Neuroretinitis in ocular bartonellosis

Bartonella henselae Neuroretinitis in Patients without Cat Scratch

Cat scratch disease (CSD) is a syndrome characterized by lymphadenopathy, fever, and skin lesions following a cat scratch or bite. Bartonella henselae is the primary bacterial agent responsible for CSD. In this report, we describe cases with atypical presentation of serologically proven B. henselae neuroretinitis. In this study, 3 patients with neuroretinitis were evaluated. Animal contact histories; results of ocular examinations and systemic investigations; clinical findings; and treatment compliance of the patients were assessed. All patients denied history of contact with cats or other animals, and they did not have CSD findings. Serologic testing via indirect immunofluorescence assay (IFA) was used to diagnose Bartonella neuroretinitis. The IFA test results were positive for all patients. Two patients were treated with antibiotics. Optic disc edema and macular exudates resolved gradually, and at their last follow-up visits, all signs had disappeared. There was no disease recurrence after the completion of treatment. Serious complications were seen in the untreated patient. In conclusion, B. henselae infection should be considered even when there are no systemic signs and symptoms of CSD in patients with neuroretinitis.

Seek and Find! PCR analyses of skin infections in West-European travelers returning from abroad with an eschar

BACKGROUND

Skin infections are among the leading causes of diseases in travelers. Diagnosing pathogens could be difficult.

METHOD

We applied molecular assays for the diagnostic of a large collection of skin biopsies and swabs from travelers with suspected skin infections. All samples were tested by qPCR for Coxiella burnetti, Bartonella sp., Rickettsia sp., Borrelia sp., Ehrlichia sp., Tropheryma whipplei, Francisella tularensis, Mycobacteria sp., Staphylococcus aureus, Streptococcus pyogenes, Leishmania spp., Ortho poxvirus and Para poxvirus and then screened for the presence of bacteria by PCR amplification and sequencing, targeting the 16S rRNA gene.

RESULTS

From January 2009 to January 2017, 100 international travelers presenting with a suspected skin infection were enrolled. We detected 51 patients with an identified pathogen on skin samples. Travelers presenting with eschars were more likely to have a positive PCR sample (n = 44/76, 57.9%) compared to other patients (n = 7/24, 29.2%). Spotted fever group Rickettsia (n = 28) was the most frequently detected pathogens (19 R. africae, 6 R. conorii, 3 R. mongolitimonae); S. aureus were detected in 11 patients; S. pyogenes in 3; Leishmania sp.; M. leprae and B. henselae in 1 patient, respectively.

CONCLUSION

By targeting the most commonly encountered causative agents of travel-related skin infections, our strategy provides a sensitive and rapid diagnostic method.