Neuroretinitis, Aseptic Meningitis, and Lymphadenitis Associated with Bartonella (Rochalimaea) henselae Infection in Immunocompetent Patients and Patients Infected with Human Immunodeficiency Virus Type 1

Abstract

Bartonella (Rochalimaea) henselae causes a variety of diseases, including bacillary angiomatosis, peliosis hepatis, lymphadenitis, aseptic meningitis with bacteremia, and cat-scratch disease (CSD). Cases of B. henselae-related disease were collected from September 1991 through November 1993. Patients with suspected CSD, unexplained fever and lymphadenitis, or suspected B. henselae infection who were seen in the Infectious Diseases Clinic at Wilford Hall Medical Center (Lackland Air Force Base, TX) underwent physical and laboratory examinations. In addition to three previously described cases, 23 patients with R. henselae-related infection were identified. The patients included 19 immunocompetent individuals presenting with lymphadenitis (11), stellate neuroretinitis (5), Parinaud's oculoglandular syndrome with retinitis (1), chronic fatigue syndrome-like disease (1), and microbiologically proven adenitis without the presence of immunofluorescent antibodies to B. henselae (1) and four patients infected with human immunodeficiency virus type 1 presenting with isolated lymphadenitis (1), diffuse upper-extremity adenitis (1), neuroretinitis (1), and aseptic meningitis (1). A couple with neuroretinitis and their pet cat, a persistently fatigued patient, and a patient with Parinaud's oculoglandular syndrome were shown to have bacteremia. Tissue cultures were positive for B. henselae in three recent cases of adenitis. Twenty-two patients were exposed to cats. This series further demonstrates the similarities between B. henselae-related diseases and CSD and identifies several new syndromes due to B. henselae.

Macular findings on optical coherence tomography in cat-scratch disease neuroretinitis

“…[3][4][5] Disseminated CSD may involve the eye and cause vision-threatening manifestations, including neuroretinitis, optic neuritis, retinitis, choroiditis, anterior uveitis, vitritis, branch retinal arteriolar and venular occlusions, vasculitis, and peripapillary angiomatosis. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] In 1970, Sweeney and Drance 22 were first to find a connection between CSD and the appearance of neuroretinitis. Since then, numerous reports had been published on cases of neuroretinitis in CSD and it is the most common posterior segment complication of CSD.…”

Seroprevalence ofBartonella henselaein cattery cats: Association with cattery hygiene and flea infestation

“…Other less common syndromes associated with B. henselae occur mainly in irnmunocompromised people, and include the vasculoproliferative disease bacillary angiomatosis (BA) (18,19,21,24,27,28,30,31), bacillary peliosis (29,33), endocarditis (15), and other syndromes (34). CSD varies in severity from a benign, self-limiting disease to a severe disseminated disease which may require hospitalization.…”

Cat scratch disease complicated with aseptic meningitis and neuroretinitis

“…A syndrome of aseptic meningitis is rarely described and we have found three cases in the literature, one reported by Lucey et al in immunocompetent patient whose CSF analysis revealed 19 leukocytes/mm 3 (100% mononuclear), a protein level of 62 mg/dL, and a glucose level of 76 mg/dL [1]. The other two cases were reported by Wong et al one in HIV-positive patient [2]. These findings are compatible with the alterations encountered in our patient and probably could be more often than is currently diagnosed.…”

“…So far only three cases have been described in the literature, two of them in patients with HIV infection [1,2]. We report a case of aseptic meningitis in a previously healthy patient, HIV negative, who also had visual loss due to neuroretinitis, a far more common complication of CSD.…”