Bartonella and intraocular inflammation: a series of cases and review of literature

Abstract

Purpose:To present various forms of uveitis and/or retinal vasculitis attributed to Bartonella infection and review the impact of this microorganism in patients with uveitis.Methods:Retrospective case series study. Review of clinical records of patients diagnosed with Bartonella henselae and Bartonella quintana intraocular inflammation from 2001 to 2010 in the Ocular Inflammation Department of the University Eye Clinic, Ioannina, Greece. Presentation of epidemiological and clinical data concerning Bartonella infection was provided by the international literature.Results:Eight patients with the diagnosis of Bartonella henselae and two patients with B. quintana intraocular inflammation were identified. Since four patients experienced bilateral involvement, the affected eyes totaled 14. The mean age was 36.6 years (range 12–62). Uveitic clinical entities that we found included intermediate uveitis in seven eyes (50%), vitritis in two eyes (14.2%), neuroretinitis in one eye (7.1%), focal retinochoroiditis in one eye (7.1%), branch retinal vein occlusion (BRVO) due to vasculitis in one eye (7.1%), disc edema with peripapillary serous retinal detachment in one eye (7.1%), and iridocyclitis in one eye (7.1%). Most of the patients (70%) did not experience systemic symptoms preceding the intraocular inflammation. Antimicrobial treatment was efficient in all cases with the exception of the case with neuroretinitis complicated by anterior ischemic optic neuropathy and tubulointerstitial nephritis.Conclusion:Intraocular involvement caused not only by B. henselae but also by B. quintana is being diagnosed with increasing frequency. A high index of suspicion is needed because the spectrum of Bartonella intraocular inflammation is very large. In our study the most common clinical entity was intermediate uveitis.

Molecular characterisation of Bartonella species in cats from São Luís, state of Maranhão, north-eastern Brazil

“…In addition, the ability of B. henselae to adhere and invade mature human erythrocytes (Pitassi et al 2007) and remain viable in red blood cells after 35 days of storage at 4ºC (Magalhães et al 2008) underscore the possibility that these organisms may be transmitted by blood transfusion (Magalhães et al 2009, Velho 2009). Although immunocompromised patients may present with a systemic and fatal disease, immunocompetent individuals infected with Bartonella spp may develop non-specific and usually non-life-threatening clinical symptoms that have a significant impact on quality of life (Breitschwerdt et al 2008, 2010a, b, Kaiser et al 2011, Kalogeropoulos et al 2011. Epidemiologic data on human bartonellosis in Brazil is very limited.…”

Branch Retinal Vein Occlusion

“…Over the recent years, there have been a number of anecdotal case reports of BRVO with many systemic diseases, including Bartonella [ 17 ], Behcet's disease [ 18 , 19 ], Coats' disease [ 20 ], Crohn's disease [ 21 ], deep-sea diving [ 22 ], Eales' disease [ 23 ], focal retinal phlebitis [ 24 ], high altitude [ 25 ], human immunodefi ciency virus [ 26 , 27 ], infl iximab treatment [ 28 ], interferon therapy [ 29 ], lipemia retinalis [ 30 ], during fi ngolimod treatment of multiple sclerosis [ 31 ], ocular candidiasis [ 32 ], ocular Lyme borreliosis [ 33 ], ocular tuberculosis [ 34 ], primary intraocular lymphoma [ 35 ], pseudoexfoliation [ 36 , 37 ], quetiapine fumarate [ 38 ], sarcoidosis [ 39 -42 ], superior ophthalmic vein thrombosis [ 43 ], systemic lupus erythematosus [ 44 ], Takayasu's arteritis [ 45 ], tamoxifen [ 46 ], toxoplasmic chorioretinitis [ 47 ], Tsutsugamushi disease [ 48 ], and Waardenburg syndrome [ 49 ]. As discussed above, the association of a condition with a systemic disease does not always mean cause and effect.…”

Solitary Idiopathic Choroiditis in the Setting of Extensive Animal Exposure

“…Although the primary reservoir of B. henselae is the cat, this organism has also been found in other animals, including horses, dogs, and rodents. 5 There are several modalities for detection of Bartonella infection, and polymerase chain reaction hybridization assay demonstrates the highest sensitivity. 6 However, because polymerase chain reaction is not as cost-effective, more widely available serologic testing of indirect immunofluorescence assay or enzyme immunoassay is generally used.…”

“…9,10 Although B. henselae is responsible for typical cat scratch disease, other species such as Bartonella grahamii and Bartonella elizabethae are also known to cause ocular disease. 5 The reservoir host for these strains are rodents, and the vector for human disease is typically the rodent flea. 5 Although there is some cross-reactivity between Bartonella species on immunofluorescence testing, polymerase chain reaction is more sensitive and specific for nonhenselae species but is not regularly performed.…”