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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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Retinal vasculitis: A framework and proposal for a classification system. Surv Ophthalmol 2020; 66:54-67. [PMID: 32450158 DOI: 10.1016/j.survophthal.2020.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Abstract
Retinal vasculitis, a poorly understood process involving inflammation or ischemia of the retinal vessel wall, may occur in association with a systemic process, although it can also be isolated to the retina. Because of the limited ability to perform histopathological studies on retinal vessels, there is no gold standard for diagnosis. Thus, there is utility in creating a classification system for retinal vasculitis and improving diagnostic strategies for this disease. We provide a framework for understanding retinal vasculitis based on size, location, and etiology. We hope that this information can be implemented in the clinical setting to provide some diagnostic strategies for this often confusing entity.
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Bartonella henselae- and quintana-associated uveitis: a case series and approach of a potentially severe disease with a broad spectrum of ocular manifestations. Int Ophthalmol 2019; 39:2505-2515. [PMID: 30852734 DOI: 10.1007/s10792-019-01096-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the clinical manifestations of intraocular inflammation associated with Bartonella infection and describe the assessment and management of patients with cat-scratch disease (CSD). METHODS This is a retrospective review of the clinical records of patients diagnosed with Bartonella henselae and Bartonella quintana intraocular inflammation from 2011 to 2018 in the Department of Ocular Inflammations and Infections of the University Eye Clinic of Ioannina (Greece). An analysis of the current literature concerning Bartonella-related intraocular infections was also carried out. RESULTS This is a retrospective study of 13 patients (7 males and 6 females) with a mean age of 39.2 years that were diagnosed with unilateral intraocular inflammation, except one case with bilateral affection, attributed to Bartonella (either henselae or quintana). Twelve (12) patients (92.3%) had a positive history of traumatic cat contact. The main ocular clinical findings with regard to the type of uveitis included neuroretinitis in 5 eyes (38.5%), vasculitis in 3 eyes (23.1%), iridocyclitis in 2 eyes (15.4%), intermediate uveitis in 2 eyes (15.4%), posterior uveitis in 1 eye (7.7%), panuveitis in 2 eyes (15.4%), retinochoroiditis in 2 eyes (15.4%), vitritis in 1 eye (7.7%), peripheral choroidal granuloma in 1 eye (7.7%). Immunoglobulin (Ig) G was positive in all cases. All patients were treated with antibiotics (mainly rifampicin, doxycycline and azithromycin). The visual acuity was noted to be improved in all patients after treatment, but some of them experienced disturbing complications. CONCLUSION CSD may manifest with various ocular pathological findings. Taking into consideration the increasing frequency of infections by B. henselae and B. quintana, clinicians should always incorporate CSD in the differential diagnosis of such presentations of uveitis. Educating vulnerable groups (children, immunosuppressed, etc.) and also general population, the appropriate preventing measures can contribute in limiting the risk of infection.
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Abstract
PURPOSE The study reports an unusual presentation of a young female patient presenting with a granulomatous posterior pole mass and profound vision loss secondary to infection with Bartonella henselae. METHODS A single case report in a child. RESULTS An 8-year-old female presented with a recent history of flu-like illness associated with profound vision loss, panuveitis and leukocoria in the left eye. She was found to have a posterior granulomatous mass associated with an exudative retinal detachment presumed as a toxocara granuloma. Magnetic Resonance Imaging ruled out retinoblastoma. Lab work done was negative for toxocariasis and positive for Bartonella henselae titers. She was treated for Cat Scratch Disease (CSD) with steroids and azithromycin. With treatment, the inflammation and exudative retinal detachment resolved, however, the patient had no improvement in visual acuity. CONCLUSIONS Young patients presenting with leukocoria need a full work up, which includes ruling out retinoblastoma. CSD can present as a granulomatous mass similar to toxocariasis, which can rarely lead to debilitating and irreversible vision loss.
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Barros S, de Andrade GC, Cavalcanti C, Nascimento H. Cat Scratch Disease: Not a Benign Condition. Ocul Immunol Inflamm 2017; 26:1115-1122. [PMID: 28665750 DOI: 10.1080/09273948.2017.1327077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Describe a case series of ocular Cat-scratch-disease (CSD) with vision-threatening findings and poor outcomes, indicating severity of disease. METHODS Retrospective case series from the Uveitis Department of São Paulo Federal University from 2011 to 2015. RESULTS In this period, six eyes of four patients had confirmed diagnosis of CSD. Two were male and two female. Mean age was 24.8 years old [7-45]. Two had bilateral disease. Visual acuity at presentation ranged from no light perception to 20/25. Three patients were treated with doxycycline and one with clarithromycin and prednisone. Visual outcome after treatment ranged from counting fingers to 20/20: 5/6 eyes had final visual acuity of less than 20/40 and 3/6 had final visual acuity equal or less than 20/400. CONCLUSION Although usually described as a benign disease with spontaneous resolution, CSD can present with atypical manifestations such as vascular angiomatous lesions, serous retinal detachment, and vascular occlusion syndromes, carrying a severe course and guarded prognosis.
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Affiliation(s)
- Sandra Barros
- a Ophthalmology Department , Hospital Garcia de Orta , Almada , Portugal
| | - Gabriel Costa de Andrade
- b Uveitis Clinic of the Ophthalmology and Visual Sciences Department, Universidade Federal de Sao Paulo Escola Paulista de Medicina , Sao Paulo , Brazil
| | - Cecilia Cavalcanti
- b Uveitis Clinic of the Ophthalmology and Visual Sciences Department, Universidade Federal de Sao Paulo Escola Paulista de Medicina , Sao Paulo , Brazil
| | - Heloisa Nascimento
- b Uveitis Clinic of the Ophthalmology and Visual Sciences Department, Universidade Federal de Sao Paulo Escola Paulista de Medicina , Sao Paulo , Brazil
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Oray M, Önal S, Koç Akbay A, Tuğal Tutkun İ. Diverse Clinical Signs of Ocular Involvement in Cat Scratch Disease. Turk J Ophthalmol 2017; 47:9-17. [PMID: 28182175 PMCID: PMC5282546 DOI: 10.4274/tjo.28009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/25/2016] [Indexed: 12/03/2022] Open
Abstract
Objectives: To describe ocular manifestations, diagnosis, and treatment of cat scratch disease. Materials and Methods: Clinical records of patients with ocular cat scratch disease were reviewed. Results: Thirteen eyes of 10 patients (7 female, 3 male) with a mean age of 26.9±18.5 years were included. Nine patients had a history of cat contact and had systemic symptoms associated with cat scratch disease 2-90 days prior to the ocular symptoms. Ocular signs were: neuroretinitis in 4 eyes (associated with serous retinal detachment in the inferior quadrant in 1 eye), optic neuropathy in 2 eyes (1 papillitis and optic disc infiltration, 1 optic neuritis), retinal infiltrates in 6 eyes, retinochoroiditis in 1 eye, branch retinal arteriolar occlusion in 3 eyes, and endophthalmitis in 1 eye. Visual acuities at presentation were 1.0 in 7 eyes, 0.3 in 1 eye, ≤0.1 in 4 eyes, and light perception in 1 eye. Bartonella henselae immunoglobulin (Ig) M and/or IgG were positive in all patients. Systemic antibiotic therapy was administered in all patients. Systemic corticosteroid treatment (15-40 mg/day) was added to the therapy in 4 patients, following 5 days of intravenous pulse methylprednisolone in 2 patients. Treatment was ongoing for 1 patient and the mean treatment duration of the other 9 patients was 47±14.5 days. Visual acuities at final visit were 1.0 in 9 eyes, 0.8 in 1 eye, 0.4 in 1 eye, and no light perception in 1 eye. Conclusion: Cat scratch disease may present with different ocular signs and should be considered in the differential diagnosis in patients with such presentations.
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Affiliation(s)
- Merih Oray
- İstanbul University İstanbul Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | - Sumru Önal
- Koç University Faculty of Medicine, Department of Ophthalmology; VKV American Hospital, Ophthalmology Clinic, İstanbul, Turkey
| | - Aylin Koç Akbay
- Koç University Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | - İlknur Tuğal Tutkun
- İstanbul University İstanbul Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
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Eiger-Moscovich M, Amer R, Oray M, Tabbara KF, Tugal-Tutkun I, Kramer M. Retinal artery occlusion due to Bartonella henselae infection: a case series. Acta Ophthalmol 2016; 94:e367-70. [PMID: 26748767 DOI: 10.1111/aos.12932] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 10/18/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To report a case series of six patients suffering from branch retinal artery occlusion due to Bartonella henselae infection, in order to raise awareness to this etiology in the differential diagnosis of retinal artery occlusion. METHODS A retrospective case series of patients with branch retinal artery occlusion due to ocular cat scratch disease who presented at four tertiary medical centers in Israel, Turkey and Saudi Arabia between the years 2008-2014. Data retrieved from the medical records included demographic data, exposure, complaints, visual acuity, clinical findings and imaging, laboratory assessment, treatment, disease course and visual outcome. RESULTS The study group consisted of six patients who presented with branch retinal artery occlusion with or without neuroretinitis. One patient had multiple artery occlusions. Diagnosis of cat scratch disease was established based on positive serology and accompanying systemic symptoms, after ruling out other causes of retinal artery occlusion. Treatment included various regimens of antibiotics and systemic steroids. Visual outcome depended upon the obstructed artery. CONCLUSION Cat scratch disease may cause retinal artery occlusion in infected patients, leaving them with a permanent visual field defect. When retinal artery occlusion occurs as an early sign of the disease, prompt recognition may prevent further events. Thorough history and relevant tests may be of great value.
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Affiliation(s)
| | - Radgonde Amer
- Department of Ophthalmology; Hadassah Medical Center; Jerusalem Israel
| | - Merih Oray
- Department of Ophthalmology; Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - Khalid F. Tabbara
- Wilmer Ophthalmological Institute; Johns Hopkins University; School of Medicine; Baltimore MD USA
- Eye Center and Eye Foundation for Research in Ophthalmology; Riyadh Saudi Arabia
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology; Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - Michal Kramer
- Department of Ophthalmology; Rabin Medical Center; Petach Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
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Anders UM, Taylor EJ, Doty DC, Martel JR, Martel JB. Neuroretinitis secondary to Bartonella henselae in the emergent setting. Am J Emerg Med 2015; 33:740.e1-3. [DOI: 10.1016/j.ajem.2014.11.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 11/18/2014] [Indexed: 11/25/2022] Open
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Maggi RG, Ericson M, Mascarelli PE, Bradley JM, Breitschwerdt EB. Bartonella henselae bacteremia in a mother and son potentially associated with tick exposure. Parasit Vectors 2013; 6:101. [PMID: 23587194 PMCID: PMC3637281 DOI: 10.1186/1756-3305-6-101] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 03/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bartonella henselae is a zoonotic, alpha Proteobacterium, historically associated with cat scratch disease (CSD), but more recently associated with persistent bacteremia, fever of unknown origin, arthritic and neurological disorders, and bacillary angiomatosis, and peliosis hepatis in immunocompromised patients. A family from the Netherlands contacted our laboratory requesting to be included in a research study (NCSU-IRB#1960), designed to characterize Bartonella spp. bacteremia in people with extensive arthropod or animal exposure. All four family members had been exposed to tick bites in Zeeland, southwestern Netherlands. The mother and son were exhibiting symptoms including fatigue, headaches, memory loss, disorientation, peripheral neuropathic pain, striae (son only), and loss of coordination, whereas the father and daughter were healthy. METHODS Each family member was tested for serological evidence of Bartonella exposure using B. vinsonii subsp. berkhoffii genotypes I-III, B. henselae and B. koehlerae indirect fluorescent antibody assays and for bacteremia using the BAPGM enrichment blood culture platform. RESULTS The mother was seroreactive to multiple Bartonella spp. antigens and bacteremia was confirmed by PCR amplification of B. henselae DNA from blood, and from a BAPGM blood agar plate subculture isolate. The son was not seroreactive to any Bartonella sp. antigen, but B. henselae DNA was amplified from several blood and serum samples, from BAPGM enrichment blood culture, and from a cutaneous striae biopsy. The father and daughter were seronegative to all Bartonella spp. antigens, and negative for Bartonella DNA amplification. CONCLUSIONS Historically, persistent B. henselae bacteremia was not thought to occur in immunocompetent humans. To our knowledge, this study provides preliminary evidence supporting the possibility of persistent B. henselae bacteremia in immunocompetent persons from Europe. Cat or flea contact was considered an unlikely source of transmission and the mother, a physician, reported that clinical symptoms developed following tick exposure. To our knowledge, this is the first time that a B. henselae organism has been visualized in and amplified from a striae lesion. As the tick bites occurred three years prior to documentation of B. henselae bacteremia, the mode of transmission could not be determined.
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Affiliation(s)
- Ricardo G Maggi
- Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
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