Bartonella henselae neuroretinitis in cat scratch disease : Diagnosis, management, and sequelae
This study aimed to report the long-term outcomes of patients treated with an antibiotic drug combination for Bartonella henselae neuroretinitis. The study design was a retrospective case series. Seven consecutive patients with neuroretinitis and cat scratch disease participated. Patients underwent...
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| Veröffentlicht in: | Ophthalmology (Rochester, Minn.) Minn.), 1998-03, Vol.105 (3), p.459-466 |
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| creator | REED, J. B SCALES, D. K WONG, M. T LATTUADA, C. P DOLAN, M. J SCHWAB, I. R |
| description | This study aimed to report the long-term outcomes of patients treated with an antibiotic drug combination for Bartonella henselae neuroretinitis.
The study design was a retrospective case series.
Seven consecutive patients with neuroretinitis and cat scratch disease participated.
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.
The changes in ocular inflammation and visual function associated with treatment were recorded. Follow-up examinations and electrophysiologic testing documented sequelae.
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.
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. |
| doi_str_mv | 10.1016/S0161-6420(98)93028-7 |
| format | Article |
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The study design was a retrospective case series.
Seven consecutive patients with neuroretinitis and cat scratch disease participated.
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.
The changes in ocular inflammation and visual function associated with treatment were recorded. Follow-up examinations and electrophysiologic testing documented sequelae.
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.
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.</description><identifier>ISSN: 0161-6420</identifier><identifier>EISSN: 1549-4713</identifier><identifier>DOI: 10.1016/S0161-6420(98)93028-7</identifier><identifier>PMID: 9499776</identifier><identifier>CODEN: OPHTDG</identifier><language>eng</language><publisher>New York, NY: Elsevier</publisher><subject>Adult ; Antibacterial agents ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antibodies, Bacterial - analysis ; Bartonella henselae - immunology ; Bartonella henselae - isolation & purification ; Biological and medical sciences ; Cat-Scratch Disease - complications ; Cat-Scratch Disease - diagnosis ; Cat-Scratch Disease - drug therapy ; Color Perception ; Contrast Sensitivity ; Doxycycline - therapeutic use ; Drug Therapy, Combination - therapeutic use ; Electroretinography ; Evoked Potentials, Visual ; Eye Infections, Bacterial - diagnosis ; Eye Infections, Bacterial - drug therapy ; Eye Infections, Bacterial - microbiology ; Female ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Male ; Medical sciences ; Optic Neuritis - diagnosis ; Optic Neuritis - drug therapy ; Optic Neuritis - microbiology ; Pharmacology. Drug treatments ; Retinitis - diagnosis ; Retinitis - drug therapy ; Retinitis - microbiology ; Retrospective Studies ; Rifampin - therapeutic use ; Visual Acuity</subject><ispartof>Ophthalmology (Rochester, Minn.), 1998-03, Vol.105 (3), p.459-466</ispartof><rights>1998 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2163047$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9499776$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>REED, J. B</creatorcontrib><creatorcontrib>SCALES, D. K</creatorcontrib><creatorcontrib>WONG, M. T</creatorcontrib><creatorcontrib>LATTUADA, C. P</creatorcontrib><creatorcontrib>DOLAN, M. J</creatorcontrib><creatorcontrib>SCHWAB, I. R</creatorcontrib><title>Bartonella henselae neuroretinitis in cat scratch disease : Diagnosis, management, and sequelae</title><title>Ophthalmology (Rochester, Minn.)</title><addtitle>Ophthalmology</addtitle><description>This study aimed to report the long-term outcomes of patients treated with an antibiotic drug combination for Bartonella henselae neuroretinitis.
The study design was a retrospective case series.
Seven consecutive patients with neuroretinitis and cat scratch disease participated.
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.
The changes in ocular inflammation and visual function associated with treatment were recorded. Follow-up examinations and electrophysiologic testing documented sequelae.
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.
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.</description><subject>Adult</subject><subject>Antibacterial agents</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antibodies, Bacterial - analysis</subject><subject>Bartonella henselae - immunology</subject><subject>Bartonella henselae - isolation & purification</subject><subject>Biological and medical sciences</subject><subject>Cat-Scratch Disease - complications</subject><subject>Cat-Scratch Disease - diagnosis</subject><subject>Cat-Scratch Disease - drug therapy</subject><subject>Color Perception</subject><subject>Contrast Sensitivity</subject><subject>Doxycycline - therapeutic use</subject><subject>Drug Therapy, Combination - therapeutic use</subject><subject>Electroretinography</subject><subject>Evoked Potentials, Visual</subject><subject>Eye Infections, Bacterial - diagnosis</subject><subject>Eye Infections, Bacterial - drug therapy</subject><subject>Eye Infections, Bacterial - microbiology</subject><subject>Female</subject><subject>Fluorescein Angiography</subject><subject>Fundus Oculi</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Optic Neuritis - diagnosis</subject><subject>Optic Neuritis - drug therapy</subject><subject>Optic Neuritis - microbiology</subject><subject>Pharmacology. Drug treatments</subject><subject>Retinitis - diagnosis</subject><subject>Retinitis - drug therapy</subject><subject>Retinitis - microbiology</subject><subject>Retrospective Studies</subject><subject>Rifampin - therapeutic use</subject><subject>Visual Acuity</subject><issn>0161-6420</issn><issn>1549-4713</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kF9LwzAUxYMoc04_wiAPIgqrJk2aLL7p_AsDH9TncpukW6RNZ5I--O3tsPhyL9zz41zOQWhOyTUlVNy8D4NmgufkUi2vFCP5MpMHaEoLrjIuKTtE03_kGJ3E-EUIEYLxCZoorpSUYorKewip87ZpAG-tj7YBi73tQxdsct4lF7HzWEPCUQdIeouNixaixbf4wcHGd9HFBW7Bw8a21qcFBm9wtN_93usUHdXQRHs27hn6fHr8WL1k67fn19XdOtvlrEgZCK3AsKImxGjDpC4UrTivtIAhQi6FIpSq2piKGlovxXCwvK6WNeG1ttSwGbr4892FbvgcU9m6qPexvO36WEolc05oPoDzEeyr1ppyF1wL4accGxn081GHqKGpA3jt4j-WU8EIl-wXDb1xbg</recordid><startdate>19980301</startdate><enddate>19980301</enddate><creator>REED, J. B</creator><creator>SCALES, D. 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Drug treatments</topic><topic>Retinitis - diagnosis</topic><topic>Retinitis - drug therapy</topic><topic>Retinitis - microbiology</topic><topic>Retrospective Studies</topic><topic>Rifampin - therapeutic use</topic><topic>Visual Acuity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>REED, J. B</creatorcontrib><creatorcontrib>SCALES, D. K</creatorcontrib><creatorcontrib>WONG, M. T</creatorcontrib><creatorcontrib>LATTUADA, C. P</creatorcontrib><creatorcontrib>DOLAN, M. J</creatorcontrib><creatorcontrib>SCHWAB, I. 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R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bartonella henselae neuroretinitis in cat scratch disease : Diagnosis, management, and sequelae</atitle><jtitle>Ophthalmology (Rochester, Minn.)</jtitle><addtitle>Ophthalmology</addtitle><date>1998-03-01</date><risdate>1998</risdate><volume>105</volume><issue>3</issue><spage>459</spage><epage>466</epage><pages>459-466</pages><issn>0161-6420</issn><eissn>1549-4713</eissn><coden>OPHTDG</coden><abstract>This study aimed to report the long-term outcomes of patients treated with an antibiotic drug combination for Bartonella henselae neuroretinitis.
The study design was a retrospective case series.
Seven consecutive patients with neuroretinitis and cat scratch disease participated.
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.
The changes in ocular inflammation and visual function associated with treatment were recorded. Follow-up examinations and electrophysiologic testing documented sequelae.
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.
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.</abstract><cop>New York, NY</cop><pub>Elsevier</pub><pmid>9499776</pmid><doi>10.1016/S0161-6420(98)93028-7</doi><tpages>8</tpages></addata></record> |
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| ispartof | Ophthalmology (Rochester, Minn.), 1998-03, Vol.105 (3), p.459-466 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Antibacterial agents Antibiotics. Antiinfectious agents. Antiparasitic agents Antibodies, Bacterial - analysis Bartonella henselae - immunology Bartonella henselae - isolation & purification Biological and medical sciences Cat-Scratch Disease - complications Cat-Scratch Disease - diagnosis Cat-Scratch Disease - drug therapy Color Perception Contrast Sensitivity Doxycycline - therapeutic use Drug Therapy, Combination - therapeutic use Electroretinography Evoked Potentials, Visual Eye Infections, Bacterial - diagnosis Eye Infections, Bacterial - drug therapy Eye Infections, Bacterial - microbiology Female Fluorescein Angiography Fundus Oculi Humans Male Medical sciences Optic Neuritis - diagnosis Optic Neuritis - drug therapy Optic Neuritis - microbiology Pharmacology. Drug treatments Retinitis - diagnosis Retinitis - drug therapy Retinitis - microbiology Retrospective Studies Rifampin - therapeutic use Visual Acuity |
| title | Bartonella henselae neuroretinitis in cat scratch disease : Diagnosis, management, and sequelae |
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