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Fulltext Cat scratch disease: a diagnostic dilemma

Lina LC, Rosalind S, Chong AW, Toha A, Shaffie B

Med J Malaysia, 2010 Jun;65(2):155-6.
PMID: 23756805 MyJurnal

Cat scratch disease (CSD) caused by Bartonella henselae is the most common Bartonella infection worldwide. CSD usually presents as self-limiting lymphadenitis characterized by lymphadenopathy that occurs after contact with a cat and the symptoms resolve within 2 to 4 months. Serology testing is the cornerstone of diagnosis. However, it may require the use of clinical specimens for microbiologic evaluation for diagnosis. A number of antimicrobial agents have been advocated for the treatment of cat-scratch disease and treatment with azithromycin has been shown to be beneficial.

Matched MeSH terms: Cat-Scratch Disease*
Fulltext Neuroretinitis with dual infections

Kiu KH, Hanizasurana H, Zunaina E

Int Med Case Rep J, 2015;8:255-8.
PMID: 26527902 DOI: 10.2147/IMCRJ.S91323

A 22-year-old Malay female presented with left eye floaters for 2 weeks, associated with temporal visual field defect and metamorphopsia for 3 days. She has a guinea pig and a hedgehog at home, but denied being bitten or scratched by them. Her visual acuity at presentation was 6/12 on the left eye and 6/6 on the right eye. Her left eye relative afferent pupillary defect was barely positive with mild anterior chamber reaction. Fundus examination of the left eye showed mild vitritis, swollen optic disc with macular star, crops of active choroidal lesions at superonasal retina with a linear arrangement in the form of migratory track nasally. However, there were no nematodes seen on fundus examination. Investigations showed normal full blood count with no eosinophilia and positive serology test for Bartonella henselae. She was diagnosed to have dual infection - diffuse unilateral subacute neuroretinitis (DUSN), based on the presence of crops of choroidal lesions with migratory track, and cat scratch disease (CSD) based on a positive serological test. She was treated with oral albendazole 400 mg 12 hourly for 6 weeks for DUSN and oral doxycycline 100 mg 12 hourly for 4 weeks for CSD. Focal laser had been applied to the area of migratory track in the left eye. Her left eye vision improved to 6/6 at 1 month after treatment, with resolution of neuroretinitis.

Matched MeSH terms: Cat-Scratch Disease
Fulltext The clinical spectrum of ocular bartonellosis: a retrospective study at a tertiary centre in Malaysia

Tey MS, Govindasamy G, Vendargon FM

J Ophthalmic Inflamm Infect, 2020 Nov 16;10(1):31.
PMID: 33191467 DOI: 10.1186/s12348-020-00224-0

BACKGROUND: Cat scratch disease (CSD) is a systemic illness caused by the gram-negative bacillus, Bartonella henselea, which can occasionally involve the ocular structures. The objective of this study is to evaluate the various clinical presentations of ocular bartonellosis at our institution. A retrospective review of the clinical records of 13 patients (23 eyes) with ocular manifestations of Bartonella infections over a 3-year period between January 2016 to December 2018 was undertaken at our institution.
RESULTS: The diagnosis was made based on clinical findings and in addition, with the support of the evidence of Bartonella hensalae IgG and/or IgM. Small retinal white lesions were the most common ocular findings in this series of patients (82.6% of eyes, 76.9% of patients). Neuroretinitis was the second most common finding (47.8% of eyes, 69.2% of patients), followed by exudative retinal detachment involving the macula (34.8% of eyes, 53.8% of patients) and Parinaud's oculoglandular syndrome (17.4% of eyes, 23.1% of patients). Other findings like isolated optic disc oedema without macular star (8.7% of eyes, 15.4% of patients) and vitritis (4.3% of eyes, 7.7% of patients) were also observed. Ten patients (76.9%) had bilateral ocular involvement. Most of the patients were young, immunocompetent and had systemic symptoms like fever prior to their ocular symptoms. The visual acuity (VA) at initial presentation ranged from 6/6 to hand movement (mean, 6/20), and at final visit 6/6 to 6/60, (mean, 6/9). 91.7% of patients were treated with antibiotics. Only 2 patients received oral corticosteroids together with antibiotics due to very poor vision on presentation. The visual prognosis of ocular bartonellosis is generally good with 16 (88.9%) of 23 eyes having VA of 6/12 or better at final follow-up visit.
CONCLUSION: Small foci of retinal white lesions were the most common manifestation of ocular bartonellosis in this series, followed by neuroretinitis, though an array of other ocular findings may also occur. Therefore, we should consider bartonella infection as a possible differential diagnosis in those patients.

Matched MeSH terms: Cat-Scratch Disease

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