A case of cat scratch disease neuroretinitis confirmed by polymerase chain reaction

BACKGROUND: Cat scratch disease neuroretinitis is caused by infection by Bartonella henselae. To demonstrate B. henselae infection, serologic examination is commonly used, but sometimes serologic examination is not adequate for correct diagnosis. Here we present a case of cat scratch disease neuroretinitis confirmed by polymerase chain reaction in addition to serologic examination. CASE: A 55-year-old woman, presenting with headache and high fever, had noticed visual disturbance. The best-corrected visual acuity in her right eye was 0.01. Meningitis, optic neuritis and retinitis were observed and she was treated with oral prednisolone. After repeated questioning, the patient remembered being scratched by a cat. Systemic examination focusing on B. henselae infection was conducted and B. henselae-specific immunoglobulin (Ig) G, but not IgM, was detected in both serum and cerebrospinal fluid. To confirm B. henselae infection, polymerase chain reaction (PCR) analysis using cerebrospinal fluid was performed and the presence of B. henselae-specific DNA was demonstrated. From these results, we diagnosed cat scratch disease neuroretinitis and treated the patient with minocycline hydrochloride together with prednisolone. Following this treatment regimen, the patient's condition improved, and the best-corrected visual acuity in her right eye increased to 0.6 five months after the onset.CONCLUSION: The PCR technique is useful to correctly diagnose cat scratch disease neuroretinitis, if patients exhibit marginal data on B. henselae-specific antibody titer.     

Disciforme keratitis caused by Bartonella henselae: an unusual ocular complication in cat scratch disease

Cat scratch disease (CSD) is a common infectious disease, however, its association with disciforme keratitis is a previously unreported ocular complication. With the use of the 16S rDNA-PCR technique with subsequent DANN sequencing on corneal material obtained by corneal scrape we were able to identify Bartonella henselae in an unusual form of disciforme keratitis.     

Submacular exudates with serous retinal detachment caused by cat scratch disease

Purpose: To present submacular exudates as a manifestation of cat scratch disease. Methods: Report of two cases. Results: The first patient, a 34-year-old man, developed submacular exudates with serous retinal detachment ten days after having axillary lymphadenopathy and fever. The second patient, a 30-year-old woman, developed submacular exudates with serous retinal detachment mimicking central serous chorioretinopathy. Fluorescein angiography revealed late staining of the subretinal lesions in both cases.The lesion resolved spontaneously in the first patient, while sulfamethoxazole and trimethoprim was required for the second patient. Both patients had a positive IgG titer for Bartonella henselae. Conclusions: Submacular exudates with serous retinal detachment can occur in cat scratch disease. Cat scratch disease should be included in the differential diagnosis of submacular exudates with central serous chorioretinopathy.     

Disciform keratatis caused by Bartonella henselae infection: detection of a rare ocular complication of cat-scratch disease with PCR

BACKGROUND: Cat scratch disease (CSD) is a common infectious disease, however its association with a disciforme keratitis is to our knowledge a previously unreported ocular complication. PATIENT: A 65-year old female was treated unsuccessfully with topical antibiotics, acyclovir and corticosteroids for several weeks because of a disciforme keratitis. Repeatedly, microbiological investigations (microscopy and culture) were negative. 16S rDNA-PCR with subsequent DNA-sequencing on material obtained by corneal scrape identified Bartonella henselae. Based on this result we have initiated a treatment with topical cephotaxim and within a short period of time the cornea healed with a paracentral scar. CONCLUSION: 16S rDNA-PCR was very helpful in identifying the intracellular sited bacterium Bartonella henselae as the causative pathogen of an unusual form of disciforme keratitis.     

Optic neuropathy secondary to cat scratch disease: case report

Optic neuropathy due to cat scratch disease is a relatively infrequent occurrence associated with macular star formation and is characterized by sudden painless loss of vision mostly unilateral. Bartonella henselae is well recognized as the etiologic agent in cat scratch disease. Ocular complications of the disease occur in up to 10% of patients and include neuroretinitis. Ocular bartonelosis is usually self-limited with complete or near-complete recovery of vision in otherwise healthy patients. A case of a boy with neuroretinitis caused by B. henselae is reported.     

Retinal Arterial Occlusive Disease in a Young Patient with Cat Scratch Disease

Purpose

To report an unusual case of a branch retinal arterial occlusion and bilateral multifocal retinitis in a young woman with cat scratch disease.

Methods

A 23-year-old woman was referred to our clinic complaining of a sudden scotoma in the upper part of the visual field of her left eye. Fundoscopy revealed occlusion of an inferior temporal branch of the retinal artery in the left eye and bilateral multifocal retinitis, which was confirmed by fluorescein angiography. Subsequent indocyanine angiography did not reveal choroidal involvement. Laboratory analysis showed rising IgG titers for Bartonella henselae.

Results

Cat scratch disease was diagnosed, and a 4-week course of doxycycline was initiated. The patient responded well to the antibiotics. Both retinitis and arterial occlusion were resolved, the visual field was regained and the patient reported elimination of her symptoms.

Conclusions

Cat scratch disease should be considered in the differential diagnosis in young patients with retinal occlusive disease.Key words: Cat scratch disease, Retinal arterial occlusion, Multifocal retinitis     

Bartonella henselae infection presenting as a unilateral panuveitis simulating Vogt-Koyanagi-Harada syndrome

PURPOSE: To report an unusual ocular manifestation of cat scratch disease. DESIGN: Observational case report. METHODS: Review of the clinical, laboratory, photographic, and angiographic records of a patient with cat scratch disease. RESULTS: A 54-year-old woman presented with counting fingers visual acuity in the right eye associated with optic disk edema, diffuse choroidal thickening, and panuveitis. Fluorescein angiography showed disk leakage and hyperfluorescent spots with late leakage suggestive of Vogt-Koyanagi-Harada disease. She was diagnosed with cat scratch disease by serum antibody titers and clinical course. CONCLUSIONS: Ocular manifestations of cat scratch disease can include diffuse thickening of the choroid. Cat scratch disease may manifest with angiographic features suggestive of Vogt-Koyanagi-Harada disease.     

Prevalence of serologic evidence of cat scratch disease in patients with neuroretinitis

OBJECTIVE: To determine the prevalence of Bartonella henselae seropositivity in patients with a clinical diagnosis of neuroretinitis. DESIGN: Retrospective, clinic-based, cross-sectional study. PARTICIPANTS: Eighteen consecutive patients seeking treatment at the Casey Eye Institute from November 1993 through November 1998 who had neuroretinitis. METHODS: The billing and photographic records of the Casey Eye Institute were searched for patients with a primary or secondary diagnosis of neuroretinitis or Leber's idiopathic stellate neuroretinitis. Charts were then reviewed to determine the results of B. henselae antibody titers and other pertinent clinical information. MAIN OUTCOME MEASURES: Results of B. henselae serologic testing. RESULTS: Fourteen of 18 patients with neuroretinitis had serologic studies. Nine of the 14 tested patients (64.3%) were found to have elevated IgM or IgG for B. henselae, suggesting current or past infection. Patients with positive serologic analysis results tended to have worse vision at presentation. There were no other obvious differences between seropositive and seronegative groups in this study, including duration or quality of recovery. CONCLUSIONS: At our tertiary care ophthalmology institution, most tested patients with neuroretinitis had evidence of past or present cat-scratch disease based on positive serologic analysis for B. henselae, a much greater prevalence than is expected to be found in the general population or in patients with idiopathic uveitis. Further study is indicated to clarify the prevalence of cat-scratch disease in neuroretinitis and the role and efficacy of antibiotics in treatment.     

Cat-scratch neuroretinitis.

BACKGROUND: Cat-scratch disease is a subacute regional lymphadenitis, usually preceded by a history of a cat scratch or exposure to kittens. The disease is caused by Bartonella henselae, and possibly Bartonella quintana, pleomorphic gram-negative rods formerly known as Rochalimaea henselae and Rochalimaea quintana. Ocular involvement is rare and typically manifests as either Parinaud's oculoglandular syndrome or neuroretinitis. Patients with neuroretinitis resulting from cat-scratch disease may be asymptomatic or experience mild-to-severe vision loss. The clinical features, angiographic appearance, differential diagnosis, and management of cat-scratch neuroretinitis are discussed. CASE REPORT: A 30-year-old white woman reported to the eye clinic with painless, decreased vision in the right eye. A diagnosis of cat scratch neuroretinitis was made on the basis of the history of cat scratch, clinical appearance, and angiographic findings. Treatment with oral ciprofloxacin restored vision to normal in 4 weeks. CONCLUSION: Painless vision loss associated with optic nerve swelling and macular star exudate should alert suspicion of systemic disease. Additional findings--including positive history of a cat scratch, lymphadenopathy, and flu-like symptoms--may indicate Bartonella henselae or Bartonella quintana infection. While treatment remains controversial, appropriate serology testing may aid in the diagnosis and management of the underlying infection.     

Presumed ocular bartonellosis

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 exceeding 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 affected eyes. At 6 months' follow up, 3/18 (17%) affected 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.     

Ocular bartonellosis

PURPOSE: To review recent advances in the basic and clinical biology of Bartonella-related eye disease. METHOD: A review of the pertinent medical literature was performed. RESULTS: A number of novel Bartonella species have been identified over the past decade. Of these, Bartonella henselae, the etiologic agent in cat scratch disease, is most often associated with ocular complications, which may include Parinaud oculoglandular syndrome, neuroretinitis, and focal retinochoroiditis. Although cat and flea exposure appear to be the main risk factors for contracting cat scratch disease, the diagnosis of ocular bartonellosis relies primarily on the recognition of suggestive clinical signs in conjunction with positive serologic testing. B. henselae-associated ocular complications are usually self-limited but may be treated with doxycycline or erythromycin, with or without rifampin, when the infections are severe or sight-threatening. CONCLUSIONS: B. henselae infection is common and should be considered in patients with Parinaud oculoglandular syndrome, neuroretinitis, or focal retinochoroiditis, particularly when there is a history of cat or flea exposure.     

Cat scratch disease with posterior segment involvement

PURPOSE: To describe the clinical characteristics of patients with cat scratch disease during the last 2 years. METHODS: Clinical characteristics and anterior and posterior segment manifestations were reviewed in five patients who were serologically diagnosed as having cat scratch disease. RESULTS: Four women and one man were examined. Their ages ranged from 7 to 60 years. Each patient had a markedly elevated serum anti-Bartonella henselae antibody titer. Visual symptoms developed 2 weeks or less after the onset of systemic symptoms. Lymphadenopathy was detected in one of five patients. Neuroretinitis was found in 4 patients, and papillitis in 1 patient. Seven eyes showed retinochoroidal exudates. Anterior uveitis was observed in three eyes. Four patients received systemic corticosteroids. CONCLUSION: The ocular manifestations of cat scratch disease include neuroretinitis, papillitis, retinochoroidal exudates, and anterior uveitis.     

Neuroretinitis in cat scratch disease

We report a patient with neuroretinitis, whose associated lymphadenopathy, exposure to cats, and strongly positive cat scratch antigen skin tests suggested the diagnosis of cat scratch disease. Cat scratch disease should be added to the list of infectious agents believed to produce the clinical picture of neuroretinitis.     

Cat-scratch disease neuroretinitis diagnosed by a polymerase chain reaction approach

PURPOSE: To assess the value of polymerase chain reaction in the diagnosis of cat-scratch disease neuroretinitis without conclusive serology. METHODS: Interventional case report. A 13-year-old girl developed a right neuroretinitis 2 months after a cat scratch. Despite the lack of accompanying features, an infection by Bartonella henselae was suspected and a systemic check-up was performed. RESULTS: Serologic results excluded other proposed origins but were insufficient in making the diagnosis because of low B. henselae specific IgG level in serum. A polymerase chain reaction analysis for B. henselae DNA in a small axillary lymphadenopathy aspirate enabled us to achieve a definitive diagnosis of cat-scratch disease. CONCLUSION: Polymerase chain reaction is a valuable method of diagnosing cat-scratch disease when serology is considered negative or borderline.     

Macular hole following Bartonella henselae neuroretinitis

PURPOSE. To report a case of macular hole secondary to Bartonella henselae neuroretinitis. METHODS. Observational case report. An 11 year-old boy presented urgently with a decrease of visual acuity in the left eye. Posterior segment examination revealed neuroretinitis attributed to Bartonella henselae. Treatment was initiated, resulting in the disappearance of symptoms. RESULTS. Follow-up consultations 7 months later showed a further decline in visual acuity secondary to a macular hole. CONCLUSIONS. Cat scratch disease is a rare pathology and is most often considered benign. Serious complications can nonetheless occur, such as neuroretinitis, choroidal nodules, and disciform keratitis. The authors report a case of sequellar macular hole. They found only one previous report of macular hole caused by B henselae, which, contrary to their case, appeared rapidly 12 days after presentation.     

Bartonella henselae infection associated with neuroretinitis, central retinal artery and vein occlusion, neovascular glaucoma, and severe vision loss

PURPOSE: To report a case of Bartonella henselae infection. DESIGN: Observational case report. METHODS: Review of the clinical, laboratory, photographic, and angiographic records of a patient with cat scratch disease associated with central retinal artery and vein occlusion, neovascular glaucoma, and severe vision loss. RESULTS: A 21-year-old man had no light perception in the left eye secondary to concurrent central retinal artery and vein occlusion believed to have resulted from infection with Bartonella henselae. Forty days later, he developed neovascular glaucoma in the left eye. CONCLUSION: Ocular complications associated with Bartonella henselae infection may include central retinal artery and vein occlusion, neovascular glaucoma, and severe vision loss.     

Cat scratch disease associated with neuroretinitis in a 6-year-old girl.

Cat scratch disease is a subacute regional lymphadenitis usually preceded by a history of being scratched by a cat or young kitten. The spectrum of illness ranges from mild self-limited adenopathy to severe systemic disease, including hepatosplenomegaly, encephalopathy, osteolytic lesions, splenic abscesses, mediastinal masses, and neuroretinitis. Vision loss is a rare complication of the disease. The authors report a patient with cat scratch disease associated with acute febrile illness, lymphocytic meningitis, and acute vision loss secondary to neuroretinitis. To their knowledge, this is the first ophthalmic case reported in which the diagnosis is supported by both a positive skin test and positive histopathology.     

Serous macular detachment as an atypical sign in cat scratch disease

CASE REPORT: A 58-year-old woman presented with 0.1 visual acuity in the left eye associated with a serous retinal detachment of the macula as the only ocular manifestation of cat scratch disease. This diagnosis was made by serum antibody titers and the clinical course. DISCUSSION: Although uncommon, cat scratch disease should be considered in patients with a serous detachment in the macula region of the retina.     

Lacrimal gland involvement in Kikuchi-Fujimoto disease

PURPOSE. A 32-year-old Saudi female presented with typical Kikuchi-Fujimoto disease, i.e., fever, cervical lymphadenitis and leukopenia, but there was also painful upper eyelid swelling with pain on upgaze. METHODS. A connective tissue disease and lymphoma workup were unremarkable, as were antibody titers to Apifia felis and Bartonella henselae. RESULTS. Orbital computed tomography showed significant lacrimal gland enlargement. Cervical node biopsy revealed necrotizing lymphadenitis. CONCLUSION. Concomitant lacrimal gland inflammation and cervical lymphadenopathy may be a benign self-limited disease.     

Lacrimal gland involvement in Kikuchi-Fujimoto disease

PURPOSE A 32-year-old Saudi female presented with typical Kikuchi-Fujimoto disease, i.e., fever, cervical lymphadenitis and leukopenia, but there was also painful upper eyelid swelling with pain on upgaze. METHODS A connective tissue disease and lymphoma workup were unremarkable, as were antibody titers to Apifia felis and Bartonella henselae . RESULTS Orbital computed tomography showed significant lacrimal gland enlargement. Cervical node biopsy revealed necrotizing lymphadenitis. CONCLUSION Concomitant lacrimal gland inflammation and cervical lymphadenopathy may be a benign self-limited disease.