humans through a scratch, bite, or contamination of wound or mucous membrane. Reporting the first documented case in Pakistan, in a young boy with painful ‘lumps’ on his neck. Case description: A 7-year-old boy, from rural area of Rawalpindi presented with malaise, anorexia, fever for 3 weeks and painful development of a ‘lumps’ on the right side of his neck in August 2018. The patient was treated with Amoxicillin-Clavulanate and Cephradine. On examination, grade-I malnutrition and multiple tender enlarged lymph nodes on the right angle of Mandibula was noted. All labs including TB and Rheumatoid screening were normal. Neck sonography revealed multiple enlarged matted lymph-nodes at level II B, III and IV. Findings were suggestive of chronic inflammation, Indiafection process. He was given Anti Tuberculosis treatment (ATT) on clinical grounds but no response after 4months. Epidemiological history revealed contact with young cats. Serology and histopathology confirmed Cat Scratch Disease. Azithromycin for 14 days resulted with notable improvement and was followed up for the next 6 months for progression/remission. Discussion: CSD,is a bacterial cutaneous and systemic zoonosis of cats. Contact with cats is almost invariably reported. The present case was diagnosed within 6 months of the initial symptoms and had only fever, malaise and unilateral cervical lymphadenopathy. There was no involvement of bones, joints or musculoskeletal system except raised ALT levels. Treatment with azithromycin showed to hasten the resolution of the lymphadenopathy as compared with placebo (Manfredi & Sabbatani, 2006). In our case, the patient was treated with Tab. Azithromycine for 10 days following ATT of 4 months that led to complete recovery. Conclusion: One of the most common causes of benign regional lymphadenopathy in children. Physicians must rule out CSD among patients with lymphadenopathy and history of cats contact. Surgical excision and Azithromycin should be considered. Health education & awareness in public, pet owners as well as in health practitioners is recommended.

Spread of Bartonella henselae in cats and potential related risks

Background: Bartonellosis, or cat scratch disease, is an emerging bacterial zoonosis caused mainly by Bartonella henselae. Cats are the most important epidemiological risk factor for transmission of infection in humans. The results first refer about the spread of Bartonella henselae in Sicily (Italy). Methods & Materials: WinEpi-Working in Epidemiology software was used to establish a sample size statistically representative. The serum and whole blood samples were collected from 359 cats of the city of Palermo. I.F.A. kit (MegaFLUO Bartonella henselae kit, Diagnostic Megacor) was used for the detection of IgG antibodies against B. henselae in cat serum samples. Fluorescence Microscope with FITC filter was used to read the slides. RT-PCR method was used for the evaluation of the presence of B. henselae DNA in cat whole blood samples. The DNA extraction from blood was carried out with the commercial kit Purelink Genomic DNA (Invitrogen). The RT-PCR instrument was Biorad CFX96 System. The detection of B. henselae DNA was carried out using TaqMan chemistry with a hydrolysis probe. Results: 170 of 359 serum samples were positive for IgG antibodies against B. henselae. The RT-PCR revealed the presence of B. henselae DNA in 124 of 359 whole blood samples analyzed. Among these 124 positive samples for B. henselae DNA, 52 sera were negative and 72 sera were positive for IgG antibodies to B. henselae. Probably the cats IgG-negative and positive for DNA presence were in the bacteremic phase and in the early or acute phase of disease. The serological prevalence, calculated on cats with the presence of antibodies against B. henselae, was 47%. The prevalence of cats in bacteremia, calculated on subjects with the presence of B. henselae DNA in whole blood, was 34.5%. Conclusion: Bartonellosis, considered a marginal pathology, is a zoonosis present in cats of the Sicilian Region. The data obtained in this study highlighted high prevalence percentages. Cats in the acute phase represent the main potential risk of transmission of the disease.

First molecular detection of Bartonella spp. in stray cats and dogs in Morocco

Background: Infections, which are caused by species of Bartonella produce a broad group of zoonosis with a worldwide distribution. In fact, Bartonella henselae is the main causal agent of cat scratch disease (CSD), and several other syndromes in humans. Furthermore, cats and dogs can be a source of many zoonotic diseases for human being. The aim of this study is to determine the prevalence of Bartonella henselae, Bartonella vinsonii subsp. Berkhoffii and Bartonella clarridgeiae in stray cats and dogs in Morocco, and assess the potential risk factors for feline and canine infections. Methods & Materials: As a matter of fact, blood samples of 130 cats and 158 dogs were collected from the West region of Morocco including Kenitra, Rabat, Temara, Casablanca, Settat, and Eljadida areas. Later on, DNA was extracted and tested by nested polymerase chain reaction (PCR), targeting a fragment of the intergenic transcribed sequence (ITS) with specific primers. Then, positive samples were confirmed by PCR using the FtsZ gene. Last but not least, the PCR products were sequenced to identify Bartonella species. Results: As a result, Bartonella henselae and B. clarridgeiae were detected in 30% (39/130) of stray cats. However, none of the dogs’ samples were tested positive in the PCR assays. It is worth to note that female gender and exposure to fleas were statistically associated with the infection. Conclusion: After reviewing all scientific studies conducted in Morocco and related to the vector borne diseases field, it is confirmed that this is the first study of its kind in Morocco, which examines blood of stray dogs and cats using molecular techniques. What is more, we should highlight the importance of the feline and canine population as a source of zoonotic agents and potential infection risk to humans.

Experience of Cat Scratch Disease (CSD) in Rawalpindi, Pakistan – Could Physician's vigilance help in detection and case management?

Experience of Cat Scratch Disease (CSD) in Rawalpindi, Pakistan – Could Physician's vigilance help in detection and case management?

Molecular detection of Bartonella henselae, Bartonella clarridgeiae and Rickettsia felis in cat and dog fleas in Tenerife, Canary Islands, Spain.

The cat flea Ctenocephalides felis is the main vector of Bartonella henselae and Bartonella clarridgeiae, the causative agents of cat-scratch disease (CSD) and the spotted-fever agent Rickettsia felis. In spite of their worldwide distribution, there are no data on the occurrence of CSD-causing Bartonella species or the prevalence of Rickettsia species in the Canary Islands, Spain. Therefore, the aim of our study was to screen cat and dog fleas for both pathogens. A total of 128 C. felis from cats and dogs were screened for Bartonella and Rickettsia by PCR. Bartonella henselae (2.3%) and B. clarridgeiae (3.9%) were found in fleas infesting cats, whereas R. felis was identified in both cat (36.6%) and dog (40.7%) fleas. Further, co-infections were observed. This work constitutes the first finding of CSD-causing Bartonella species and the first study on the prevalence of R. felis in fleas from domestic animals in the Canary Islands. These results indicate public health importance, as associated infections could be misdiagnosed in the Archipelago despite their clinical relevance. Establishing human and animal routine diagnosis procedures for these pathogens along with improving vector control in shelters is necessary in order to prevent the spread of the infections among animals.

Infections in Patients with Chronic Granulomatous Disease Treated with Tumor Necrosis Factor Alpha Blockers for Inflammatory Complications.

Management of inflammatory complications of chronic granulomatous disease (CGD) is challenging. The aim of this study was to assess safety, with a focus on infections, and effectiveness of tumor necrosis factor alpha (TNF-α) blockers in CGD patients. A retrospective, single-center cohort study of CGD patients treated by anti-TNF-α agents at Necker-Enfants Malades University Hospital (Paris, France) and registered at the French National Reference Center for Primary Immunodeficiencies (CEREDIH). Between 2006 and 2019, 14 (X-linked: n = 10, 71.4%; autosomal-recessive: n = 4, 28.6%) CGD patients with gastrointestinal (n = 12, 85.7%), pulmonary (n = 10, 71.4%), cutaneous (n = 3, 21.4%), and/or genitourinary (n = 2, 14.3%) inflammatory manifestations received one or more doses of infliximab because of steroid-dependent (n = 7, 50%), refractory (n = 4, 28.6%) inflammatory disease or as first-line drug (n = 2, 14.3%; missing data, n = 1). All patients received adequate antimicrobial prophylaxis. Infliximab achieved complete (n = 2, 14.3%) or partial (n = 9, 64.3%) response in 11 (78.6%) patients. Seven (50%) patients were switched to adalimumab. During anti-TNF-α treatment, 11 infections (pneumonia, adenitis, invasive candidiasis, each n = 2; intra-abdominal abscess, bacteremic salmonellosis, Pseudomonas aeruginosa-related folliculitis, cat-scratch disease, proven pulmonary mucormycosis, each n = 1) occurred in 7 (50%) patients. All infectious complications had a favorable outcome. Anti-TNF-α treatment was definitively stopped because of infection in two patients. Nine (64.3%) patients finally underwent hematopoietic stem cell transplantation. No death occurred during follow-up. Anti-TNF-α treatment could improve the outcome of severe inflammatory complications in CGD patients, but increases their risk of infections. We suggest that anti-TNF-α treatment might be of short-term benefit in selected CGD patients with severe inflammatory complications awaiting hematopoietic stem cell transplantation.

Cat-scratch fever in a 14-year-old girl – a case report

Cat-scratch fever is a bacterial zoonotic disease most commonly caused by the bacteria Bartonella henselae. In the majority of cases, the pathogens enter the body as a consequence of a scratch by young cats. The disease usually presents as local lymphadenopathy and resolves spontaneously over a period of 8–12 weeks. The epidemiological status of bartonellosis in Poland varies. According to the latest epidemiological data, a total of 36 cases of the disease were reported in 2008, with 75% of cases requiring hospitalisation. The clinical presentation of cat-scratch fever is often non-specific, so a wide panel of tests is required to rule out other diseases that may be accompanied by local lymphadenopathy. The disease is usually mild and selflimiting, but some patients may require antibiotic therapy. The case reported here shows that a thorough evaluation of medical history plays a key role in the diagnostic process, providing a rapid and accurate preliminary diagnosis.

Azithromycin – more than an antibiotic

Azithromycin, which belongs to the azalide subclass, is a derivative of erythromycin, obtained by inserting a methyl substituted nitrogen atom into the lactone ring. In this way, better stability at the low pH of the gastric juice, improved bioavailability, and an extended half-life relative to erythromycin were achieved. The mechanism of azithromycin antibacterial activity is to inhibit bacterial cell protein synthesis by binding to the 50S ribosomal subunit and preventing bacterial mRNA translation and protein biosynthesis. In addition to bactericidal activity, azithromycin also has immunomodulatory, anti-inflammatory, and antiviral properties. For this reason, it is used in exacerbations of asthma and chronic obstructive pulmonary disease. However, its antibacterial efficacy and high safety are most important. In clinical practice, several model clinical profiles of patients can be presented: children with community-acquired Mycoplasma pneumoniae pneumonia, recurrent respiratory tract infections and exacerbations of chronic inflammations, acute bronchitis of likely bacterial aetiology, tonsillitis and allergy to β-lactam antibiotics, and pertussis. Efficacy has also been proven in primary skin and soft tissue infections as well as erysipelas. However, azithromycin may also have an unusual use, as confirmed by recent reports. These include travellers’ diarrhoea, cat scratch disease (bartonellosis – rickettsiosis), and mycobacteriosis (nontuberculous mycobacteria). Appropriate spectrum of action, efficacy and safety, as well as a low percentage of resistant bacteria, good bioavailability, easy to remember, practical and simple dosage regimen and optimal cost are features of a good antibiotic. Azithromycin is close to meeting all these criteria.

Epidemiological of cat scratch disease among inpatients in the Spanish health system (1997-2015).

Cat scratch disease, whose causative agent is Bartonella henselae, is an anthropozoonosis with a worldwide distribution that causes significant public health problems. Although it is an endemic disease in Spain, the available data are very limited. The aim of our study was to describe cat scratch disease inpatients in the National Health System (NHS) of Spain. This was a retrospective descriptive study using the minimum basic data set (CMBD in Spanish) in patients admitted to hospitals of the NHS between 1997 and 2015 with a diagnosis of cat scratch disease (ICD-9: 078.3). We found 781 hospitalized patients diagnosed with cat scratch disease. The mean age (± SD) was 30.7 ± 25.3 years old. The male/female ratio was 1.1:1. The incidence rate over the study period was 0.93 (95% CI, 0.86-0.99) cases per million person-years. The incidence rate in men was 0.98 cases per million person-years and that in women was 0.88 cases per million person-years. The cases were more frequent from September to January. A total of 652 (83.5%) cases were urgent hospital admissions. The average hospital stay was 8.4 ± 8.9 days. The overall lethality rate of the cohort was 1.3%. We have demonstrated that CSD causes a substantial burden of disease in Spain, affecting both adult and pediatric patients with a stable incidence rate. Our data suggest that CSD is benign and self-limited, with low mortality, and its incidence is possibly underestimated. Finally, there is a need for a common national strategy for data collection, monitoring, and reporting, which would facilitate a more accurate picture and the design of more strategic control measures. Hospital discharge records (HDRs) could be a good database for the epidemiological analysis of the hospital management of CSD.

Transmission of Bartonella henselae within Rhipicephalus sanguineus: Data on the Potential Vector Role of the Tick.

Bartonella henselae is a fastidious intraerythrocytic, gram-negative bacteria that causes cat scratch disease in humans. Ixodes ricinus has been confirmed to be a competent vector of B. henselae, and some indirect evidences from clinical cases and epidemiological studies also suggested that some other tick species, including Rhipicephalus sanguineus, may transmit the bacteria. B. henselae has been detected in R. sanguineus but no experimental investigations have been performed to evaluate the vector competency of this tick species regarding B. henselae transmission. To this end, this work aimed to assess the transstadial transmission of B. henselae between larvae and nymphs of R. sanguineus as well as transmission by nymphs infected at the larval stage. Four hundred B. henselae negative larvae were fed with B. henselae-infected blood by using an artificial membrane feeding system. After five days of feeding, B. henselae was detected by PCR in 57.1% (8/14) of engorged larval pools, 66.7% (4/6) of semi-engorged larval pools, and 66.7% (2/3) of larval feces pools. After molting, B. henselae DNA was also detected in 10% (1/10) of nymph pools, but not in tick feces. After a pre-fed step of nymphs infected at the larval stage on non-infected blood meal, B. henselae was detected by PCR in blood sample from the feeder, but no Bartonella colonies could be obtained from culture. These findings showed that B. henselae could be transstadial transmitted from R. sanguineus larvae to nymphs, and also suggest that these nymphs may retransmitted the bacteria through the saliva during their blood meal. This is the first study that validated the artificial membrane feeding system for maintaining R. sanguineus tick colony. It shows the possibility of transstadial transmission of B. henselae from R. sanguineus larvae to nymphs.

Molecular and Serological Survey of the Cat-Scratch Disease Agent (Bartonella henselae) in Free-Ranging Leopardus geoffroyi and Leopardus wiedii (Carnivora: Felidae) From Pampa Biome, Brazil.

The genus Bartonella comprises emerging bacteria that affect humans and other mammals worldwide. Felids represent an important reservoir for several Bartonella species. Domestic cats are the main reservoir of Bartonella henselae, the agent of cat scratch disease (CSD). It can be transmitted directly by scratches and bites from infected cats and via cat fleas. This study aims to investigate the circulation of Bartonella spp. in free-ranging Neotropical wild felids from Southern Brazil using serological and molecular methods. In this study, 53 live-trapped free-ranging wild felids were sampled, 39 Leopardus geoffroyi and 14 Leopardus wiedii, from five municipalities in the Rio Grande, do Sul state, southern Brazil. All captured animals were clinically healthy. Two blood samples of L. geoffroyi were positive, by PCR, for the presence of B. henselae DNA. Conversely, none of L. wiedii blood samples were positive when tested using PCR. Indirect immunofluorescence assay (IFA) showed that 28% of serum samples of wild felids were reactive (seropositive) for B. henselae by immunofluorescence, with titers ranging from 64 to 256. The results presented here provide the first evidence of a Bartonella-enzootic cycle involving L. geoffroyi and L. wiedii, which may account for the spillover of the emerging zoonotic pathogen B. henselae for the indigenous fauna in Southern Brazil.

Neurorretinitis por Bartonella henselae en Gipuzkoa, 2014-2019

IntroductionBartonella henselae causes cat scratch disease (CSD), spread by a cat scratch or bite. Cats are its main reservoir. This sometimes results in optic neuritis or neuroretinitis. ObjectiveTo review these conditions in Gipuzkoa (Spain), 2014-2019. MethodsA retrospective review of serology and clinical records, selecting those with consistent clinical signs, contact with cats and positive serology for B. henselae (IgG-IFA≥1/256). ResultsSixty-four patients had CSD. Of these, one had optic neuritis and 3 had neuroretinitis (4/64; 6.3%). In 3 patients, flu-like symptoms preceded eye symptoms. Two suffered from loss of visual acuity at discharge, despite prolonged treatment with antibiotics and corticosteroids. ConclusionOptic neuritis and neuroretinitis caused by B. henselae are severe complications with a non-negligible incidence among patients with CSD in Gipuzkoa. We recommend ruling out CSD in patients with symptoms of optic neuritis or neuroretinitis (sudden vision loss, etc.) and contact with cats.

Serosurvey of IgG Antibodies against Bartonella henselae and Rickettsia typhi in the Population of Attica, Greece.

Rickettsia typhi and Bartonella henselae are the causative agents of murine typhus and cat-scratch disease, respectively. A small-scale survey (N = 202) was conducted in the Attica region, Greece, for determining the prevalence rates of IgG antibodies against B. henselae and R. typhi by indirect fluorescence antibody test. IgG against B. henselae and R. typhi were present in 17.8% (36/202) and 4.5% (9/202) of the participants, respectively; co-occurring IgG against both B. henselae and R. typhi were detected in 3.5% (7/202), whereas only anti-B. henselae IgG in 14.3% (29/202), and only anti-R. typhi IgG in 1.0% (2/202). Titres 1/64, 1/128, 1/256, and 1/512, of anti-B. henselae IgG were identified in 6.4%, 4.5%, 4.5%, and 2.4%, whereas titres 1/40 and 1/80 of anti-R. typhi IgG were detected in 4.0%, and 0.5%, respectively. A positive association of anti-B. henselae IgG prevalence with a coastal area featuring a major seaport (p = 0.009) and with younger age (p = 0.046) was identified. The findings of this survey raise concern for exposure of the population of Attica to B. henselae and R. typhi, which should be considered in the differential diagnosis when compatible symptoms are present. Our results also suggest that seaports may represent high-risk areas for exposure to Bartonella spp.

Hopping species and borders: detection of Bartonella spp. in avian nest fleas and arctic foxes from Nunavut, Canada

BackgroundIn a warmer and more globally connected Arctic, vector-borne pathogens of zoonotic importance may be increasing in prevalence in native wildlife. Recently, Bartonella henselae, the causative agent of cat scratch fever, was detected in blood collected from arctic foxes (Vulpes lagopus) that were captured and released in the large goose colony at Karrak Lake, Nunavut, Canada. This bacterium is generally associated with cats and cat fleas, which are absent from Arctic ecosystems. Arctic foxes in this region feed extensively on migratory geese, their eggs, and their goslings. Thus, we hypothesized that a nest flea, Ceratophyllus vagabundus vagabundus (Boheman, 1865), may serve as a vector for transmission of Bartonella spp.MethodsWe determined the prevalence of Bartonella spp. in (i) nest fleas collected from 5 arctic fox dens and (ii) 37 surrounding goose nests, (iii) fleas collected from 20 geese harvested during arrival at the nesting grounds and (iv) blood clots from 57 adult live-captured arctic foxes. A subsample of fleas were identified morphologically as C. v. vagabundus. Remaining fleas were pooled for each nest, den, or host. DNA was extracted from flea pools and blood clots and analyzed with conventional and real-time polymerase chain reactions targeting the 16S-23S rRNA intergenic transcribed spacer region.ResultsBartonella henselae was identified in 43% of pooled flea samples from nests and 40% of pooled flea samples from fox dens. Bartonella vinsonii berkhoffii was identified in 30% of pooled flea samples collected from 20 geese. Both B. vinsonii berkhoffii (n = 2) and B. rochalimae (n = 1) were identified in the blood of foxes.ConclusionsWe confirm that B. henselae, B. vinsonii berkhoffii and B. rochalimae circulate in the Karrak Lake ecosystem and that nest fleas contain B. vinsonii and B. henselae DNA, suggesting that this flea may serve as a potential vector for transmission among Arctic wildlife.

Cat-Scratch Disease Pneumonia: An Atypical Presentation

Purpose: Cat-scratch disease is caused by Bartonella henselae infection and it commonly presents in children with a mild cutaneous lesion and adjacent lymphadenitis. It has rarely been observed that it can present as a disseminated infection, such as encephalitis or pneumonia. We present a case report of a 35-year old, immunocompetent, patient who suffered pneumonia and encephalitis, resulting from Bartonella henselae infection. We also present a review of the literature published regarding this rare complication.
 Methods: We’ve searched the literature in the databases of Pubmed and Google Scholar to find articles that report pulmonary presentations of cat-scratch disease.
 Results: We’ve found only 16 other reported similar cases with pulmonary involvement in cat-scratch disease.
 Conclusions: Pulmonary presentation in cat-scratch disease is an uncommon presentation of a common disease, and it should be ruled out, even in cases it seems unlikely.

Akut lenfadenit ile gelen bir kedi tırmığı olgusu

Cat-scratch disease is an infectious disease caused by Bartonella henselae. It mostly passes through kittens. Although it can cause systemic disease in people with a weak immune system, it usually progresses with local infection and painful lymphadenitis. Today, serology and PCR provide great convenience in diagnosis. This disease may be more than known. Keeping mind will facilitate diagnosis and treatment. We presented a 10-year-old child case with painful lymphadenitis, which we detected by diagnosing Bartonella henselae antibodies in a serological test that did not respond to amoxicillin and responded to specific treatment.

The Story of Post-exposure Rabies Prophylaxis at the Pediatric Emergency Department

Abstract Objectives This study aimed to determine the epidemiological and medical features of suspected rabies exposures at a pediatric emergency department in a small city center in middle-northern Turkey. Methods Data were abstracted from a standard “Rabies Suspected Animal Contact Cases Examination Form.” The following information was recorded: sociodemographic and clinical features of the victim, history of rabies vaccination, date of event, time to hospital administration, animal species and its vaccination history with owner records, type of suspected contact, wound care, tetanus prophylaxis, rabies vaccination, and forensic notifications. Immunoprophylaxis was determined as “appropriate” or “inappropriate” in accordance with the Rabies Field Guideline (2014). Discussion A total of 306 cases were evaluated at the emergency department of the hospital. The age of the victims ranged between 1.5 and 17 years old, and 61.4% of them were males. Cat scratches were the most common source of suspected rabies exposure. Meanwhile, primary wound care and tetanus immunoprophylaxis were the frequent inappropriate medical applications. Rabies prophylaxis was completed in 76.5% of the cases. However, forensic notifications were missing. In addition, the rate of animal immunization was lower than it should be. Conclusion Our city is rabies free; however, risky exposures are frequent among children. Lack of knowledge about first aid and animal vaccination is revealed to be a major public health problem. Health care workers should follow current guidelines to provide a holistic approach to the treatment of potential rabies exposures.