What is the most appropriate next step in management for a child bitten by a febrile and lethargic cat?

Management of Cat Bite with Febrile and Lethargic Animal

The cat should be immediately reported to local health authorities and confined for 10-day observation, with rabies immunoglobulin and vaccine administered to the child if the cat develops signs of rabies or cannot be observed. 1

Immediate Assessment and Action

The critical concern here is rabies risk assessment, not bacterial infection prophylaxis. A febrile and lethargic cat represents a potentially rabid animal, which fundamentally changes management from a routine cat bite. 1

Key Management Steps:

1. Animal Confinement and Observation

• The cat must be confined and observed daily for 10 days by a veterinarian 1
• Any illness during confinement should be reported immediately to the local health department 1
• If signs suggestive of rabies develop, the animal should be euthanized immediately and the head submitted for rabies testing 1

2. Wound Management

• Immediate and thorough washing of the bite wound with soap and water for 15 minutes is the single most effective measure for preventing rabies 2, 3
• This local wound cleansing has been shown in experimental animals to markedly reduce the likelihood of rabies 2

3. Decision on Rabies Post-Exposure Prophylaxis (PEP)

Given the cat's clinical signs (febrile and lethargic), do not wait for the 10-day observation period to complete if:

• The cat develops any signs suggestive of rabies during observation 1
• The cat cannot be confined for observation 1
• The cat dies or is euthanized during the observation period 1

If any of these occur, immediately initiate rabies PEP consisting of:

• Rabies immunoglobulin infiltrated deep in and around the wound 2, 3
• Rabies vaccine series (the 1-week intradermal regimen is WHO-recommended as safe, cost-effective, and time-sparing) 3, 4

Critical Pitfalls to Avoid

Do not simply reassure or only give prophylactic antibiotics when dealing with a sick cat that has bitten someone. The febrile and lethargic state of the cat is a red flag for possible rabies, which is 100% fatal once symptoms develop. 2, 3

Do not delay reporting to public health authorities. Management of animals that bite humans requires immediate coordination with local health departments to ensure proper animal observation and testing protocols are followed. 1

Do not administer rabies vaccine to the cat during the 10-day observation period, as this can confuse clinical signs of rabies with vaccine side effects. 1

Why Not the Other Options?

• Option A (Reassure): Inappropriate given the animal's clinical signs suggesting possible rabies
• Option B (Prophylactic antibiotics alone): Addresses bacterial infection risk but ignores the life-threatening rabies risk from a symptomatic animal
• Option C (Irrigate wound alone): While wound irrigation is essential and should be done immediately, it is insufficient as the sole intervention given rabies risk 2, 3

Option D is correct IF the cat cannot be observed or develops rabies signs. The immediate next step is reporting to health authorities and arranging animal confinement/observation, with readiness to initiate PEP based on the animal's clinical course. 1, 2