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Li P, Qian Z, Tao Y. Application of metagenomic next-generation sequencing in the diagnosis of Bartonella neuroretinitis: a case report and literature review. J Ophthalmic Inflamm Infect 2024; 14:17. [PMID: 38637335 PMCID: PMC11026355 DOI: 10.1186/s12348-024-00387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/13/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Cat-scratch disease (CSD) is caused by Bartonella henselae infection. In atypical cases of CSD, pathogen determination is challenging. We report a case of Bartonella neuroretinitis with neither a clear history of scratches nor typical general symptoms. The diagnosis was made using metagenomic next-generation sequencing (mNGS), a high-throughput sequencing technology. CASE PRESENTATION A female patient presented to the ophthalmologist with complaint of blurred vision in her right eye. Although with history of raising a cat, she reported no clear history of scratches or typical general symptoms, except a fever of unknown origin which resolved spontaneously. The best corrected visual acuity (BCVA) of the right eye was count fingers. Fundus examination showed optic disc oedema, macular exudates and inferior exudative retinal detachment. Laboratory examination results showed increased value of serum C-reactive protein and erythrocyte sedimentation rate. Ocular involvement of toxoplasmosis, syphilis and tuberculosis were excluded. To identify the possible causative pathogen of the disease, mNGS of aqueous humour sample was performed and 521 reads of B. henselae were identified. Serological test results further showed a positive immunoglobulin G (IgG) titre of 1:64. Taking the contact history, clinical manifestations, mNGS and serological results into consideration, the diagnosis of Bartonella neuroretinitis (ocular CSD) was made. After appropriate treatment, the BCVA of the right eye improved to 20/25 in the last follow-up. Fundus examination showed a normal optic disc and macula, and the exudates had reduced. CONCLUSION mNGS, a fast and unbiased method, can be used to detect B. henselae (if present) in intraocular fluid samples.; however, the results should be interpreted together with the clinical symptoms and other auxiliary test results.
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Affiliation(s)
- Pengcheng Li
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China.
| | - Zhuyun Qian
- Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Road of Worker's Stadium Chaoyang District, Beijing, 100020, China
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Road of Worker's Stadium Chaoyang District, Beijing, 100020, China.
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Curi ALL, de-la-Torre A, Schlaen A, Mahendradas P, Biswas J. Pediatric Posterior Infectious Uveitis. Ocul Immunol Inflamm 2023; 31:1944-1954. [PMID: 38096404 DOI: 10.1080/09273948.2023.2284990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE To describe the most important cause of infectious posterior uveitis in pediatric patients. METHODS Review of the literature. RESULTS The most important causes of infectious uveitis in pediatric patients are: cat-scratch disease, toxocariasis, tuberculosis, viral diseases and toxoplasmosis. Ocular manifestations include retinitis, neuroretinitis, choroidal granulomas, peripheral granulomas and posterior pole granulomas. CONCLUSION Infectious posterior uveitis is a challenging subject and should be considered in the differential diagnosis of any posterior uveitis in children. Infectious uveitis must be excluded before initiating immunosuppressive therapy.
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Affiliation(s)
- André Luiz Land Curi
- Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Disease - INI/Fiocruz, Rio de Janeiro, Brazil
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Ariel Schlaen
- Department of Ophthalmology, Hospital Universitario Austral, Derqui-Pilar, Argentina
| | | | - Jyortimay Biswas
- Uveitis and Ocular Pathology Department, Sankara Nethralaya, Chennai, India
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3
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Pandya BU, Jhaveri A, Shamshad F, Margolin EA, Micieli JA. The Causes of Optic Disc Edema in Patients Presenting With Significantly Compromised Vision. J Neuroophthalmol 2023:00041327-990000000-00499. [PMID: 37938075 DOI: 10.1097/wno.0000000000002030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND To evaluate the most common causes of optic disc edema (ODE) in patients with significantly compromised vision (initial best-corrected visual acuity [BCVA] of 20/400 or worse) at presentation. METHODS Retrospective chart review over a 5-year period of consecutive patients presenting to tertiary neuro-ophthalmology clinics at the University of Toronto. RESULTS A total of 656 patients with ODE were included, and 49 patients (7.47%) had an initial BCVA of 20/400 or worse. There were 54 eyes included at baseline and 49 eyes at final follow-up. There were 29 female and 20 male patients. The mean age at first visit across patients was 55.9 years. Female patients (n = 29) were significantly older than male patients (n = 20) (P < 0.05). The causes of ODE were optic neuritis (ON) (n = 22; 40.7%), nonarteritic anterior ischemic optic neuropathy (NAION) (n = 22; 40.7%), arteritic anterior ischemic optic neuropathy (AAION) (n = 5; 9.26%), uveitis-related (n = 3; 5.56%), papilledema from idiopathic intracranial hypertension (IIH) (n = 1; 1.85%), and Vogt-Koyanagi-Harada disease (n = 1; 1.85%). Initial BCVA was not significantly different between ON and NAION groups (P = 0.52); however, final BCVA was significantly better in the ON group (P < 0.0001). The mean initial BCVA was worst in the AAION group (2.62 ± 0.54 logarithm of the minimum angle of resolution). The most common cause of ODE in patients <40 years old was ON (83.3%), whereas the 2 most common causes in patients >80 were NAION (60%) and AAION (40%). In patients between the ages of 60-80, NAION (100%) was the only cause. CONCLUSIONS Patients with ODE and poor vision at presentation represent a minority of cases seen in neuro-ophthalmology clinics (<10%). Optic neuritis and NAION are the 2 most common causes of ODE with poor vision at presentation. These findings are limited by a small sample size and potential sampling bias.
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Affiliation(s)
- Bhadra U Pandya
- Temerty Faculty of Medicine (BUP, AJ), University of Toronto, Toronto, Canada; Faculty of Medicine (FS), University of Alberta, Edmonton, Canada; Department of Ophthalmology and Vision Sciences (EAM, JAM), Faculty of Medicine, University of Toronto, Toronto, Canada; and Kensington Vision and Research Centre (JAM), Toronto, Canada
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Kara M, Ozdemir GN, Tasdemir M, Ata S, Karini B, Valiyev E, Tutkun IT, Kose G, Ozkaya O. A case of Bartonellosis mimicking systemic lupus erythematosus. Eur J Ophthalmol 2023; 33:NP41-NP48. [PMID: 36345218 DOI: 10.1177/11206721221137163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND AIM Cat-scratch disease (CSD) is a systemic bacterial infection caused by Bartonella henselae. The disease is typically characterized by regional lymphadenopathy developing after scratches from domestic or feral cats. Rarely, systemic involvement may be observed. The co-occurrence with glomerulonephritis and positive antinuclear antibody (ANA) tests have been reported before. In these cases, the disease can be misdiagnosed as systemic lupus erythematosus. Ocular involvement occurs in 5%-10% of the cases with CSD, and neuroretinitis is among the common manifestations. Administration of corticosteroids (CSs) in addition to antibiotics has been shown to improve prognosis in neuroretinitis cases. However, the optimal dose and duration, remain ill-defined. CASE REPORT In this article, we present an 11-year-old girl with CSD and neuroretinitis with a positive ANA test and hematuria, who benefited from high-dose methyl-prednisolone and antibiotics. CONCLUSION Further research is warranted in order to determine the dose and duration of CSs in the treatment of Bartonella neuroretinitis.
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Affiliation(s)
- Manolya Kara
- Department of Pediatric Infectious Diseases, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Gul Nihal Ozdemir
- Department of Pediatric Hematology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Mehmet Tasdemir
- Department of Pediatric Nephrology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Serap Ata
- Department of Pediatrics, Memorial Atasehir Hospital, Istanbul, Turkey
| | - Belma Karini
- Department of Ophthalmology, Memorial Sisli Hospital, Istanbul, Turkey
| | - Eldar Valiyev
- Department of Radiology, Liv Hospital Ulus, Istanbul, Turkey
| | - Ilknur Tugal Tutkun
- Department of Opthalmology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Gulsen Kose
- Department of Pediatric Neurology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Ozan Ozkaya
- Department of Pediatric Rheumatology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
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Norrie JL, Lupo M, Shirinifard A, Djekidel N, Ramirez C, Xu B, Dundee JM, Dyer MA. Latent Epigenetic Programs in Müller Glia Contribute to Stress, Injury, and Disease Response in the Retina. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.15.562396. [PMID: 37905050 PMCID: PMC10614790 DOI: 10.1101/2023.10.15.562396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Previous studies have demonstrated the dynamic changes in chromatin structure during retinal development that correlate with changes in gene expression. However, a major limitation of those prior studies was the lack of cellular resolution. Here, we integrate single-cell (sc) RNA-seq and scATAC-seq with bulk retinal data sets to identify cell type-specific changes in the chromatin structure during development. Although most genes' promoter activity is strongly correlated with chromatin accessibility, we discovered several hundred genes that were transcriptionally silent but had accessible chromatin at their promoters. Most of those silent/accessible gene promoters were in the Müller glial cells. The Müller cells are radial glia of the retina and perform a variety of essential functions to maintain retinal homeostasis and respond to stress, injury, or disease. The silent/accessible genes in Müller glia are enriched in pathways related to inflammation, angiogenesis, and other types of cell-cell signaling and were rapidly activated when we tested 15 different physiologically relevant conditions to mimic retinal stress, injury, or disease in human and murine retinae. We refer to these as "pliancy genes" because they allow the Müller glia to rapidly change their gene expression and cellular state in response to different types of retinal insults. The Müller glial cell pliancy program is established during development, and we demonstrate that pliancy genes are necessary and sufficient for regulating inflammation in the murine retina in vivo. In zebrafish, Müller glia can de-differentiate and form retinal progenitor cells that replace lost neurons. The pro-inflammatory pliancy gene cascade is not activated in zebrafish Müller glia following injury, and we propose a model in which species-specific pliancy programs underly the differential response to retinal damage in species that can regenerate retinal neurons (zebrafish) versus those that cannot (humans and mice).
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Dutta Majumder P, Mochizuki M, González-López JJ, Gonzales J, Sharma M, Sharma K, Biswas J. Laboratory Investigations in Infectious Uveitis. Ocul Immunol Inflamm 2023; 31:1405-1415. [PMID: 36698066 DOI: 10.1080/09273948.2022.2164728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 01/27/2023]
Abstract
Laboratory investigations can play a significant role in the diagnosis and decision-making of infectious uveitis. Though direct demonstration of the infective organism remains the gold standard of diagnosis, it is not always possible with ocular tissues. Recent advancements in molecular techniques have made it possible to overcome these limitations and to identify the genomic DNA of pathogens associated with infectious uveitis. Techniques such as next-generation sequencing can analyze all DNA-based lifeforms, regardless of whether they are bacteria, fungi, viruses, or parasites and have been used in the laboratory diagnosis of intraocular inflammation. On the other hand, serological tests, though they dominate the diagnostic landscape of various infectious etiologies in uveitis in routine clinical practice, have varied specificities and sensitivities in different infectious uveitis. In this review, we focus on various methods of laboratory diagnosis of infectious uveitis and discuss the recent advances in molecular diagnosis and their role in various infectious clinical entities.
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Affiliation(s)
| | - Manabu Mochizuki
- Miyata Eye Hospital, Miyakonojo, Japan
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Julio J González-López
- Ophthalmology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Surgery Department, Universidad de Alcalá, Madrid, Spain
| | - John Gonzales
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
| | - Kusum Sharma
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh (PGIMER), Chandigarh, India
| | - Jyotirmay Biswas
- Director of Uveitis & Ocular Pathology, Sankara Nethralaya, Chennai, India
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Avaylon J, Lau K, Harter K, Mamoor A, Mehendale R, Ranasinghe L, Durant E, Bains G. Neuroretinitis as a Complication of Cat Scratch Disease. Cureus 2023; 15:e45866. [PMID: 37885521 PMCID: PMC10599218 DOI: 10.7759/cureus.45866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
In this case report, a patient with neuroretinitis from a Bartonella henselae infection is described, and insights into methods to distinguish this type of case from more common etiologies of optic nerve edema are presented. A 21-year-old female with a history of right monocular vision loss due to amblyopia presented to the emergency department (ED) with occipital headache, fever, dizziness, nasal congestion, and painless blurry vision in the left eye for one day. A lumbar puncture found a slightly high opening pressure but no evidence of meningitis. The patient was diagnosed with a viral illness and discharged with outpatient follow-up. The patient, however, had persistent central vision loss and recurring headaches and returned to the ED. Subsequent ultrasound of the patient's optic nerve revealed significant optic nerve swelling. A new working diagnosis of idiopathic intracranial hypertension was made, and the patient was started on oral acetazolamide. On the next day, she was seen by ophthalmology, and recent scratches from her cat were noted on her arm. She tested positive for B. henselae and was started on doxycycline and rifampin. Nearly two weeks after the initial presentation, a macular star pattern, indicative of neuroretinitis, was noted on the fundoscopic exam. The patient had recovered her vision by three months later. In ED cases with unilateral vision loss, early use of point-of-care ultrasound and infection with B. henselae should always be considered. Early serology testing may be warranted to allow for earlier treatment since classic signs of neuroretinitis may not be apparent at the onset.
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Affiliation(s)
- Jaycob Avaylon
- Clinical Sciences, California Northstate University College of Medicine, Elk Grove, USA
| | - Kimberly Lau
- Clinical Sciences, California Northstate University College of Medicine, Elk Grove, USA
| | - Kirk Harter
- Clinical Sciences, California Northstate University College of Medicine, Elk Grove, USA
| | - Azaam Mamoor
- Clinical Sciences, California Northstate University College of Medicine, Elk Grove, USA
| | | | - Leonard Ranasinghe
- Clinical Medicine, California Northstate University College of Medicine, Elk Grove, USA
| | - Edward Durant
- Emergency Medicine, Kaiser Permanente Central Valley, Modesto, USA
| | - Gurvijay Bains
- Emergency Medicine, Kaiser Permanente Central Valley, Modesto, USA
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8
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Acar A, Çakar Özdal P, Başarır B, Özdemir Yalçınsoy K, Altan Ç, Budakoğlu Ö. A Case Series of Cat-Scratch Disease with Ocular Manifestations: Clinical Findings and Treatment Approach. Turk J Ophthalmol 2023; 53:226-233. [PMID: 37602640 PMCID: PMC10442748 DOI: 10.4274/tjo.galenos.2022.44692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/30/2022] [Indexed: 08/22/2023] Open
Abstract
Objectives To present the clinical and demographic characteristics, imaging findings, diagnosis and treatment approach in cases of cat scratch disease (CSD) with ocular involvement. Materials and Methods The records of 19 patients followed-up and treated between 2010 and 2020, including detailed ophthalmological examinations, imaging findings, and treatment approach, were evaluated retrospectively. Results Twenty-three eyes of 19 patients, 7 female (37%) and 12 male (63%), were included in the study. The mean age was 34.1±13.3 (range: 11-56) years, and the mean follow-up duration was 12.6±18.0 (range: 1-81) months. Unilateral involvement was observed in 15 cases (79%). Cat contact was reported in 14 cases (74%). In 6 cases (32%), flu-like symptoms were present before the ocular complaints. The mean visual acuity (VA) at presentation was 0.42±0.36 (range: 0.001-1.0). Anterior uveitis was observed in 3 eyes (13%). Posterior segment findings included neuroretinitis in 14 (61%), superficial retinal infiltrate(s) in 8 (35%), papillitis in 3 (13%), branch retinal artery occlusion in 2 (8%), and cilioretinal artery occlusion in 1 (4%) of the eyes. All cases were positive for Bartonella henselae immunglobulin (Ig)M and/or IgG. Systemic antibiotic therapy was administered to all patients. Intravenous pulse or oral corticosteroids were given, especially in cases with optic disc involvement. The mean final VA was 0.80±0.25 (range: 0.01-1.0). Conclusion CSD may present with different ocular involvement patterns. Apart from the classical neuroretinitis and macular star appearance, patients may present with isolated optic disc edema, branch retinal artery occlusion, and retinal infiltrations. In such patients, cat contact history and Bartonella serology should be evaluated to differentiate CSD.
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Affiliation(s)
- Atakan Acar
- University of Health Sciences Türkiye Ulucanlar Eye Training and Research Hospital, Ankara, Türkiye
| | - Pınar Çakar Özdal
- University of Health Sciences Türkiye Ulucanlar Eye Training and Research Hospital, Ankara, Türkiye
| | - Berna Başarır
- University of Health Sciences Türkiye Beyoğlu Eye Training and Research Hospital, İstanbul, Türkiye
| | - Kübra Özdemir Yalçınsoy
- University of Health Sciences Türkiye Ulucanlar Eye Training and Research Hospital, Ankara, Türkiye
| | - Çiğdem Altan
- University of Health Sciences Türkiye Beyoğlu Eye Training and Research Hospital, İstanbul, Türkiye
| | - Özlem Budakoğlu
- Erzincan Dr. Binali Yıldırım University Faculty of Medicine, Department of Ophthalmology, Erzincan, Türkiye
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Lin S, Saccoccio FM. Cat scratch disease: Pediatric case series for varying presentations of Bartonella henselae. IDCases 2023; 33:e01875. [PMID: 37609448 PMCID: PMC10440502 DOI: 10.1016/j.idcr.2023.e01875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
Cat scratch disease (CSD) typically presents as regional lymphadenopathy, following inoculation via scratch, bite, or lick to an open wound by a young cat. Annual prevalence is 22,000 cases in the United States. Although CSD is self-limiting in the majority of cases, CSD can manifest in varying presentations and affect multiple organ systems. Serology testing for Bartonella henselae antibodies is a practical diagnostic tool but has limitations. Therefore, it is important for medical providers to recognize CSD in its multiple forms, as antibacterials are indicated in certain presentations. The following cases focus on cardiac and ophthalmic manifestations, as well as delayed seroconversion.
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Affiliation(s)
- Sallie Lin
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Frances M. Saccoccio
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Florida, Gainesville, FL, United States
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Hong H, Li T, Ying Y, An Q, Liu H, Liang K. Cat-scratch disease manifesting as uveitis and binocular fundus nodular lesions: a case report. BMC Ophthalmol 2023; 23:345. [PMID: 37544996 PMCID: PMC10405493 DOI: 10.1186/s12886-023-03063-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Cat-scratch disease typically presents with various ocular manifestations such as uveitis, vitritis, retinitis, retinochoroiditis, and optic neuritis. However, fundus nodular lesions was rarely reported. In our study, we reported a case of Cat-Scratch disease with binocular fundus nodular lesions. CASE PRESENTATION An 11-year old male presented with uveitis in the right eye and bilateral fundus nodular lesions after indirect contact with unvaccinated cats. Comprehensive ancillary examinations including wide-angle fundus photography, ultrasonography, fluorescein fundus angiography, optical coherence tomography, and orbital magnetic resonance imaging were performed to elucidate the multidimensional features of the binocular lesions. Metagenomics next-generation sequencing was utilized to confirm the diagnosis of Cat-scratch disease. The patient's condition showed improvement after a 6-month combination treatment regimen involving systemic administration of doxycycline hyclate and methylprednisolone tablets, as well as local application of mydriatic and corticosteroid eye drops. CONCLUSIONS We firstly reported a case of Cat-scratch disease presenting simultaneously with uveitis and fundus nodular lesions caused by Bartonella henselae infection in a child. Timely diagnosis and treatment with antibiotics and corticosteroids showed promising outcomes for the prognosis of these ocular disorders.
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Affiliation(s)
- Hao Hong
- Department of Ophthalmology, Nanjing hospital, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Tianxi Li
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Ye Ying
- Department of Ophthalmology, Nanjing hospital, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Qi An
- Department of Ophthalmology, Nanjing hospital, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Kang Liang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Bellur S, Ali A, Nguyen NV, Fernandes JK, Kodati S. Central retinal vein occlusion associated with Bartonella henselae infection. J Ophthalmic Inflamm Infect 2023; 13:14. [PMID: 36977910 PMCID: PMC10050272 DOI: 10.1186/s12348-023-00334-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE To report the clinical features and treatment course of a case of central retinal vein occlusion (CRVO) as the initial sign of ocular Bartonella henselae (B. henselae) infection. OBSERVATION A 36-year-old male was evaluated for unilateral vision loss. He denied prodromal symptoms but reported prior exposure to fleas. Best corrected visual acuity (BCVA) was 20/400 in the left eye. Clinical examination revealed a CRVO with atypical features including significant peripapillary exudates and peripheral vascular sheathing. Laboratory testing revealed elevated B. henselae IgG titers (1:512) with no abnormalities on hypercoagulability testing. The patient was treated with doxycycline and aflibercept with an excellent clinical response and improvement in BCVA to 20/25 in the left eye two months later. CONCLUSION CRVO is a rare but sight-threatening complication of ocular bartonellosis and can be the presenting sign of infection, even in the absence of cat exposure or prodromal symptoms.
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Affiliation(s)
- Sunil Bellur
- National Eye Institute, National Institutes of Health, 10 Center Dr, 10/10N248, Bethesda, Maryland, 20892, USA
| | - Amir Ali
- National Eye Institute, National Institutes of Health, 10 Center Dr, 10/10N248, Bethesda, Maryland, 20892, USA
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Nam V Nguyen
- National Eye Institute, National Institutes of Health, 10 Center Dr, 10/10N248, Bethesda, Maryland, 20892, USA
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Shilpa Kodati
- National Eye Institute, National Institutes of Health, 10 Center Dr, 10/10N248, Bethesda, Maryland, 20892, USA.
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Sykes DAW, Joseph SL, Williams SP, Das SU. A 13-Year-Old Girl With Unilateral Visual Changes. J Investig Med High Impact Case Rep 2023; 11:23247096221150635. [PMID: 36738077 PMCID: PMC9900647 DOI: 10.1177/23247096221150635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Neuroretinitis is a condition typically characterized by unilateral optic neuropathy and is most commonly a sequelae of cat scratch disease (CSD) due to infection with Bartonella henselae. Ophthalmologic examination will reveal a swollen optic nerve and may eventually reveal a canonical macular star; optical coherence tomography (OCT) will reveal flattening of the fovea, a thickened neurosensory retina, and subretinal fluid accumulation. Although CSD rarely presents with isolated neuorretinitis, it should be considered in patients presenting with unilateral visual changes. The differential diagnosis for neuroretinitis includes optic neuritis, inflammatory optic neuropathies (sarcoid, para-infectious, autoimmune), compressive, toxic, and more. We describe a pediatric patient presenting with visual changes that were initially concerning for optic neuritis and the diagnostic workup that ultimately led to a diagnosis of CSD neuroretinitis.
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Muacevic A, Adler JR. Unilateral Focal Retinitis as an Initial Manifestation of Cat-Scratch Disease. Cureus 2022; 14:e30907. [PMCID: PMC9622414 DOI: 10.7759/cureus.30907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 11/07/2022] Open
Abstract
We report on a case of focal retinitis as the initial manifestation of cat-scratch disease. A 56-year-old Hispanic woman presented for a routine follow-up examination. A fundus examination of the right eye revealed a white retinal lesion along the inferotemporal artery; this lesion was noted to have progressed after one week of observation. On further inquiry, the patient reported she had seven cats at home, some of which were less than six months old and had recently scratched her. She received empirical treatment for focal retinitis with azithromycin (500 mg daily) and valacyclovir (1 g three times daily), which would cover the most common parasitic, viral, and bacterial etiologies. She was lost to a follow-up examination. However, she continued the same dose of antibiotic and antiviral treatment. Upon her eventual follow-up, three months later, it was noted that the lesion had resolved. The initial work-up revealed that she was positive for Bartonella henselae IgM (1:20) and IgG (1:512), as well as for B. quintana IgG (1:256); however, she was negative for B.quintana IgM. At a four-month follow-up appointment, the B. henselae IgM was negative, the IgG had decreased from 1:512 to 1:64, and the B. quintana antibody test was negative for IgM and IgG, all of which are consistent with an adequately treated case of cat-scratch disease. Focal retinitis can be a rare initial manifestation of cat-scratch disease, which should be considered part of the differential diagnosis in cases of focal retinitis, especially in patients with a history of close contact with young cats. Additionally, oral azithromycin may be considered as a treatment for some cases of cat-scratch-associated focal retinitis.
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14
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A Case of Cat Scratch Disease with Neuroretinitis in a 16-Month-Old Boy. Case Rep Ophthalmol Med 2022; 2022:2841683. [PMID: 36277508 PMCID: PMC9584725 DOI: 10.1155/2022/2841683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose We report a case of neuroretinitis associated with cat scratch disease (CSD) in young children. Method Case report. Results A 16-month-old boy was admitted for a detailed examination and treatment of a fever of unknown origin. Blood tests revealed no significant findings other than a white blood cell count of 16,100/mm3 and C-reactive protein level of 9.89 mg/dL. Computed tomography revealed no relevant findings to determine the causative disease. Antibiotic therapy with cefotaxime was initiated; however, the fever did not resolve. The patient was referred to our department for further examination to detect the cause of the fever. Fundoscopy revealed neuroretinitis in the right eye. His mother reported a history of breeding cats. Cat scratch disease (CSD) was suspected based on the clinical course and fundus findings. Cefotaxime was discontinued, and azithromycin, rifampicin, and prednisolone were administered, following which the fever disappeared and fundus findings improved. Immunoglobulin G (IgG) and IgM antibodies against Bartonella henselae was positive, leading to a definitive diagnosis of CSD. Conclusion Infants cannot complain of decreased visual acuity; therefore, these findings may be overlooked unless a fundus examination is performed. As in this case, the early detection of neuroretinitis by an ophthalmologist may help in the diagnosis of CSD. It is extremely difficult to capture a photograph of the fundus of an infant, and recording with a smartphone is relatively simple and useful for monitoring continuous changes. Summary. We describe a case of neuroretinitis associated with cat scratch disease (CSD) that was diagnosed on the basis of fundus findings. The findings suggest the importance of an aggressive ophthalmologic examination when CSD is suspected in young children who are unable to describe their symptoms.
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15
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Koretz ZA, Apostolopoulou A, Chen E, Beale O, Veldkamp P, Viehman JA, Sahel JA, Chhablani J, Dansingani KK, Errera MH, Bonhomme GR. Clinical Features and Multimodal Imaging in Atypical Posterior Uveitis Secondary to Bartonella Henselae Infection. Ocul Immunol Inflamm 2022; 30:2047-2054. [PMID: 34402723 DOI: 10.1080/09273948.2021.1961812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To characterize an unusual presentation of infectious posterior uveitis using multimodal imaging, and discuss the clinical decision-making involved in diagnosis and treatment. METHODS Wide-field fundus photography, swept-source optical coherence tomography (OCT), swept-source OCT angiography, fluorescein angiography, and indocyanine green angiography. RESULTS This patient presented with cyclical fevers and blurry vision. Fundus examination revealed bilateral optic disc edema, macular intraretinal white spots and many scattered yellow-white chorioretinal lesions. Multimodal imaging characteristics suggested that many of these lesions represent choroidal granulomas. Extensive systemic workup was only notable for borderline elevated Bartonella henselae IgG titers (1:128), however convalescent IgG titers were elevated at 38 days (1:512) supporting the diagnosis of Bartonella chorioretinitis. CONCLUSION Ocular manifestations of Bartonella henselae infection are varied and may include choroidal granulomas. Multimodal imaging characteristics may help identify etiologies of infectious uveitis. Convalescent titers are important when evaluating patients with suspected Bartonellosis, especially patients with atypical presentations.
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Affiliation(s)
- Zachary A Koretz
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anna Apostolopoulou
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Edwin Chen
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Oliver Beale
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Peter Veldkamp
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - John Alex Viehman
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gabrielle R Bonhomme
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Sucasas Costa P, Rocha Alvarenga L, Carnot Iori GF, de Toledo Lima T, Marques Fortes P. Periorbital Cellulitis in a Previously Healthy Boy: Scratch and Win. Clin Infect Dis 2022; 75:1265-1267. [PMID: 36179341 DOI: 10.1093/cid/ciab788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paulo Sucasas Costa
- Department of Pediatrics, School of Medicine, Hospital das Clinicas, Universidade Federal de Goias, Brazil
| | - Lucas Rocha Alvarenga
- Department of Pediatrics, School of Medicine, Hospital das Clinicas, Universidade Federal de Goias, Brazil
| | | | - Talita de Toledo Lima
- Department of Ophtalmology, School of Medicine, Hospital das Clinicas, CEROF, Universidade Federal de Goias, Brazil
| | - Patricia Marques Fortes
- Department of Pediatrics, School of Medicine, Hospital das Clinicas, Universidade Federal de Goias, Brazil
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17
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Cooper SA, Leddy SG, Skipper NT, Barrett VJM, Plant GT. Optic neuritis with potential for poor outcome. Pract Neurol 2022; 22:190-200. [DOI: 10.1136/practneurol-2021-003228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/03/2022]
Abstract
The Optic Neuritis Treatment Trial previously reported that corticosteroids accelerated visual recovery in optic neuritis (ON) without improving outcome. This finding related largely to multiple sclerosis (MS), and subsequently neurologists tended to await spontaneous recovery in ON. Since then, non-MS cases of ON have been identified with antibodies to aquaporin-4 (AQP4) or myelin oligodendrocyte glycoprotein (MOG). These disorders can closely mimic multiple sclerosis-associated or idiopathic demyelinating optic neuritis (MS/IDON) initially but risk a worse visual outcome. Scrutinising the clinical features and neuroimaging often enables differentiation between MS/IDON and other causes of ON. Early treatment with high-dose corticosteroids is an important determinant of visual outcome in non-MS/IDON. Prompt use of plasma exchange may also save sight. In this review, we contrast the presentations of myelin oligodendrocyte glycoprotein associated optic neuritis (MOG-ON) and aquaporin 4 associated optic neuritis (AQP4-ON) with MS/IDON and provide an approach to acute management while awaiting results of antibody testing.
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18
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Nikolic B, Ivancevic N, Pepic A, Kovacevic M, Mladenovic J, Rovcanin B, Samardzic J, Jancic J. Child Neurology: Bartonella henselae Neuroretinitis in 2 Patients. Neurology 2022; 98:896-900. [DOI: 10.1212/wnl.0000000000200572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/04/2022] [Indexed: 11/15/2022] Open
Abstract
Neuroretinitis due to Bartonella henselae infection is a rare cause of vision loss in children. Two pediatric cases of acute unilateral vision loss accompanied by edema of the optic nerve on fundoscopic examination are presented. Severe causes of vision loss were excluded. During the course of the disease, macular stellate exudates emerged on control fundoscopic examinations and diagnosis of neuroretinitis was made. A causative agent was confirmed by serologic examination, as high titers of IgM and IgG antibodies to Bartonella henselae were detected. Both patients significantly recovered after oral antibiotic treatment.
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Yu J, Zhang XY, Chen YX, Cheng HB, Li DM, Rao HX. Molecular detection and genetic characterization of small rodents associated Bartonella species in Zhongtiao Mountain, China. PLoS One 2022; 17:e0264591. [PMID: 35226692 PMCID: PMC8884503 DOI: 10.1371/journal.pone.0264591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/11/2022] [Indexed: 11/18/2022] Open
Abstract
The prevalence and molecular characteristics of Bartonella infections in small rodents in the Zhongtiao Mountain, China have been explored. In this study, the liver, spleen and kidney tissues of captured rodents were used for Bartonella spp. detection and identification by combination of real-time PCR of transfer-mRNA (ssrA) gene and traditional PCR and sequencing of citrate synthase (gltA) gene. It was shown that 49.52% of the rodents (52/105) were positive for Bartonella spp.. The infection rate in different gender (χ2 = 0.079, P = 0.778) and tissues (χ2 = 0.233, P = 0.890) of small rodents did not have statistical difference, but that in different small rodents (Fisher’s exact test, P < 0.001) and habitats (χ2 = 5.483, P = 0.019) had statistical difference. And, the sequencing data suggests that Bartonella sequences (n = 31) were identified into three species, including 14 of B. grahamii, 3 of B. queenslandensis and 14 of unknown Bartonella species. Phylogenetic analysis showed that B. grahamii sequences were clustered with the isolates from South Korea and China, and B. queenslandensis sequences were mainly closely related to the isolates from China and Thailand. The genetic diversity analysis showed that B. grahamii and B. queenslandensis sequences exhibited noticeable intraspecies diversity. Taken together our data demonstrates the high prevalence and genetic diversity of Bartonella infections in small rodents in the Zhongtiao Mountain, especially a potential novel Bartonella specie was detected, which could benefit the prevention and control of rodent-Bartonella species in this area.
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Affiliation(s)
- Juan Yu
- Department of Basic Medical Sciences, Changzhi Medical College, Changzhi, Shanxi, China
| | - Xiong-Ying Zhang
- Department of Basic Medical Sciences, Changzhi Medical College, Changzhi, Shanxi, China
| | - Yun-Xia Chen
- Department of Basic Medical Sciences, Changzhi Medical College, Changzhi, Shanxi, China
| | - Hong-Bing Cheng
- Department of Basic Medical Sciences, Changzhi Medical College, Changzhi, Shanxi, China
| | - Dong-Mei Li
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (DL); (HR)
| | - Hua-Xiang Rao
- Department of Public Health and Preventive Medicine, Changzhi Medical College, Changzhi, Shanxi, China
- * E-mail: (DL); (HR)
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20
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A Teenager With Fevers and Progressive Visual Impairment. Pediatr Infect Dis J 2022; 41:175-177. [PMID: 33902080 DOI: 10.1097/inf.0000000000003142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Karti O, Ataş F, Saatci AO. Posterior Segment Manifestations of Cat-scratch Disease: A Mini-review of the Clinical and Multi-modal Imaging Features. Neuroophthalmology 2021; 45:361-371. [PMID: 34720266 DOI: 10.1080/01658107.2021.1939393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Bartonella henselae, an intracellular gram-negative bacillus, is usually transmitted from infected cats to humans by direct or indirect contact. The bacterium mainly infects erythrocytes and endothelial cells thereby leading to so called cat-scratch disease (CSD) and may present with various localised and/or systemic manifestations. The eye is the most commonly affected organ in disseminated CSD and ocular bartonellosis has been reported in 5-10% of CSD patients. The most well-known clinical feature of ocular bartonellosis is neuroretinitis but various sight-threatening posterior segment lesions involving the optic nerve, retinal vasculature, retinal and choroidal tissues may occur during the disease course. This mini-review aims to overview both the clinical and multi-modal imaging characteristics of posterior ocular segment manifestations of CSD.
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Affiliation(s)
- Omer Karti
- Department of Ophthalmology, Democracy University, İzmir, Turkey
| | - Ferdane Ataş
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
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22
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Özer I. As a Failure to Follow Basic Medical Rules for a Sample, Has a Costly Diagnosis of a Zoonosis. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211052415. [PMID: 34720603 PMCID: PMC8552389 DOI: 10.1177/11795476211052415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/12/2021] [Indexed: 11/24/2022]
Abstract
Cat-scratch disease can be transmitted from cats and dogs in winter. It is usually self-limited and caused by Bartonella henselae. It may cause serious symptoms, including neurological findings, especially in immune-deficient patients. A female patient was referred to our outpatient clinic at the age of 3 years and 10 months with a preliminary diagnosis of neurodegenerative metabolic disease. Her complaints began after a stray cat scratched her. We found out that the hospital to which she was admitted provided only local wound care due to her history of contact with a cat and that she was vaccinated against rabies. Her body temperature increased, her neck lymph nodes became swollen, and she developed otitis and mastoiditis after 1 month. Additionally, we discovered that she had deteriorated in her walking ability after 6 weeks and developed hand tremors after 10 weeks. It was discovered that previous centers to which the patient applied did not question cat contact. All metabolic tests performed for the differential diagnosis of last admission findings were considered nonspecific. Considering cat-scratch disease due to her clinical history, she was referred to the pediatric infection unit for a Bartonella henselae test, and the test result was 1/256 positive. Failure to follow basic medical rules might be costly in diagnosis and treatment. Cat scratch disease is a zoonosis and a major public health problem. In differential diagnosis, these medical procedures should always be considered before rare metabolic diseases.
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Affiliation(s)
- Işil Özer
- Medical Faculty, Child Metabolism Division, Ondokuz Mayıs University, Atakum, Samsun, Turkey
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23
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Cat scratch disease neuroretinitis: A case report. Ann Med Surg (Lond) 2021; 69:102722. [PMID: 34457255 PMCID: PMC8377531 DOI: 10.1016/j.amsu.2021.102722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Cat scratch disease (CSD) is a ubiquitous infectious disease caused by a Gram-negative intracellular bacillus, Bartonella henselae. Neuroretinitis is a classical but rare manifestation of CSD. Case presentation A 20-year-old woman presented with a 5-day-history of reduced vision in the left eye (LE). Two weeks before eye symptoms, she complained from fever, fatigue and arthromyalgia which resolved spontaneously. In the LE, visual acuity (VA) was 7/10, fundus photography showed optic disc edema with macular exudates arranged in incomplete macular star. Serologic test for Bartonella henselae using indirect immunofluorescent assay (IFA) was highly positive (1:2560 UI/L) for immunoglobulin G (Ig G). The diagnosis of CSD associated neuroretinitis has been made and the patient was treated with doxycycline, rifampicin and oral prednisolone. Twelve months after the end of therapy, VA was 10/10, fundus photography and Macular OCT were normal. Discussion In CSD, neuroretinitis occurs 2–3 weeks after systemic symptoms. The clinical features of CSD are not specific hence the need for bacteriological diagnosis which is based mainly on serologic testing by the detection of Ig G and Ig M by IFA or ELISA. The treatment of CSD-associated neuroretinitis is not standardized. Antibiotics active against intracellular bacteria, with or without systemic corticosteroids, should be prescribed especially in severe cases. The outcome of Bartonella henslae neuroretinitis is usually favourable. Conclusion Despite rarely reported in Tunisia, CSD should be considered in patients with presence of typical neuroretinitis with macular star and of a history of contact with cats. Cat scratch disease is usually a self-limited lymphadenitis. Neuroretinitis is a rare but classic manifestation of cat scratch disease. Neuroretinitis occurs in 1–2% of patients with cat scratch disease. Diagnosis confirmation is based on serologic testing. The prognosis is usually good.
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24
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Salicio-Bermejo Y, Cilla-Eguiluz G, Blanco-Esteban A, Martin-Peñaranda T, Grandioso-Vas D, Echeverría-Irigoyen MJ. Neuroretinitis caused by Bartonella henselae in Gipuzkoa, 2014-2019. ACTA ACUST UNITED AC 2021; 39:451-453. [PMID: 34446396 DOI: 10.1016/j.eimce.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Bartonella henselae causes cat scratch disease (CSD), spread by a cat scratch or bite. Cats are its main reservoir. This sometimes results in optic neuritis or neuroretinitis. OBJECTIVE To review these conditions in Gipuzkoa (Spain), 2014-2019. METHODS A retrospective review of serology registries and clinical registries, selecting those with consistent clinical signs, contact with cats and positive serology for B. henselae (IgG-IFA ≥1/256). RESULTS Sixty-four patients had CSD. Of these, one had optic neuritis and 3 had neuroretinitis (4/64; 6.3%). In 3 patients, flu-like symptoms preceded eye symptoms. Two suffered from loss of visual acuity at discharge, despite prolonged treatment with antibiotics and corticosteroids. CONCLUSION Optic neuritis and neuroretinitis caused by B. henselae are severe complications with a non-negligible incidence among patients with CSD in Gipuzkoa. We recommend ruling out CSD in patients with symptoms of optic neuritis or neuroretinitis (sudden vision loss, etc.) and contact with cats.
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Affiliation(s)
- Yolanda Salicio-Bermejo
- Servicio de Microbiología, Hospital Universitario Donostia, Organización Sanitaria Integrada Donostialdea, San Sebastián, Gipuzkoa, Spain
| | - Gustavo Cilla-Eguiluz
- Servicio de Microbiología, Hospital Universitario Donostia, Organización Sanitaria Integrada Donostialdea, San Sebastián, Gipuzkoa, Spain; Instituto de Investigación Sanitaria Biodonostia, Área de Enfermedades Infecciosas, San Sebastián, Gipuzkoa, Spain
| | - Ana Blanco-Esteban
- Departamento de Oftalmología, Hospital Universitario Donostia, Organización Sanitaria Integrada Donostialdea, San Sebastián, Gipuzkoa, Spain
| | - Tania Martin-Peñaranda
- Servicio de Microbiología, Hospital Universitario Donostia, Organización Sanitaria Integrada Donostialdea, San Sebastián, Gipuzkoa, Spain
| | - David Grandioso-Vas
- Servicio de Microbiología, Hospital Universitario Donostia, Organización Sanitaria Integrada Donostialdea, San Sebastián, Gipuzkoa, Spain
| | - María Julia Echeverría-Irigoyen
- Servicio de Microbiología, Hospital Universitario Donostia, Organización Sanitaria Integrada Donostialdea, San Sebastián, Gipuzkoa, Spain.
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25
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Hopkins BJ, Prokesch BC. Bartonella quintana Infection Manifesting as Leucocytoclastic Vasculitis Rash. Open Forum Infect Dis 2021; 8:ofab333. [PMID: 34307730 PMCID: PMC8297702 DOI: 10.1093/ofid/ofab333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
We present the first case described in the literature of leucocytoclastic vasculitis due to Bartonella quintana infection. A 73-year-old woman presented to the hospital with persistent fevers, retro-orbital headache, generalized weakness, and left lower thigh pain for 1 week. She was found to have truncal and proximal lower extremity papules and small plaques. Serology revealed Bartonella quintana immunoglobulin M (IgM) titer of 1:256 with undetectable Bartonella quintana immunoglobulin G (IgG) and undetectable Bartonella henselae IgG and IgM. Skin biopsy of an abdominal lesion revealed fibrinoid necrosis of vessel walls in the superficial and mid-dermis consistent with leucocytoclastic vasculitis. Doxycycline 100 mg orally twice daily was initiated, after which she had defervescence within 36 hours and rapid improvement of other presenting symptoms.
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Affiliation(s)
- Brian J Hopkins
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bonnie C Prokesch
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Medical Director of Antimicrobial Stewardship, Parkland Health and Hospital System, Dallas, Texas, USA
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26
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Ducloyer JB, Marignier R, Wiertlewski S, Lebranchu P. Optic neuritis classification in 2021. Eur J Ophthalmol 2021; 32:11206721211028050. [PMID: 34218696 DOI: 10.1177/11206721211028050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Optic neuritis (ON) can be associated with inflammatory disease of the central nervous system or can be isolated, with or without relapse. It can also be associated with infectious or systemic disease. These multiple associations based on a variety of clinical, radiological, and biological criteria that have changed over time have led to overlapping phenotypes: a single ON case can be classified in several ways simultaneously or over time. As early, intensive treatment is often required, its diagnosis should be rapid and precise. In this review, we present the current state of knowledge about diagnostic criteria for ON aetiologies in adults and children, we discuss overlapping phenotypes, and we propose a homogeneous classification scheme. Even if distinctions between typical and atypical ON are relevant, their phenotypes are largely overlapping, and clinical criteria are neither sensitive enough, nor specific enough, to assure a diagnosis. For initial cases of ON, clinicians should perform contrast enhanced MRI of the brain and orbits, cerebral spinal fluid analysis, and biological analyses to exclude secondary infectious or inflammatory ON. Systematic screening for MOG-IgG and AQP4-IgG IgG is recommended in children but is still a matter of debate in adults. Early recognition of neuromyelitis optica spectrum disorder, MOG-IgG-associated disorder, and chronic relapsing idiopathic optic neuritis is required, as these diagnoses require therapies for relapse prevention that are different from those used to treat multiple sclerosis.
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Affiliation(s)
| | - Romain Marignier
- Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Lyon, Auvergne-Rhône-Alpes, France
| | | | - Pierre Lebranchu
- Department of Ophthalmology, University Hospital of Nantes, Nantes, France
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27
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Touhami S, Leclercq M, Stanescu-Segall D, Touitou V, Bodaghi B. Differential Diagnosis of Vitritis in Adult Patients. Ocul Immunol Inflamm 2021; 29:786-795. [PMID: 34003716 DOI: 10.1080/09273948.2021.1898001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The term "vitritis" refers to the presence of a cellular infiltration of the vitreous body, usually in the context of an intraocular inflammation, but not exclusively. Intermediate uveitis is the most prominent cause of vitritis, including infectious and auto-immune/auto-inflammatory etiologies. Corticosteroids and immunosuppressive therapies should not be started before ruling out the infectious causes of vitritis, especially in immunosuppressed individuals. Other situations can mimic intermediate uveitis such as amyloidosis and ocular tumors. Primary intraocular lymphoma should always be suspected in case of vitreous infiltrations in individuals aged over 50 years.
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Affiliation(s)
- Sarah Touhami
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Mathilde Leclercq
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Dinu Stanescu-Segall
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France.,Centre Nord Exploration Ophtalmologique, Lille, France
| | - Valérie Touitou
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
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28
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El Matri K, Falfoul Y, Amoroso F, Souied EH, Dekli Z, Chebil A, Mili-Boussen I, Khairallah M, El Matri L. Multimodal imaging of branch retinal artery occlusion and multiple retinal infiltrates associated to cat's scratch disease. J Fr Ophtalmol 2021; 44:e199-e204. [PMID: 33451868 DOI: 10.1016/j.jfo.2020.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- K El Matri
- Institut Hédi Rais d'ophtalmologie de Tunis, Department B / Oculogenetic laboratory LR14SP01, boulevard du 9 Avril 1938, 1006 Tunis, Tunisia; Université Tunis - El Manar, Faculté de médecine de Tunis, rue Djebal Lakhdar, 1006 Tunis, Tunisia; Centre hospitalier intercommunal de Créteil, Ophthalmology department, 40 avenue de Verdun, 94000 Créteil, France; Université Paris-Est Créteil, Faculté de médecine de Créteil, 8, rue du Général Sarrail, 94000 Créteil, France.
| | - Y Falfoul
- Institut Hédi Rais d'ophtalmologie de Tunis, Department B / Oculogenetic laboratory LR14SP01, boulevard du 9 Avril 1938, 1006 Tunis, Tunisia
| | - F Amoroso
- Centre hospitalier intercommunal de Créteil, Ophthalmology department, 40 avenue de Verdun, 94000 Créteil, France; Université Paris-Est Créteil, Faculté de médecine de Créteil, 8, rue du Général Sarrail, 94000 Créteil, France
| | - E H Souied
- Centre hospitalier intercommunal de Créteil, Ophthalmology department, 40 avenue de Verdun, 94000 Créteil, France; Université Paris-Est Créteil, Faculté de médecine de Créteil, 8, rue du Général Sarrail, 94000 Créteil, France
| | - Z Dekli
- Institut Hédi Rais d'ophtalmologie de Tunis, Department B / Oculogenetic laboratory LR14SP01, boulevard du 9 Avril 1938, 1006 Tunis, Tunisia; Université Tunis - El Manar, Faculté de médecine de Tunis, rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - A Chebil
- Institut Hédi Rais d'ophtalmologie de Tunis, Department B / Oculogenetic laboratory LR14SP01, boulevard du 9 Avril 1938, 1006 Tunis, Tunisia; Université Tunis - El Manar, Faculté de médecine de Tunis, rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - I Mili-Boussen
- Université Tunis - El Manar, Faculté de médecine de Tunis, rue Djebal Lakhdar, 1006 Tunis, Tunisia; Centre hospitalier universitaire Charles Nicolle, Ophthalmology department boulevard du 9-Avril 1938, Tunis, Tunisia
| | - M Khairallah
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, avenue Farhat Hached, 5000 Monastir, Tunisia; Université de Monastir, Faculté de médecine de Monastir, avenue Avicenne, 5000 Monastir, Tunisia
| | - L El Matri
- Institut Hédi Rais d'ophtalmologie de Tunis, Department B / Oculogenetic laboratory LR14SP01, boulevard du 9 Avril 1938, 1006 Tunis, Tunisia; Université Tunis - El Manar, Faculté de médecine de Tunis, rue Djebal Lakhdar, 1006 Tunis, Tunisia
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Salicio-Bermejo Y, Cilla-Eguiluz G, Blanco-Esteban A, Martin-Peñaranda T, Grandioso-Vas D, Echeverría-Irigoyen MJ. Neuroretinitis caused by Bartonella henselae in Gipuzkoa, 2014-2019. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30261-5. [PMID: 32950265 DOI: 10.1016/j.eimc.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Bartonella henselae causes cat scratch disease (CSD), spread by a cat scratch or bite. Cats are its main reservoir. This sometimes results in optic neuritis or neuroretinitis. OBJECTIVE To review these conditions in Gipuzkoa (Spain), 2014-2019. METHODS A retrospective review of serology and clinical records, selecting those with consistent clinical signs, contact with cats and positive serology for B. henselae (IgG-IFA≥1/256). RESULTS Sixty-four patients had CSD. Of these, one had optic neuritis and 3 had neuroretinitis (4/64; 6.3%). In 3 patients, flu-like symptoms preceded eye symptoms. Two suffered from loss of visual acuity at discharge, despite prolonged treatment with antibiotics and corticosteroids. CONCLUSION Optic neuritis and neuroretinitis caused by B. henselae are severe complications with a non-negligible incidence among patients with CSD in Gipuzkoa. We recommend ruling out CSD in patients with symptoms of optic neuritis or neuroretinitis (sudden vision loss, etc.) and contact with cats.
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Affiliation(s)
- Yolanda Salicio-Bermejo
- Servicio de Microbiología, Hospital Universitario Donostia, Organización Sanitaria Integrada Donostialdea, San Sebastián, Gipuzkoa, España
| | - Gustavo Cilla-Eguiluz
- Servicio de Microbiología, Hospital Universitario Donostia, Organización Sanitaria Integrada Donostialdea, San Sebastián, Gipuzkoa, España; Instituto de Investigación Sanitaria Biodonostia, Área de Enfermedades Infecciosas, San Sebastián, Gipuzkoa, España
| | - Ana Blanco-Esteban
- Departamento de Oftalmología, Hospital Universitario Donostia, Organización Sanitaria Integrada Donostialdea, San Sebastián, Gipuzkoa, España
| | - Tania Martin-Peñaranda
- Servicio de Microbiología, Hospital Universitario Donostia, Organización Sanitaria Integrada Donostialdea, San Sebastián, Gipuzkoa, España
| | - David Grandioso-Vas
- Servicio de Microbiología, Hospital Universitario Donostia, Organización Sanitaria Integrada Donostialdea, San Sebastián, Gipuzkoa, España
| | - María Julia Echeverría-Irigoyen
- Servicio de Microbiología, Hospital Universitario Donostia, Organización Sanitaria Integrada Donostialdea, San Sebastián, Gipuzkoa, España.
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Bartonella henselae neuroretinitis: a case report. Med Clin (Barc) 2020; 157:199-200. [PMID: 32819774 DOI: 10.1016/j.medcli.2020.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 11/21/2022]
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Yap SM, Saeed M, Logan P, Healy DG. Bartonella neuroretinitis (cat-scratch disease). Pract Neurol 2020; 20:505-506. [DOI: 10.1136/practneurol-2020-002586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2020] [Indexed: 11/04/2022]
Abstract
We report a patient with cat-scratch disease presenting with meningitis and neuroretinitis. This condition, caused by Bartonella henselae, has a worldwide distribution and is among the most common infective causes of neuroretinitis. Bartonella neuroretinitis is a rare but under-recognised mimic of optic neuritis; it should be suspected in a patient with an infective prodrome whose fundus shows optic disc oedema and a macular star. A low-positive initial serological test for Bartonella henselae does not exclude cat-scratch disease if there is high clinical suspicion, and repeat testing is recommended to look for titre rise.
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Johnson A. Ocular complications of cat scratch disease. Br J Ophthalmol 2020; 104:1640-1646. [PMID: 32122915 DOI: 10.1136/bjophthalmol-2019-315239] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/22/2020] [Accepted: 02/13/2020] [Indexed: 11/03/2022]
Abstract
Cat scratch disease (CSD) in humans is caused by infection with Bartonella henselae or other Bartonella spp. The name of the disease reflects the fact that patients frequently have a history of contact (often involving bites or scratches) with infected cats. Patients with CSD typically develop lesions at the site where the skin is broken together with regional lymphadenopathy but may go on to exhibit systemic symptoms and with deep-seated infections at a range of sites including the eye. Patients with CSD may present with a range of inflammatory eye conditions, including Parinaud's oculoglandular syndrome, neuroretinitis, multifocal retinitis, uveitis and retinal artery occlusion. Bartonella spp. are fastidious bacteria that are difficult to culture from clinical specimens so microbiological diagnosis is frequently made on the basis of positive serology for anti-Bartonella antibodies or detection of bacterial DNA by PCR. Due to the lack of clinical trials, the evidence base for optimal management of patients with CSD-associated eye infections (including the role of antibiotics) is weak, being derived from single reports or small, uncontrolled case series.
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Affiliation(s)
- Alan Johnson
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
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