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Wildner G, Bansal R, Ayyadurai N, Thurau S, Basu S. Pathogenesis of Bacterial Uveitis. Ocul Immunol Inflamm 2023; 31:1396-1404. [PMID: 36622856 DOI: 10.1080/09273948.2022.2155842] [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: 07/13/2022] [Revised: 09/02/2022] [Accepted: 12/02/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE To describe the pathogenesis and the general immune mechanisms of the most frequent causes of bacterial uveitis. METHODOLOGY Narrative review. RESULTS Both extra- and intracellular bacteria can induce uveitis, whereas intracellular bacteria are generally transported into the inner eye via cells of the innate immune system, mainly macrophages. Systemic adaptive immunity is usually induced before the bacteria are localized to the inner eye, and once T and B cells have detected the pathogens behind the blood-eye barriers they elicit an acute and/or chronic inflammatory response deteriorating visual acuity that can severely affect the non-regenerating, intraocular tissues. CONCLUSIONS An understanding of pathogenic mechanisms, and its correlation with clinical and imaging features, can facilitate early recognition of microbial factors and institution of appropriate therapy.
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Affiliation(s)
- Gerhild Wildner
- Department of Ophthalmology, University Hospital, LMU, Munich, Germany
| | - Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nikitha Ayyadurai
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Stephan Thurau
- Department of Ophthalmology, University Hospital, LMU, Munich, Germany
| | - Soumyava Basu
- Prof Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
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2
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Waseem R, Seher M, Ghazal S, Shah HH, Habiba U. Cat scratch disease in a 23-year-old male-Case report. Front Public Health 2023; 10:1046666. [PMID: 36711423 PMCID: PMC9880049 DOI: 10.3389/fpubh.2022.1046666] [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] [Received: 09/16/2022] [Accepted: 12/05/2022] [Indexed: 01/14/2023] Open
Abstract
Cat-scratch disease (CSD) is an infectious disease that usually presents with fever, headache, loss of appetite, weight loss, tender lymphadenopathy, and other symptoms. CSD is also the most common cause of infectious lymphadenitis in children, adolescents, and young adults. This contagious disease most often results from a scratch or bite of a cat. The course of this disease depends on the patient's immune status. CSD sometimes presents as a systemic disease and leads to various disease entities. In this study, we describe the case of a 23-year-old man exhibiting fever, generalized weakness, and neck swelling. The patient was unconscious when presented to the Emergency Department. He was given at least 3-4 liters IV bolus of 0.9% normal saline, but it failed to raise the blood pressure. He was then given an inotropic drug (noradrenaline) for low blood pressure and antibiotics (azithromycin) for fever. Venereal disease research laboratory (VDRL) and human immunodeficiency virus (HIV) serology came out negative. Histopathology ruled out tuberculosis and malignancy and confirmed necrotizing/suppurative granulomatous inflammation. These features favor the diagnosis of CSD.
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3
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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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4
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A Comprehensive Update on Retinal Vasculitis: Etiologies, Manifestations and Treatments. J Clin Med 2022; 11:jcm11092525. [PMID: 35566655 PMCID: PMC9101900 DOI: 10.3390/jcm11092525] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 12/18/2022] Open
Abstract
Retinal vasculitis is characterized by inflammatory involvement of retinal arterioles, venules and/or capillaries and can be associated with a myriad of systemic and ophthalmic diseases. In this review, we have comprehensively discussed the etiologies, clinical manifestations, and presentations of retinal vasculitis. We have also included newer advances in imaging in retinal vasculitis such as OCTA and widefield imaging.
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5
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Forrester JV, Mölzer C, Kuffova L. Immune Privilege Furnishes a Niche for Latent Infection. FRONTIERS IN OPHTHALMOLOGY 2022; 2:869046. [PMID: 38983514 PMCID: PMC11182092 DOI: 10.3389/fopht.2022.869046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 07/11/2024]
Abstract
The microenvironment of the CNS (eye and brain) is fertile ground for infection if the barriers are breached. The result of pathogen invasion is often devastating destruction of tissues. In the eye, inflammation is broadly classified either as "infectious" (i.e. caused by infection) or "non-infectious". However, increasingly, forms of intraocular inflammation (IOI), which clinically appear to be "non-infectious" turn out to be initiated by infectious agents, suggesting that pathogens have been retained in latent or persistent form within ocular tissues and have reactivated to cause overt disease. A similar pathogenesis applies to latent infections in the brain. Not all CNS tissues provide an equally protective niche while different pathogens escape detection using different strategies. This review summarises how immune privilege (IP) in the CNS may be permissive for latent infection and allow the eye and the brain to act as a reservoir of pathogens which often remain undetected for the lifetime of the host but in states of immune deficiency may be activated to cause sight- and life-threatening inflammation.
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Affiliation(s)
- John V Forrester
- Ocular Immunology Group, Section of Infection and Immunity, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Christine Mölzer
- Ocular Immunology Group, Section of Infection and Immunity, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Lucia Kuffova
- Ocular Immunology Group, Section of Infection and Immunity, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Eye Clinic, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
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6
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Jurja S, Stroe AZ, Pundiche MB, Docu Axelerad S, Mateescu G, Micu AO, Popescu R, Oltean A, Docu Axelerad A. The Clinical Profile of Cat-Scratch Disease’s Neuro-Ophthalmological Effects. Brain Sci 2022; 12:brainsci12020217. [PMID: 35203980 PMCID: PMC8870711 DOI: 10.3390/brainsci12020217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 12/29/2022] Open
Abstract
Cat-scratch disease is an illness caused by Bartonella henselae that occurs as a result of contact with an infected kitten or dog, such as a bite or scratch. It is more prevalent in children and young adults, as well as immunocompromised individuals. There are limited publications examining the features of CSD in patients. As such, the purpose of this research was to assess the clinical neuro-ophthalmological consequences of CSD reported in the literature. Among the ophthalmologic disorders caused by cat-scratch disease in humans, Parinaud oculoglandular syndrome, uveitis, vitritis, retinitis, retinochoroiditis and optic neuritis are the most prevalent. The neurological disorders caused by cat-scratch disease in humans include encephalopathy, transverse myelitis, radiculitis, and cerebellar ataxia. The current review addresses the neuro-ophthalmological clinical manifestations of cat-scratch disease, as described in papers published over the last four decades (1980–2022). All the data gathered were obtained from PubMed, Medline and Google Scholar. The current descriptive review summarizes the most-often-encountered clinical symptomatology in instances of cat-scratch disease with neurological and ocular invasion. Thus, the purpose of this review is to increase knowledge of cat-scratch disease’s neuro-ophthalmological manifestations.
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Affiliation(s)
- Sanda Jurja
- Department of Ophthalmology, Faculty of Medicine, ‘Ovidius’ University of Constanta, 900527 Constanta, Romania;
- County Emergency Clinical Hospital “Sf. Apostol Andrei”, Tomis Street, nr. 145, 900591 Constanta, Romania; (M.B.P.); (A.D.A.)
| | - Alina Zorina Stroe
- County Emergency Clinical Hospital “Sf. Apostol Andrei”, Tomis Street, nr. 145, 900591 Constanta, Romania; (M.B.P.); (A.D.A.)
- Department of Neurology, General Medicine Faculty, Ovidius University, 900470 Constanta, Romania
- Correspondence: ; Tel.: +40-727-987-950
| | - Mihaela Butcaru Pundiche
- County Emergency Clinical Hospital “Sf. Apostol Andrei”, Tomis Street, nr. 145, 900591 Constanta, Romania; (M.B.P.); (A.D.A.)
- Surgery Department, Faculty of General Medicine, ‘Ovidius’ University of Constanta, 900470 Constanta, Romania
| | | | - Garofita Mateescu
- Morphology Department, Faculty of Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania;
| | - Alexandru Octavian Micu
- Department of Economic Engineering in Transports, Maritime University of Constanta, Str. Mircea cel Bătrân, 104, 900663 Constanta, Romania;
| | - Raducu Popescu
- Physical Education, Sport and Kinetotherapy Department, ‘Ovidius’ University of Constanta, 900470 Constanta, Romania; (R.P.); (A.O.)
| | - Antoanela Oltean
- Physical Education, Sport and Kinetotherapy Department, ‘Ovidius’ University of Constanta, 900470 Constanta, Romania; (R.P.); (A.O.)
| | - Any Docu Axelerad
- County Emergency Clinical Hospital “Sf. Apostol Andrei”, Tomis Street, nr. 145, 900591 Constanta, Romania; (M.B.P.); (A.D.A.)
- Department of Neurology, General Medicine Faculty, Ovidius University, 900470 Constanta, Romania
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7
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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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8
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Fleissig E, Kim F, Sigford DK, Barr CC. Bilateral neuroretinits and exudative retinal detachment with multifocal subretinal deposits secondary to Bartonella henselae infection. Am J Ophthalmol Case Rep 2021; 24:101201. [PMID: 34541379 PMCID: PMC8437794 DOI: 10.1016/j.ajoc.2021.101201] [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: 01/14/2021] [Revised: 07/23/2021] [Accepted: 08/31/2021] [Indexed: 11/01/2022] Open
Abstract
Purpose to describe a case of bilateral neuroretinitis with bullous retinal detachment and multiple subretinal lesions, in a 10-year-old immunocompetent girl. Observations A broad workup for infectious, inflammatory and masquerade etiologies was done for the patient, resulting in positive IgM and IgG for Bartonella henselae. The patient demonstrated improvement in the visual acuity, and rapid resolution of the retinal detachment and subretinal lesions in both eyes in response to systemic rifampin, doxycycline and corticosteroids. Conclusions and Importance Bartonella henselae neuroretinitis may present as an acute form of bullous retinal detachment with multiple subretinal lesions and markedly reduced vision. Significant visual improvement may occur with prompt treatment with a combination of systemic antibiotics and corticosteroids.
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Affiliation(s)
- Efrat Fleissig
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, KY, USA.,Department of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine,Tel-Aviv University, Tel-Aviv, Israel
| | - Fiona Kim
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Douglas Kenneth Sigford
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Charles C Barr
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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9
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The clinical importance of uveomeningeal syndromes. SPEKTRUM DER AUGENHEILKUNDE 2021. [DOI: 10.1007/s00717-021-00500-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Adult Primary Capillary Hemangioma of the Sclera: A Previously Undescribed Entity With a Review of Epibulbar Vascular Lesions. Ophthalmic Plast Reconstr Surg 2021; 36:327-333. [PMID: 31895731 DOI: 10.1097/iop.0000000000001582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this article is to document a unique case of a primary hemangioma and review epibulbar vascular tumors of the conjunctiva and episclera. METHODS A case report with detailed histopathologic, histochemical, and immunohistochemical studies coupled with a comprehensive review of the relevant literature with a tabulation of previously reported epibulbar vascular lesions was performed. RESULTS A vascular tumor developed in a 46-year-old woman over 2-3 months that histopathologically was located in the superficial third of the normally avascular sclera and was composed of capillary caliber vessels. CD31 and CD34 positivity established the vascular nature of the lesion. Despite its adult onset, the tumor was also glut-1 positive, a vascular characteristic of childhood capillary hemangiomas that will ultimately involute. Smooth muscle actin was positive in the endothelial cells and associated pericytes. An ectatic muscular vessel identified in the midst of the lesion was interpreted as an anomalous intrascleral branch of an epibulbar anterior ciliary artery, where it perforated the sclera in the vicinity of the insertion of an extraocular rectus muscle. It was deduced to be the source of the capillary proliferation. A literature review failed to identify any previously reported epibulbar vascular tumor that originated primarily in the sclera or secondarily infiltrated this ocular tunic. CONCLUSION An adult primary capillary intrascleral neoplasm is described as the rarest of all epibulbar vascular tumors and in keeping with the exceptional status of the ocular endothelium was glut-1 positive. This lesion must be distinguished from an array of other common and esoteric epibulbar vascular conditions.
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11
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Khatri A, Wagle B, Hony KC, Chaurasiya BD, Timalsena S, Singh K, Agrawal R. Post typhoid fever neuroretinitis with serous retinal detachment and choroidal involvement-A case report. Am J Ophthalmol Case Rep 2021; 21:101025. [PMID: 33615037 PMCID: PMC7878975 DOI: 10.1016/j.ajoc.2021.101025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/04/2020] [Accepted: 01/25/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To report post typhoid fever neuroretinitis with Serous Retinal Detachment and choroidal involvement. Observation Patients with diminished vision post typhoid fever can present with neuroretinitis with serous retinal detachment. Conclusion and importance With help from noninvasive imaging such as optical coherence tomography angiography(OCTA) and Deep Range Imaging(DRI), we were able to conclude choroidal involvement – which has not been discussed in literatures yet.OCTA and choroidal thicknessboth served as agood indicators for monitoring the response of treatment in this case.
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Affiliation(s)
- Anadi Khatri
- Department of Vitreoretinal Services, Birat Eye Hospital, Biratnagar, Nepal.,Department of Ophthalmology, Birat Medical College and Teaching Hospital, Biratnagar, Nepal
| | - Bivek Wagle
- Morehouse School of Medicine, Atlanta, GA, USA
| | - K C Hony
- Department of Ophthalmology,Birat Eye Hospital, Biratnagar, Nepal
| | | | - Satish Timalsena
- Department of Ophthalmology,Birat Eye Hospital, Biratnagar, Nepal
| | | | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Singapore Eye Research Institute, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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Tey MSY, Govindasamy G, Vendargon FM. The clinical spectrum of ocular bartonellosis: a retrospective study at a tertiary centre in Malaysia. J Ophthalmic Inflamm Infect 2020; 10:31. [PMID: 33191467 PMCID: PMC7667203 DOI: 10.1186/s12348-020-00224-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Michele Shi-Ying Tey
- Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia.
| | - Gayathri Govindasamy
- Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
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13
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Hindsight Is 20/20. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.100728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Ksiaa I, Abroug N, Mahmoud A, Zina S, Hedayatfar A, Attia S, Khochtali S, Khairallah M. Update on Bartonella neuroretinitis. J Curr Ophthalmol 2019; 31:254-261. [PMID: 31528758 PMCID: PMC6742623 DOI: 10.1016/j.joco.2019.03.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/24/2019] [Accepted: 03/26/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To review the clinical features, diagnosis, treatment modalities, and prognosis of Bartonella-associated neuroretinitis. METHODS This is a narrative review on Bartonella-associated neuroretinitis including general and ophthalmological aspects of the disease. A comprehensive literature review between January 1950 and September 2018 was conducted in PubMed database. Epidemiology, clinical features, diagnosis, treatment, and prognosis of Bartonella neuroretinitis were reviewed. RESULTS Cat scratch disease (CSD) is a worldwide distributed systemic infectious disease caused by a bacterium, Bartonella henselae (B. henselae) which is usually transmitted to humans through contact with infected cats. Ocular manifestations of CSD are diverse, with neuroretinitis and superficial retinal infiltrates being the most common and typical manifestations. Neuroretinitis typically presents as optic disc edema with a partial or complete macular star in association with mild vitritis. Macular star may be absent at the initial presentation, becoming evident 1-2 weeks after the onset of optic disc edema. Diagnosis of CSD is confirmed by reliable laboratory tests. Neuroretinitis usually has a self-limited course. Antibiotic therapy is required for severe systemic disease and vision-threatening ocular involvement. The adjunctive use of oral corticosteroids may further improve the visual outcome. CONCLUSIONS The diagnosis of Bartonella-associated neuroretinitis is based on typical clinical findings and positive serology. The prognosis is usually favorable in immunocompetent individuals.
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Affiliation(s)
- Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Anis Mahmoud
- Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Alireza Hedayatfar
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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15
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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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Stanescu-Segall D, Burton B, Rahman MM, Raja M. Multimodality imaging of multifocal ocular bartonellosis with an optic nerve head mass. Can J Ophthalmol 2019; 54:e3-e6. [DOI: 10.1016/j.jcjo.2018.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 01/29/2018] [Accepted: 02/27/2018] [Indexed: 11/27/2022]
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Celiker H, Kazokoglu H, Eraslan M, Cerman E, Karabas L. Bartonella henselae Neuroretinitis in Patients without Cat Scratch. Jpn J Infect Dis 2018; 71:397-401. [PMID: 29962482 DOI: 10.7883/yoken.jjid.2017.518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Hande Celiker
- Department of Ophthalmology, Marmara University School of Medicine
| | - Haluk Kazokoglu
- Department of Ophthalmology, Marmara University School of Medicine
| | - Muhsin Eraslan
- Department of Ophthalmology, Marmara University School of Medicine
| | - Eren Cerman
- Department of Ophthalmology, Marmara University School of Medicine
| | - Levent Karabas
- Department of Ophthalmology, Kocaeli University School of Medicine
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Habot-Wilner Z, Trivizki O, Goldstein M, Kesler A, Shulman S, Horowitz J, Amer R, David R, Ben-Arie-Weintrob Y, Bakshi E, Almog Y, Sartani G, Vishnevskia-Dai V, Kramer M, Bar A, Kehat R, Ephros M, Giladi M. Cat-scratch disease: ocular manifestations and treatment outcome. Acta Ophthalmol 2018; 96:e524-e532. [PMID: 29504674 DOI: 10.1111/aos.13684] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/26/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To characterize cat-scratch disease (CSD) ocular manifestations and visual outcome and evaluate the effect of systemic antibiotics and corticosteroids on final visual acuity (VA). METHODS Multicentre retrospective cohort study. Medical records of 86 patients with ocular disease (107 eyes) of 3222 patients identified in a national CSD surveillance study were reviewed. RESULTS Mean age was 35.1 ± 14.2 years. Median follow-up was 20 weeks (range 1-806 weeks). Of 94/107 (88%) eyes with swollen disc, 60 (64%) had neuroretinitis at presentation, 14 (15%) developed neuroretinitis during follow-up, and 20 (21%) were diagnosed with inflammatory disc oedema. Optic nerve head lesion, uveitis, optic neuropathy and retinal vessel occlusion were found in 43 (40%), 38 (36%), 34 (33%) and 8 (7%) eyes, respectively. Good VA (better than 20/40), moderate vision loss (20/40-20/200) and severe vision loss (worse than 20/200) were found in 26/79 (33%), 35/79 (44%) and 18/79 (23%) eyes at baseline and in 63/79 (80%), 11/79 (14%) and 5/79 (6%) eyes at final follow-up, respectively (p < 0.001). Significant VA improvement (defined as improvement of ≥3 Snellen lines at final follow-up compared to baseline) occurred in 12/24 (50%) eyes treated with antibiotics compared with 14/16 (88%) eyes treated with antibiotics and corticosteroids (p = 0.02). Multivariate logistic regression was suggestive of the same association (odds ratio 7.0; 95% CI 1.3-37.7; p = 0.024). CONCLUSION Optic nerve head lesion is a common and unique manifestation of ocular CSD. Most patients improved and had final good VA. Combined antibiotics and corticosteroid treatment was associated with a better visual outcome.
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Affiliation(s)
- Zohar Habot-Wilner
- Division of Ophthalmology; Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Omer Trivizki
- Division of Ophthalmology; Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Michaella Goldstein
- Division of Ophthalmology; Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Anat Kesler
- Division of Ophthalmology; Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Shiri Shulman
- Division of Ophthalmology; Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Josepha Horowitz
- Department of Ophthalmology; Carmel Medical Center; The Ruth and Bruce Rappaport Faculty of Medicine; Technion; Israel Institute of Technology; Haifa Israel
| | - Radgonde Amer
- Department of Ophthalmology; Hadassah Medical Center; The Hebrew University Hadassah Medical School; Jerusalem Israel
| | - Ran David
- Department of Ophthalmology; Hadassah Medical Center; The Hebrew University Hadassah Medical School; Jerusalem Israel
| | - Yael Ben-Arie-Weintrob
- Department of Ophthalmology; Rambam Medical Center; The Ruth and Bruce Rappaport Faculty of Medicine; Technion; Israel Institute of Technology; Haifa Israel
| | - Erez Bakshi
- Department of Ophthalmology; Assaf Harofeh Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Yehoshua Almog
- Department of Ophthalmology; Meir Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Gil Sartani
- Department of Ophthalmology; Haemek Medical Center; The Ruth and Bruce Rappaport Faculty of Medicine; Technion; Israel Institute of Technology; Haifa Israel
| | - Vicktoria Vishnevskia-Dai
- The Goldschleger Eye Institute; Department of Ophthalmology; Sheba Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Michal Kramer
- Division of Ophthalmology; Rabin Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Asaf Bar
- Department of Ophthalmology; Wolfson Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Rinat Kehat
- Department of Ophthalmology; Bnai Zion Medical Center; The Ruth and Bruce Rappaport Faculty of Medicine; Technion; Israel Institute of Technology; Haifa Israel
| | - Moshe Ephros
- Pediatric Infectious Disease Unit; Carmel Medical Center; The Ruth and Bruce Rappaport Faculty of Medicine; Technion; Israel Institute of Technology; Haifa Israel
| | - Michael Giladi
- Infectious Disease Unit and The Bernard Pridan Laboratory for Molecular Biology of Infectious Diseases; Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Toumanidou V, Dastiridou A, Kourtis N, Androudi S. Neuroretinitis Secondary to Bartonella Henselae in a Patient with Myelinated Retinal Nerve Fibers: Diagnostic Dilemmas and Treatment. Ocul Immunol Inflamm 2017; 27:396-398. [PMID: 29283743 DOI: 10.1080/09273948.2017.1409357] [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: 10/18/2022]
Abstract
Purpose: To report an unusual case of Bartonella henselae neuroretinitis (BHNR) in a patient with myelinated retinal nerve fibers (MRNFs). Methods: A 56-year-old male presented for a consultation, because of a decrease in visual acuity from his right eye. Onset was unclear and the patient was not sure if this was a new symptom. Results: Fundoscopy revealed MRNF without any other clinical findings. After 2 weeks, the patient returned complaining of further visual acuity decrease. Fundoscopy disclosed macular star formation. The patient was treated with azithromycin. The visual acuity deteriorated to 20/400 and we added systemic corticosteroids with slight improvement of the visual fields but minimal visual gain to 20/160. Serology test results were positive for BH (IgG titers>1/256). Conclusions: Co-existence of BHNR and MRNF can create diagnostic dilemmas. The presence of myelinated nerve sheath in combination with the expected swelling in neuroretinitis may have caused an irreversible mechanical nerve damage.
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Affiliation(s)
| | - Anna Dastiridou
- b Department of Ophthalmology , University of Thessaly , Larissa , Greece
| | - Nikolaos Kourtis
- c Department of Ophthalmology , 424 Military Hospital , Thessaloniki , Greece
| | - Sofia Androudi
- b Department of Ophthalmology , University of Thessaly , Larissa , Greece
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20
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Phan A, Castagnini LA. Corticosteroid Treatment for Prolonged Fever in Hepatosplenic Cat-Scratch Disease: A Case Study. Clin Pediatr (Phila) 2017; 56:1291-1292. [PMID: 28006985 DOI: 10.1177/0009922816684606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatosplenic cat-scratch disease (CSD) may cause prolonged fever. We present the case of a 4-year-old boy with confirmed hepatosplenic CSD with fever lasting 3 months despite use of multiple different antimicrobial agents. The patient became afebrile soon after corticosteroid therapy was started. Our case indicates corticosteroids may be useful in patients with hepatosplenic CSD and prolonged fever.
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Affiliation(s)
- Amanda Phan
- 1 Baylor College of Medicine, San Antonio, TX, USA.,2 The Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Luis A Castagnini
- 1 Baylor College of Medicine, San Antonio, TX, USA.,2 The Children's Hospital of San Antonio, San Antonio, TX, USA
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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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Gabrial M, Islam S, Schaefer J, Pihlblad M. Case 3: Painless Vision Loss in an Adolescent. Pediatr Rev 2017; 38:385-386. [PMID: 28765202 DOI: 10.1542/pir.2016-0207] [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: 11/24/2022]
Affiliation(s)
| | - Shamim Islam
- Division of Infectious Diseases, Women and Children's Hospital of Buffalo, Buffalo, NY
| | - Jamie Schaefer
- Department of Ophthalmology, Ross Eye Institute, Buffalo, NY
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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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25
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Seroprevalence of Bartonella Species in Patients with Ocular Inflammation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1020:33-42. [PMID: 28405890 DOI: 10.1007/5584_2017_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Bartonella species, vector-borne etiologic agents of many systemic or self-limited infections, are responsible for a widening spectrum of diseases in humans, including inflammatory conditions of the eye. The aim of this study was to determine whether there is any relationship between uveitis and the evidence of Bartonella spp. infection in the serum, ocular fluid, and cataract mass in patients with intraocular inflammation. Polymerase chain reaction (PCR)-based tests and DNA sequencing were performed on surgery-extracted specimens of intraocular fluid and lens mass of 33 patients. Sera from 51 patients and 101 control subjects were tested for the presence of specific antibodies against Bartonella spp. Neither IgM-class antibodies against Bartonella spp. nor Bartonella spp. DNA were detected. A specific IgG-class antibody was found in 33.3% of the patients with uveitis. The rate of positive Bartonella serology was higher among the uveitis patients than that in control subjects. This high rate may in part result from unrecognized indirect mechanisms rather than the immediate presence and multiplication of Bartonella spp. in the eyeball. Nonetheless we believe that screening for Bartonella spp. should become part of the diagnostic workup in uveitis.
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26
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Rashid MA, Ling TJ, Mustapha M, Isa HM. Red eye in cat lovers: Case series of Parinaud's oculoglandular syndrome. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2016. [DOI: 10.1016/s2222-1808(16)61122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Welschen DVDV. Neurorretinitis por Bartonella henselae: presentación de un caso y revisión de la literatura. REVISTA MEXICANA DE OFTALMOLOGÍA 2016. [DOI: 10.1016/j.mexoft.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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28
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Aziz HA, Plesec TP, Sabella C, Udayasankar UK, Singh AD. Cat Scratch Disease: Expanded Spectrum. Ocul Oncol Pathol 2016; 2:246-250. [PMID: 27843905 DOI: 10.1159/000447063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/24/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To expand the spectrum of ophthalmic manifestations in cat scratch disease. METHODS Case report. RESULTS A 7-year-old male was referred for evaluation of his left optic disc after failing vision screening test at school. His visual acuity was 20/20 OD and light perception OS. Fundus examination showed a left optic disc lesion associated with an exudative retinal detachment and vitreous seeding. Ultrasonography revealed a 7 × 7.5 × 3.8 mm lesion with a possible 6.3 mm of retrolaminar extension into the substance of the optic nerve. Brain MRI did not show evidence of optic nerve involvement but revealed a 6-mm nodule of the pineal gland suggestive of a pineoblastoma. Enucleation was performed and histopathology revealed a suppurative granulomatous inflammation suggestive of Bartonella infection. Upon further questioning, the patient had recent exposure to kittens with areas of cat scratches along both of his arms. He was subsequently referred to and treated with a 2-week course of trimethoprim-sulfamethoxazole and rifampin by the pediatric infectious disease specialist. Repeat brain MRI showed interval total resolution of enlarged pineal gland. Conclusion: Optic nerve granulomas are a rare presentation of cat scratch disease and could potentially masquerade as retinoblastoma.
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Affiliation(s)
- Hassan A Aziz
- Department of Ophthalmology, Cole Eye Institute, Ohio, USA
| | - Thomas P Plesec
- Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Camille Sabella
- Pediatric Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Arun D Singh
- Department of Ophthalmology, Cole Eye Institute, Ohio, USA
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Kahloun R, Abroug N, Ksiaa I, Mahmoud A, Zeghidi H, Zaouali S, Khairallah M. Infectious optic neuropathies: a clinical update. Eye Brain 2015; 7:59-81. [PMID: 28539795 PMCID: PMC5398737 DOI: 10.2147/eb.s69173] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Different forms of optic neuropathy causing visual impairment of varying severity have been reported in association with a wide variety of infectious agents. Proper clinical diagnosis of any of these infectious conditions is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular findings. Diagnosis is confirmed by serologic testing and polymerase chain reaction in selected cases. Treatment of infectious optic neuropathies involves the use of specific anti-infectious drugs and corticosteroids to suppress the associated inflammatory reaction. The visual prognosis is generally good, but persistent severe vision loss with optic atrophy can occur. This review presents optic neuropathies caused by specific viral, bacterial, parasitic, and fungal diseases.
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Affiliation(s)
- Rim Kahloun
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Anis Mahmoud
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hatem Zeghidi
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Zaouali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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Bien, bien, bien…. Rev Med Interne 2015; 36:631-3. [DOI: 10.1016/j.revmed.2015.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 11/23/2022]
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Tripathy K, Sharma YR, Chawla R, Basu K, Vohra R, Venkatesh P. Triads in Ophthalmology: A Comprehensive Review. Semin Ophthalmol 2015; 32:237-250. [DOI: 10.3109/08820538.2015.1045150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Koushik Tripathy
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Yog Raj Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Koushik Basu
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajpal Vohra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Choroidal neovascularisation as an unusual ophthalmic manifestation of cat-scratch disease in an 8-year-old girl. Int Ophthalmol 2015; 35:709-16. [DOI: 10.1007/s10792-015-0093-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
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Seth A, Raina UK, Thirumalai S, Batta S, Ghosh B. Full-thickness macular hole in Bartonella henselae neuroretinitis in an 11-year-old girl. Oman J Ophthalmol 2015; 8:44-6. [PMID: 25709274 PMCID: PMC4333543 DOI: 10.4103/0974-620x.149866] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cat scratch disease is a febrile illness caused by Bartonella henselae and is associated with rash at the site of cat bite or scratch and regional lymphadenopathy. Various ocular manifestations of cat scratch disease have been described, mainly retinochoroiditis, optic disc swelling, neuroretinitis, vascular occlusive events, serous retinal detachment, vitreous hemorrhage, intermediate uveitis, inflammatory lesions of the optic nerve head and rarely full thickness macular hole. We describe a case of an 11-year-old girl who presented 2 weeks after the onset of symptoms, with B. Henselae neuroretinitis with full thickness macular hole at presentation.
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Affiliation(s)
- Anisha Seth
- Department of Ophthalmology, Guru Nanak Eye Centre, New Delhi, India
| | - Usha K Raina
- Department of Ophthalmology, Guru Nanak Eye Centre, New Delhi, India
| | - Sriram Thirumalai
- Department of Ophthalmology, Guru Nanak Eye Centre, New Delhi, India
| | - Supriya Batta
- Department of Ophthalmology, Guru Nanak Eye Centre, New Delhi, India
| | - Basudeb Ghosh
- Department of Ophthalmology, Guru Nanak Eye Centre, New Delhi, India
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Chmielewski T, Brydak-Godowska J, Fiecek B, Rorot U, Sędrowicz E, Werenowska M, Kopacz D, Hevelke A, Michniewicz M, Kęcik D, Tylewska-Wierzbanowska S. Bacterial tick-borne diseases caused by Bartonella spp., Borrelia burgdorferi sensu lato, Coxiella burnetii, and Rickettsia spp. among patients with cataract surgery. Med Sci Monit 2014; 20:927-31. [PMID: 24902636 PMCID: PMC4049946 DOI: 10.12659/msm.890149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Clinical data have shown that tick-borne diseases caused by Borrelia burgdorferi sensu lato, Bartonella spp., Coxiella burnetii, and Rickettsia spp. can affect the central nervous system, including the eye. The aim of this study was to establish a relationship between the incidence of cataract and evidence of bacterial infections transmitted by ticks. Material/Methods Fluid with lenticular masses from inside of the eye and blood from 109 patients were tested by PCR and sequencing. Sera from patients and the control group were subjected to serological tests to search specific antibodies to the bacteria. Results Microbiological analysis revealed the presence of Bartonella sp. DNA in intraoperative specimens from the eye in 1.8% of patients. Serological studies have shown that infections caused by B. burgdorferi sensu lato and Bartonella sp. were detected in 34.8% and 4.6% of patients with cataract surgery, respectively. Conclusions Presence of DNA of yet uncultured and undescribed species of Bartonella in eye liquid indicates past infection with this pathogen. Specific antibodies to B. burgdorferi sensu lato and Bartonella sp. are detected more frequently in patients with cataract compared to the control group. This could indicate a possible role of these organisms in the pathological processes within the eyeball, leading to changes in the lens. Further studies are needed to identify Bartonella species, as well as to recognize the infectious mechanisms involved in cataract development.
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Affiliation(s)
- Tomasz Chmielewski
- Laboratory of Rickettsiae, Chlamydiae and Spirochetes, National Institute of Public Heath - National Institute of Hygiene, Warsaw, Poland
| | | | - Beata Fiecek
- Laboratory of Rickettsiae, Chlamydiae and Spirochetes, National Institute of Public Heath - National Institute of Hygiene, Warsaw, Poland
| | - Urszula Rorot
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Elżbieta Sędrowicz
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | | | - Dorota Kopacz
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Hevelke
- Department of Histology, Medical University of Warsaw, Warsaw, Poland
| | | | - Dariusz Kęcik
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Stanisława Tylewska-Wierzbanowska
- Laboratory of Rickettsiae, Chlamydiae and Spirochetes, National Institute of Public Heath - National Institute of Hygiene, Warsaw, Poland
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36
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Diwo E, Merle H. Une bartonellose atypique. J Fr Ophtalmol 2014; 37:e35-6. [DOI: 10.1016/j.jfo.2013.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 05/10/2013] [Accepted: 05/17/2013] [Indexed: 11/28/2022]
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Abstract
The diagnosis of Behçet disease is clinical and based on the presence of characteristic ocular and systemic inflammatory manifestations. Patients may present with anterior, posterior, or panuveitis in one or both eyes. The differential diagnosis includes a variety of infectious and noninfectious causes of acute nongranulomatous anterior uveitis, intermediate uveitis, occlusive retinal vasculitis, focal or multifocal retinitis, and necrotizing retinitis. A course characterized by sudden onset with improvement followed by recurrence of inflammatory signs is most typical for Behçet uveitis.
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Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey
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Best JA, Price B. Central scotoma without prodromal illness caused by Bartonella henselae neuroretinitis. Am J Emerg Med 2013; 31:887.e1-2. [DOI: 10.1016/j.ajem.2012.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022] Open
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Abstract
Cat scratch disease causes the majority of cases of neuroretinitis. Neuroretinitis is characterised by clinical features of papillitis, macular oedema and macular star. We report a case study of infection with Bartonella henselae most likely transmitted by a bull ant sting. The patient presented with blurred vision and reduced visual acuity after being stung by an ant in her garden some 7 days earlier. Further testing revealed positive serology to B henselae and the patient improved with appropriate treatment.
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Affiliation(s)
- Katja Ullrich
- Department of Ophthalmology, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.
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Stewart MW. Human immunodeficiency virus and its effects on the visual system. Infect Dis Rep 2012; 4:e25. [PMID: 24470932 PMCID: PMC3892652 DOI: 10.4081/idr.2012.e25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 02/05/2012] [Accepted: 02/06/2012] [Indexed: 12/13/2022] Open
Abstract
During the first 15 years of the AIDS epidemic patients experienced a high incidence of blindness due to cytomegalovirus (CMV) retinitis and other severe ocular opportunistic infections. Highly active anti-retroviral therapy, introduced in 1996, dramatically decreased the incidence of CMV retinitis. Though CMV retinitis still causes 40% of vision loss in AIDS patients, other conditions such as immune reconstitution uveitis, cataracts, and a significant othercategory -which most investigators believe is directly due to HIV - comprise the majority of cases. HIV causes vascular abnormalities of the conjunctiva and retina in the majority of AIDS patients, as well as retinitis, anterior and posterior uveitis and vasculitis. HIV frequently causes an optic neuropathy and is responsible for the majority of eye movement disorders among HIV patients. Physicians need to be aware that these problems may be the initial manifestation of HIV infections or a sign of highly active anti-retroviral therapy (HAART) failure. Therefore, patients with identifiable risk factors for AIDS who present with ophthalmologic conditions of unknown etiology should be considered for HIV testing. Finally, anti-retroviral therapy has been reported to cause asymptomatic deposits as well as degenerative conditions of both the anterior and posterior segments of the eye.
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Affiliation(s)
- Michael W Stewart
- Department of Ophthalmology, Mayo College of Medicine, Jacksonville, FL, USA
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Chi SL, Stinnett S, Eggenberger E, Foroozan R, Golnik K, Lee MS, Bhatti MT. Clinical Characteristics in 53 Patients with Cat Scratch Optic Neuropathy. Ophthalmology 2012; 119:183-7. [DOI: 10.1016/j.ophtha.2011.06.042] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 06/29/2011] [Accepted: 06/29/2011] [Indexed: 12/24/2022] Open
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Metz CHD, Buer J, Bornfeld N, Lipski A. Bilateral Bartonella henselae neuroretinitis with stellate maculopathy in a 6-year-old boy. Infection 2011; 40:191-4. [PMID: 21826435 DOI: 10.1007/s15010-011-0168-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 07/19/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Bartonella henselae, the cause of cat-scratch disease in humans, may lead to characteristic vision-threatening ocular findings, which importantly indicate diagnosis. METHODS This is an observational case report of a 6-year-old boy who presented with bilateral stellate maculopathy and lymphadenopathy. RESULTS After serologic verification of B. henselae infection, systemic azithromycin therapy initiated the full recovery of visual acuity and bilateral complete resolution of stellate exudates during the following months. CONCLUSION Stellate maculopathy should always include the differential diagnosis of B. henselae infection. In this rare case of bilateral stellate maculopathy, we observed full recovery of function following systemic macrolide therapy.
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Affiliation(s)
- C H D Metz
- University of Duisburg-Essen, Essen, Germany.
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Narayan SK, Kaliaperumal S, Srinivasan R. Neuroretinitis, a great mimicker. Ann Indian Acad Neurol 2011; 11:109-13. [PMID: 19893649 PMCID: PMC2771962 DOI: 10.4103/0972-2327.41879] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 06/02/2008] [Accepted: 06/02/2008] [Indexed: 11/15/2022] Open
Abstract
Neuroretinitis is a less-known clinical entity, which can be funduscopically confused with papillitis or papilledema and with hypertensive, renal and infiltrative retinopathies as well as with retinal vein occlusion or anterior ischemic optic neuropathy.
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Kalogeropoulos C, Koumpoulis I, Mentis A, Pappa C, Zafeiropoulos P, Aspiotis M. Bartonella and intraocular inflammation: a series of cases and review of literature. Clin Ophthalmol 2011; 5:817-29. [PMID: 21750616 PMCID: PMC3130920 DOI: 10.2147/opth.s20157] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To present various forms of uveitis and/or retinal vasculitis attributed to Bartonella infection and review the impact of this microorganism in patients with uveitis. METHODS Retrospective case series study. Review of clinical records of patients diagnosed with Bartonella henselae and Bartonella quintana intraocular inflammation from 2001 to 2010 in the Ocular Inflammation Department of the University Eye Clinic, Ioannina, Greece. Presentation of epidemiological and clinical data concerning Bartonella infection was provided by the international literature. RESULTS Eight patients with the diagnosis of Bartonella henselae and two patients with B. quintana intraocular inflammation were identified. Since four patients experienced bilateral involvement, the affected eyes totaled 14. The mean age was 36.6 years (range 12-62). Uveitic clinical entities that we found included intermediate uveitis in seven eyes (50%), vitritis in two eyes (14.2%), neuroretinitis in one eye (7.1%), focal retinochoroiditis in one eye (7.1%), branch retinal vein occlusion (BRVO) due to vasculitis in one eye (7.1%), disc edema with peripapillary serous retinal detachment in one eye (7.1%), and iridocyclitis in one eye (7.1%). Most of the patients (70%) did not experience systemic symptoms preceding the intraocular inflammation. Antimicrobial treatment was efficient in all cases with the exception of the case with neuroretinitis complicated by anterior ischemic optic neuropathy and tubulointerstitial nephritis. CONCLUSION Intraocular involvement caused not only by B. henselae but also by B. quintana is being diagnosed with increasing frequency. A high index of suspicion is needed because the spectrum of Bartonella intraocular inflammation is very large. In our study the most common clinical entity was intermediate uveitis.
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Affiliation(s)
| | - Ioannis Koumpoulis
- Department of Ophthalmology, Medical School, University of Ioannina, Greece
| | - Andreas Mentis
- Laboratory of Medical Microbiology, Hellenic Pasteur Institute, Athens, Greece
| | - Chrisavgi Pappa
- Department of Ophthalmology, Medical School, University of Ioannina, Greece
| | | | - Miltiadis Aspiotis
- Department of Ophthalmology, Medical School, University of Ioannina, Greece
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Macular findings on optical coherence tomography in cat-scratch disease neuroretinitis. Eye (Lond) 2011; 25:1064-8. [PMID: 21660065 DOI: 10.1038/eye.2011.125] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To describe the macular findings on optical coherence tomography (OCT) in patients with cat-scratch disease (CSD) neuroretinitis. METHODS Medical records of all patients diagnosed with CSD neuroretinitis at the Tel Aviv Medical Center between April 2006 and May 2010 were retrospectively reviewed. All patients underwent Stratus OCT macular examination. RESULTS Eight eyes of seven patients with confirmed CSD neuroretinitis, (mean age 33 ± 9.9 years, range 6-48 years) were included in the study. All patients presented clinically with optic nerve swelling and macular edema or macular exudates. OCT demonstrated flattening of the foveal contour, thickening of the neurosensory retina, and accumulation of subretinal fluid (SRF) in all studied eyes. Retinal exudates appeared as multiple hyper-reflective foci in the outer plexiform layer. The average central macular thickness was 460 μm (range 170-906 μm) and the average maximal retinal thickness was 613 μm (range 387-1103 μm), at presentation. The macula appeared normal on repeated exams during follow-up. CONCLUSION Similar OCT findings were demonstrated in patients with CSD neuroretinitis. SRF was found in all eyes, although was not visible on clinical examination or fluorescein angiography. OCT may be used as an adjunct imaging tool in the diagnosis and follow-up of patients with CSD neuroretinitis.
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Unusual retinal manifestations of cat scratch disease. Int Ophthalmol 2011; 31:125-8. [DOI: 10.1007/s10792-011-9422-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 01/01/2011] [Indexed: 11/25/2022]
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Disseminated bartonellosis presenting as neuroretinitis in a young adult with human immunodeficiency virus infection. Pediatr Infect Dis J 2010; 29:675-7. [PMID: 20216243 DOI: 10.1097/inf.0b013e3181d60a6d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Rapidly declining visual acuity from neuroretinitis should prompt aggressive diagnostic intervention to preserve eyesight. We present a young adult with human immunodeficiency virus (HIV) infection in whom neuroretinitis was the presenting feature of disseminated bartonellosis. Tissue biopsy was required to establish the diagnosis and directed therapy was associated with restored vision.
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