Management of Cat Bite in a 4-Year-Old with Febrile, Lethargic Cat
The most appropriate next step is to give rabies immunoglobulin and vaccine immediately (Option D), while also thoroughly irrigating the wound and initiating prophylactic antibiotics. The combination of a newly adopted cat displaying signs of illness (fever and lethargy) creates a high-risk scenario for rabies transmission that mandates immediate post-exposure prophylaxis without waiting for observation or testing results.
Rationale for Immediate Rabies Prophylaxis
The febrile and lethargic state of the cat is highly concerning for rabies infection. According to national rabies control guidelines, a cat that bites a person and shows any signs of illness should be considered potentially rabid and warrants immediate prophylaxis 1. The guidelines explicitly state that "any illness in the animal should be reported immediately to the local health department" and "if signs suggestive of rabies develop, the animal should be euthanized" 1.
The 10-day observation period only applies to healthy cats, not sick ones. The standard recommendation is to confine and observe a healthy dog, cat, or ferret for 10 days 1. However, this cat is symptomatic at the time of the bite, which changes the management entirely. Post-exposure prophylaxis should begin "at the first sign of illness during confinement" 1, 2.
Essential Components of Management
Immediate Rabies Post-Exposure Prophylaxis
Administer both human rabies immune globulin (HRIG) and rabies vaccine simultaneously on day 0 at different anatomical sites for this previously unvaccinated child 3, 2.
HRIG dosing: 20 IU/kg body weight, with the full dose infiltrated around and into the wound if anatomically feasible, and any remaining volume injected intramuscularly at a site distant from the vaccine 3, 2.
Rabies vaccine series: 5 doses over 28 days on days 0,3,7,14, and 28 3, 2, 4.
Do not delay prophylaxis waiting for animal testing results 3, 2. The guidelines are clear that prophylaxis should be initiated immediately when an animal is suspected to be rabid.
Wound Management
Thoroughly wash and flush the wound with soap and copious amounts of water for at least 15 minutes to reduce rabies transmission risk 3, 2, 4.
Irrigate using a 20-mL or larger syringe with normal saline to ensure adequate mechanical cleansing 4.
Apply an iodine-containing or similarly viricidal topical preparation to the wound where available 2.
Antibiotic Prophylaxis
Initiate prophylactic antibiotics with amoxicillin/clavulanate as the first-line agent 4.
Cat bites have particularly high infection rates due to their puncture-wound nature and oral flora containing Pasteurella multocida, making antibiotic prophylaxis especially important 4, 5, 6.
Cat bite infections can lead to serious complications including septic shock, meningitis, and endocarditis, particularly from Capnocytophaga canimorsus and Pasteurella multocida 6.
Additional Measures
Assess and update tetanus immunization status as indicated 3, 2.
Report the incident immediately to the local health department 3, 2.
The cat should be euthanized and its brain examined for rabies virus by a qualified laboratory 1, 2.
Critical Pitfalls to Avoid
Never delay rabies prophylaxis when the biting animal is ill or suspected to be rabid 3. The "newly adopted" status means vaccination history is unknown or unreliable.
Never administer HRIG after day 7 of the vaccine series 3. It must be given on day 0 or within the first week.
Do not reassure or simply observe when the animal shows signs of illness at the time of the bite. This is not a scenario for the 10-day observation period 1.
Wound irrigation alone is insufficient without addressing the rabies risk in this high-risk scenario 3, 2.
Why Other Options Are Inadequate
Option A (Reassure) is dangerous because the symptomatic cat represents a genuine rabies risk that requires immediate intervention 1, 2.
Option B (Prophylactic antibiotics alone) addresses only bacterial infection risk but ignores the potentially fatal rabies exposure 4.
Option C (Irrigate wound alone) is necessary but insufficient as it does not address the rabies risk, which is the most critical concern given the animal's clinical presentation 3, 2.