Bartonella henselae neuroretinitis in cat scratch disease. Diagnosis, management, and sequelae.
OBJECTIVE
This study aimed to report the long-term outcomes of patients treated with an antibiotic drug combination for Bartonella henselae neuroretinitis.


METHODS
The study design was a retrospective case series.


METHODS
Seven consecutive patients with neuroretinitis and cat scratch disease participated.


METHODS
Patients underwent medical and ophthalmic evaluations. Blood cultures were obtained, and B. henselae antibody titers were measured. Tuberculosis, Lyme, toxoplasmosis, syphilis, and sarcoidosis were excluded. Patients received oral doxycycline 100 mg and rifampin 300 mg twice daily for 4 to 6 weeks and were observed for an average of 16 months (range, 10-24 months). Formal electrophysiologic testing was performed in three patients after resolution of neuroretinitis.


METHODS
The changes in ocular inflammation and visual function associated with treatment were recorded. Follow-up examinations and electrophysiologic testing documented sequelae.


RESULTS
Patients presented following cat exposure with fever, malaise, and blurred vision. Decreased visual acuity (ranging from 20/40 to counting fingers) frequently was associated with dyschromatopsia and afferent pupillary defects. Ophthalmoscopic analysis showed signs of neuroretinitis, including nerve fiber layer hemorrhages, cotton-wool spots, multiple discrete lesions in the deep retina, and stellate macular exudates. B. henselae infection was confirmed with positive blood cultures or elevated immunofluorescent antibody titers or both. Therapy appeared to promote resolution of neuroretinitis, restoration of visual acuity, and clearance of bacteremia. After 1 to 2 years, two eyes had residual disc pallor, afferent pupillary defects, retinal pigmentary changes, and mildly decreased visual acuity. Electrophysiologic studies showed that when compared to the fellow eye, affected eyes had subnormal contrast sensitivity, abnormal color vision, and abnormal visually evoked potentials. Conversely, electroretinograms were normal in all subjects.


CONCLUSIONS
B. henselae is a cause of neuroretinitis in cat scratch disease. Compared to historic cases, doxycycline and rifampin appeared to shorten the course of disease and hasten visual recovery. Long-term prognosis is good, but some individuals may acquire a mild postinfectious optic neuropathy.
Reed
J B
JB
Department of Ophthalmology, Wilford Hall Medical Center, Lackland AFB, Texas, USA.
Scales
D K
DK
Wong
M T
MT
Lattuada
C P
CP
Dolan
M J
MJ
Schwab
I R
IR
D000328:Adult; D000907:Antibodies, Bacterial / Q000032:analysis; D018416:Bartonella henselae / Q000276:immunology / Q000302:isolation & purification*; D002372:Cat-Scratch Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D003118:Color Perception; D015350:Contrast Sensitivity; D004318:Doxycycline / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004596:Electroretinography; D005074:Evoked Potentials, Visual; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D009902:Optic Neuritis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012173:Retinitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D014792:Visual Acuity
D000907:Antibodies, Bacterial; D004318:Doxycycline; D012293:Rifampin