Abstract
BackgroundCat scratch disease (CSD) is a systemic illness caused by the gram-negative bacillus, Bartonella henselea, which can occasionally involve the ocular structures. The objective of this study is to evaluate the various clinical presentations of ocular bartonellosis at our institution. A retrospective review of the clinical records of 13 patients (23 eyes) with ocular manifestations of Bartonella infections over a 3-year period between January 2016 to December 2018 was undertaken at our institution.ResultsThe diagnosis was made based on clinical findings and in addition, with the support of the evidence of Bartonella hensalae IgG and/or IgM. Small retinal white lesions were the most common ocular findings in this series of patients (82.6% of eyes, 76.9% of patients). Neuroretinitis was the second most common finding (47.8% of eyes, 69.2% of patients), followed by exudative retinal detachment involving the macula (34.8% of eyes, 53.8% of patients) and Parinaud’s oculoglandular syndrome (17.4% of eyes, 23.1% of patients). Other findings like isolated optic disc oedema without macular star (8.7% of eyes, 15.4% of patients) and vitritis (4.3% of eyes, 7.7% of patients) were also observed. Ten patients (76.9%) had bilateral ocular involvement. Most of the patients were young, immunocompetent and had systemic symptoms like fever prior to their ocular symptoms. The visual acuity (VA) at initial presentation ranged from 6/6 to hand movement (mean, 6/20), and at final visit 6/6 to 6/60, (mean, 6/9). 91.7% of patients were treated with antibiotics. Only 2 patients received oral corticosteroids together with antibiotics due to very poor vision on presentation. The visual prognosis of ocular bartonellosis is generally good with 16 (88.9%) of 23 eyes having VA of 6/12 or better at final follow-up visit.ConclusionSmall foci of retinal white lesions were the most common manifestation of ocular bartonellosis in this series, followed by neuroretinitis, though an array of other ocular findings may also occur. Therefore, we should consider bartonella infection as a possible differential diagnosis in those patients.
Highlights
Cat scratch disease (CSD) is a systemic illness caused by the gram-negative bacillus, Bartonella henselea [1]
The posterior segment findings reported in literature include neuroretinitis, optic neuritis, focal retinitis, choroiditis, chorioretinitis, exudative maculopathy, serous retinal detachment and vitritis [5–7]
We performed a retrospective review of clinical records of 13 patients (23 eyes) with ocular bartonellosis treated in Hospital Sultanah Aminah Johor Bahru, a tertiary centre in southern region of Malaysia, over a 3-year period, between January 2016 and December 2018
Summary
Cat scratch disease (CSD) is a systemic illness caused by the gram-negative bacillus, Bartonella henselea, which can occasionally involve the ocular structures. A retrospective review of the clinical records of 13 patients (23 eyes) with ocular manifestations of Bartonella infections over a 3-year period between January 2016 to December 2018 was undertaken at our institution. Cat scratch disease (CSD) is a systemic illness caused by the gram-negative bacillus, Bartonella henselea [1]. The disease is transmitted by the bite or scratch of an infected animal, often a young cat or kitten [1]. Ocular complications like branch retinal artery occlusion, macular hole and peripapillary angiomatosis had been described [8–10]. Conjunctival manifestations such as Parinaud’s oculoglandular syndrome and nonspecific follicular conjunctivitis were reported [8–11]
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