Presumed Ocular Bartonellosis

Abstract

Background-The spectrum of diseases caused by Bartonella henselae continues to expand and ocular involvement during this infection is being diagnosed with increasing frequency. Methods-The clinical features and visual prognosis for 13 patients with intraocular inflammatory disease and laboratory evidence of bartonellosis were investigated. There were nine patients with neuroretinitis and four with panuveitis with positive antibody titres against B henselae determined by an enzyme immunoassay (IgG exceding 1:900 and/or IgM exceeding 1:250). Results-Positive IgG levels were found for eight patients and positive IgM levels for five. Despite animal exposure of 10 patients, only two (IgG positive) cases had systemic symptoms consistent with the diagnosis of cat scratch disease. Pathological fluorescein leakage of the optic disc was observed in all aVected eyes. At 6 months' follow up, 3/18 (17%) aVected eyes had a visual acuity of less than 20/100, owing to optic disc atrophy and cystoid macular oedema. 12 patients (17 eyes) were treated with antibiotics; visual acuity improved two or more Snellen lines for 9/17 (53%) eyes. Conclusions-The possibility of B henselae infection should be considered in patients with neuroretinitis and panuveitis (especially in cases with associated optic nerve involvement) even in the absence of systemic symptoms typical for cat scratch disease. (Br J Ophthalmol 1999;83:270-275)

Neuroretinitis associated with cat‐scratch disease in Japanese patients

“…Lymphadenopathy (54%) and skin papule were not detected all patients. Ocular features in Japanese patients were similar to those reported in other countries (Ormerod et al 1998; Reed et al 1998; Kerkhoff et al 1999; Sobha et al 2000; Messina et al 2001).…”

“…Using these serologic data, intraocular involvement in the course of B. henselae infection is diagnosed with increasing frequency. Retrospective reviews of clinical features, diagnosis and management for ocular complications of CSD neuroretinitis series have been reported recently (Reed et al 1998; Ormerod et al 1998; Kerkhoff et al 1999; Suhler et al 2000; Wade et al 2000). However, there is no review of Japanese ocular bartonellosis in the English literature.…”

Uveitis: an emerging clinical form of Bartonella infection

“…On the basis of ELISA and immunofluorescence serology only, the frequency with which infections with Bartonella species other than B. henselae produces uveitis was previously unknown. In our series, 43% of cases were due to B. henselae and one-third to B. quintana; the latter pathogen has not been previously documented in uveitis, in contrast to B. grahamii, which has been found in four patients and previously reported as a causative agent of uveitis [2]. In three patients, the causative Bartonella species was not determined.…”

“…A few reports have now established that the cat scratch disease agent Bartonella henselae is responsible for uveitis [1]. Bartonella grahamii has also been recognized as being responsible for uveitis [2]. However, the prevalence of Bartonella uveitis remains poorly known, as is the potential role of other Bartonella species.…”

An ocular cat-scratch disease patient positive for cytoplasmic anti-neutrophil cytoplasmic antibody

“…Cat-scratch disease is usually described as a benign, self-limited illness [2] Ocular manifestations of cat-scratch disease include Parinaud's oculoglandular syndrome, papillitis, neuroretinitis [1,3], and peripapillary angiomatosis. [3] Appropriate treatment (antibiotics and/or steroid administration) usually results in markedly improved visual acuity, unless optic nerve atrophy or cystoid macular edema persists [4].…”