Bartonella henselae neuroretinitis in cat scratch disease: Diagnosis, management, and sequelae1, 2☆,
Section snippets
Materials and methods
Staff physicians in the Departments of Ophthalmology (Retina/ Uveitis service) and Infectious Diseases evaluated all seven previously healthy patients. A detailed ophthalmologic workup was conducted that included best-corrected Snellen visual acuity, dilated ophthalmoscopic analysis, and Humphrey visual field analysis. Defects in color discrimination were recorded on the day of presentation with D-15 studies or Ishihara color plates and redcap testing. Relative afferent pupillary defects
Results
Table 1 presents demographic data, month of presentation, predominant systemic findings, nature of cat exposure, and supportive laboratory results. Ages ranged from 19 to 31 years, and most recalled a scratch or bite that was an antecedent to clinical infection. Cases occurred most frequently in late fall and early winter months. Reported problems of fever, chills, night sweats, headache, and malaise were common, but none of the patients had focal neurologic signs or pain with eye movement. Two
Discussion
This case series illustrates three points that deserve special emphasis:
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B. henselae causes neuroretinitis in CSD.
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A mild optic neuropathy may result.
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Early antibiotic therapy appeared to shorten the course of infection and hasten visual recovery.
Previously, B. henselae was associated heavily with neuroretinitis based on indirect tests such as the IFA,5, 7, 8 enzyme-linked immunofluorescent antibodies,6 positive CSD skin test results,9 and suggestive bacillary forms on Warthin-Starry preparations.
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2019, American Journal of Ophthalmology Case ReportsCitation Excerpt :The majority of studies on this subject are small and retrospective. Some small studies suggest a benefit of doxycycline, ciprofloxacin, rifampin, gentamycin, or TMP/SMX with regards to shorter duration of ocular disease and improved visual outcomes in CSD.30–34 Because of contradictory reports regarding the benefit of antibiotics and a paucity of data, there is no established standard of care for the management of CSD.
Update on Bartonella neuroretinitis
2019, Journal of Current OphthalmologyCitation Excerpt :Visual field testing often demonstrates a cecocentral, central, or paracentral scotoma, or an enlarged blind spot.29 Other functional alterations include color vision abnormalities and reduction in average visually evoked potential (VEP) with normal electroretinogram.19 The diagnosis of CSD-associated neuroretinitis is based on clinical findings including young age, history of contact with a cat, typical neuroretinitis, systemic symptoms, and positive serology.
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Supported by the Research to Prevent Blindness Foundation, New York, New York.
- 1
None of the authors has a proprietary interest in the development or marketing of any drug mentioned in this article. The use of trade names or commercial products is for identification only and does not imply endorsement by any agency of the U.S. Government.
- 2
The views expressed in this article are those of the authors and do not reflect the official policy of the United States Air Force, Department of Defense, or other agencies of the U.S. Government.
- 3
Dr. Reed is assigned to the Air Force Institute of Technology.