title: Conservative management of documented neuroretinitis in cat scratch disease associated with Bartonella henselae infection.
abstract: BACKGROUND
  Bartonella henselae has been identified as the causative agent of the neuroretinitis associated with cat scratch disease (CSD). Immunofluorescent antibody tests with good sensitivity and specificity are available to aid in diagnosis. Despite diagnostic advances, optimal management remains controversial. We present a case of documented B. henselae macular neuroretinitis managed without antibiotics and discuss antibiotic use in this condition.
  
  
  METHODS
  We examined a young woman with macular neuroretinitis and established a diagnosis of CSD. Management consisted of a review of the literature, followed by educating her about the condition and close observation. We documented the course of her disease.
  
  
  RESULTS
  We diagnosed neuroretinitis associated with B. henselae infection based on immunofluorescent antibody titres and clinical presentation. Our patient's neuroretinitis resolved promptly without antibiotic therapy.
  
  
  CONCLUSIONS
  Macular neuroretinitis in CSD can be satisfactorily diagnosed with the use of fluorescent antibodies in the appropriate clinical setting. Optimal treatment for the disease has not been established and observation combined with patient education remains an appropriate option. The self-limited nature of the disease implies that treatment studies not using controls must be interpreted with great caution. Adverse drug reactions and other iatrogenic complications can be reduced by limiting antibiotic use in settings where a meaningful treatment benefit has not been established.
authors.affiliation: Centre for Ophthalmology and Visual Science, Lions Eye Institute, Nedlands, Western Australia, Australia. bradrosen@hotmail.com
authors.forename: B S
authors.initials: BS
authors.lastname: Rosen
authors.forename: C J
authors.initials: CJ
authors.lastname: Barry
authors.forename: A M
authors.initials: AM
authors.lastname: Nicoll
authors.forename: I J
authors.initials: IJ
authors.lastname: Constable
mesh_terms: D000328:Adult; D000818:Animals; D018416:Bartonella henselae / Q000302:isolation & purification*; D002372:Cat-Scratch Disease / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology*; D002415:Cats; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D009902:Optic Neuritis / Q000150:complications / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D010211:Papilledema / Q000209:etiology; D012173:Retinitis / Q000150:complications / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D012607:Scotoma / Q000209:etiology