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Ambika S, Lakshmi P. Infectious optic neuropathy (ION), how to recognise it and manage it. Eye (Lond) 2024; 38:2302-2311. [PMID: 38831116 PMCID: PMC11306351 DOI: 10.1038/s41433-024-03152-8] [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: 01/03/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/05/2024] Open
Abstract
Optic neuropathy can be of infectious or non-infectious/idiopathic aetiology. Many infectious organisms can cause optic neuropathy that can be of varied presentation including papillitis, retrobulbar optic neuritis, neuroretinitis, and optic perineuritis. Detailed history, ocular, systemic/neurologic examination along with appropriate laboratory evaluation can help clinicians to identify the infectious agent causing optic neuropathy. In spite of recent advanced techniques in serological testing and molecular diagnostics like polymerase chain reaction (PCR), the identification of these pathogens is still a diagnostic challenge. It is ideal to have an infectious disease (ID) consultant in the management team, as most of these infections are multisystem involving diseases. Most infectious agents can be effectively treated with specific antibiotics, with or without corticosteroid therapy, but visual recovery is highly variable and depends entirely on early diagnosis of the causative agent. This review article will provide an overview of common pathogens involved in ION and will describe their management paradigms.
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Affiliation(s)
- Selvakumar Ambika
- Department of Neuro-Ophthalmology, Sankara Nethralaya - A Unit of Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, 600 006, India.
| | - Padma Lakshmi
- Department of Neuro-Ophthalmology, Sankara Nethralaya - A Unit of Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, 600 006, India
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2
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Clare G, Kempen JH, Pavésio C. Infectious eye disease in the 21st century-an overview. Eye (Lond) 2024; 38:2014-2027. [PMID: 38355671 PMCID: PMC11269619 DOI: 10.1038/s41433-024-02966-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
Infectious diseases affecting the eye often cause unilateral or asymmetric visual loss in children and people of working age. This group of conditions includes viral, bacterial, fungal and parasitic diseases, both common and rare presentations which, in aggregate, may account for a significant portion of the global visual burden. Diagnosis is frequently challenging even in specialist centres, and many disease presentations are highly regional. In an age of globalisation, an understanding of the various modes of transmission and the geographic distribution of infections can be instructive to clinicians. The impact of eye infections on global disability is currently not sufficiently captured in global prevalence studies on visual impairment and blindness, which focus on bilateral disease in the over-50s. Moreover, in many cases it is hard to differentiate between infectious and immune-mediated diseases. Since infectious eye diseases can be preventable and frequently affect younger people, we argue that in future prevalence studies they should be considered as a separate category, including estimates of disability-adjusted life years (DALY) as a measure of overall disease burden. Numbers of ocular infections are uniquely affected by outbreaks as well as endemic transmission, and their control frequently relies on collaborative partnerships that go well beyond the remit of ophthalmology, encompassing domains as various as vaccination, antibiotic development, individual healthcare, vector control, mass drug administration, food supplementation, environmental and food hygiene, epidemiological mapping, and many more. Moreover, the anticipated impacts of global warming, conflict, food poverty, urbanisation and environmental degradation are likely to magnify their importance. While remote telemedicine can be a useful aide in the diagnosis of these conditions in resource-poor areas, enhanced global reporting networks and artificial intelligence systems may ultimately be required for disease surveillance and monitoring.
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Affiliation(s)
| | - John H Kempen
- Department of Ophthalmology and Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary; and Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Sight for Souls, Bellevue, WA, USA
- MCM Eye Unit; MyungSung Christian Medical Center (MCM) Comprehensive Specialized Hospital and MyungSung Medical College, Addis Ababa, Ethiopia
- Department of Ophthalmology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
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3
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Ngathaweesuk Y, Hendrikse J, Groot-Mijnes JDFD, de Boer JH, Hettinga YM. Causes of infectious pediatric uveitis: A review. Surv Ophthalmol 2024; 69:483-494. [PMID: 38182040 DOI: 10.1016/j.survophthal.2023.12.003] [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: 08/07/2023] [Revised: 12/11/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
Infectious pediatric uveitis is a rare disease that can cause severe ocular damage if not detected rapidly and treated properly. Additionally, early identification of an infection can protect the child from life-threatening systemic infection. Infectious uveitis can be congenital or acquired and may manifest as a primary ocular infection or as a reactivation. Nevertheless, publications on infectious paediatric uveitis are usually limited to a small number of patients or a case report. So far, most studies on uveitis in children have focused primarily on noninfectious uveitis, and a systematic study on infectious uveitis is lacking. In this review, we summarize the literature on infectious uveitis in pediatric populations and report on the epidemiology, pathophysiology, clinical signs, diagnostic tests, and treatment. We will describe the different possible pathogens causing uveitis in childhood by microbiological group (i.e. parasites, viruses, bacteria, and fungi). We aim to contribute to early diagnosis and management of infectious pediatric uveitis, which in turn might improve not only visual outcome, but also the general health outcome.
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Affiliation(s)
- Yaninsiri Ngathaweesuk
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Jytte Hendrikse
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - Jolanda Dorothea Francisca de Groot-Mijnes
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joke Helena de Boer
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands
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4
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Li P, Qian Z, Tao Y. Application of metagenomic next-generation sequencing in the diagnosis of Bartonella neuroretinitis: a case report and literature review. J Ophthalmic Inflamm Infect 2024; 14:17. [PMID: 38637335 PMCID: PMC11026355 DOI: 10.1186/s12348-024-00387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/13/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Cat-scratch disease (CSD) is caused by Bartonella henselae infection. In atypical cases of CSD, pathogen determination is challenging. We report a case of Bartonella neuroretinitis with neither a clear history of scratches nor typical general symptoms. The diagnosis was made using metagenomic next-generation sequencing (mNGS), a high-throughput sequencing technology. CASE PRESENTATION A female patient presented to the ophthalmologist with complaint of blurred vision in her right eye. Although with history of raising a cat, she reported no clear history of scratches or typical general symptoms, except a fever of unknown origin which resolved spontaneously. The best corrected visual acuity (BCVA) of the right eye was count fingers. Fundus examination showed optic disc oedema, macular exudates and inferior exudative retinal detachment. Laboratory examination results showed increased value of serum C-reactive protein and erythrocyte sedimentation rate. Ocular involvement of toxoplasmosis, syphilis and tuberculosis were excluded. To identify the possible causative pathogen of the disease, mNGS of aqueous humour sample was performed and 521 reads of B. henselae were identified. Serological test results further showed a positive immunoglobulin G (IgG) titre of 1:64. Taking the contact history, clinical manifestations, mNGS and serological results into consideration, the diagnosis of Bartonella neuroretinitis (ocular CSD) was made. After appropriate treatment, the BCVA of the right eye improved to 20/25 in the last follow-up. Fundus examination showed a normal optic disc and macula, and the exudates had reduced. CONCLUSION mNGS, a fast and unbiased method, can be used to detect B. henselae (if present) in intraocular fluid samples.; however, the results should be interpreted together with the clinical symptoms and other auxiliary test results.
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Affiliation(s)
- Pengcheng Li
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China.
| | - Zhuyun Qian
- Beijing GIANTMED Medical Diagnostics Lab, Beijing, China
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Road of Worker's Stadium Chaoyang District, Beijing, 100020, China
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Road of Worker's Stadium Chaoyang District, Beijing, 100020, China.
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5
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Zhou T, Zheng Y, Zhang H, Liu Y. A case report of diagnosis of cat-scratch disease using metagenomic next-generation sequencing. Front Cell Infect Microbiol 2024; 13:1322651. [PMID: 38287977 PMCID: PMC10822884 DOI: 10.3389/fcimb.2023.1322651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/12/2023] [Indexed: 01/31/2024] Open
Abstract
Cat-scratch disease (CSD) is an anthropozoonotic infection caused by Bartonella henselae, and it is one of the most common causes of lymph node infections in children and adolescents. B. henselae, belonging to the genus Bartonella, is a common human pathogen of human beings. CSD commonly develops as a result of cat scratches and bites or when injured skin comes into contact with cat saliva. The manifestation of CSD clinically differs for each patient based on their immune system. Individuals who have healthy immune systems generally manifest minimal clinical symptoms and do not necessitate any form of treatment. However, patients who have hypo-immunity require prompt medical attention due to the potential manifestation of severe symptoms that affect multiple systems of the body. Long latency and atypical clinical manifestations are characteristics of CSD. Bartonella isolation and identification are challenging procedures that require specialized equipment. There is no gold standard method for CSD diagnosis, and misdiagnosis and missed diagnosis rates are typically high. We present the case of a middle-aged male patient who developed fever, chills, anal distension, dizziness, and muscle pain for 10 days. The patient had a documented history of cat bites 1 month prior to the onset of symptoms. Following admission, he underwent an examination to determine superficial lymphadenopathy and hypoimmunity. Additionally, he had a fever during the disease. As the patient refused a needle biopsy of lymph nodes, metagenomic next-generation sequencing (mNGS) was employed and B. henselae was detected in the peripheral blood. The patient was diagnosed with CSD and treated with a combination of azithromycin and doxycycline. The fever symptoms were alleviated, and the patient was ultimately discharged. As a result of this case, we suggest that mNGS be used as a crucial supplementary diagnostic tool for individuals with compromised immune systems who may have CSD, especially when conventional diagnostic methods are inconclusive.
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Affiliation(s)
- Tao Zhou
- Department of Infectious Disease Department, The Third People’s Hospital of Chengdu, Chengdu, China
| | - Yaqiu Zheng
- Digestive Endoscopy Center, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Huizi Zhang
- Department of Geriatric, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Yongfang Liu
- Department of Infectious Disease Department, The Third People’s Hospital of Chengdu, Chengdu, China
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6
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Kara M, Ozdemir GN, Tasdemir M, Ata S, Karini B, Valiyev E, Tutkun IT, Kose G, Ozkaya O. A case of Bartonellosis mimicking systemic lupus erythematosus. Eur J Ophthalmol 2023; 33:NP41-NP48. [PMID: 36345218 DOI: 10.1177/11206721221137163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND AIM Cat-scratch disease (CSD) is a systemic bacterial infection caused by Bartonella henselae. The disease is typically characterized by regional lymphadenopathy developing after scratches from domestic or feral cats. Rarely, systemic involvement may be observed. The co-occurrence with glomerulonephritis and positive antinuclear antibody (ANA) tests have been reported before. In these cases, the disease can be misdiagnosed as systemic lupus erythematosus. Ocular involvement occurs in 5%-10% of the cases with CSD, and neuroretinitis is among the common manifestations. Administration of corticosteroids (CSs) in addition to antibiotics has been shown to improve prognosis in neuroretinitis cases. However, the optimal dose and duration, remain ill-defined. CASE REPORT In this article, we present an 11-year-old girl with CSD and neuroretinitis with a positive ANA test and hematuria, who benefited from high-dose methyl-prednisolone and antibiotics. CONCLUSION Further research is warranted in order to determine the dose and duration of CSs in the treatment of Bartonella neuroretinitis.
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Affiliation(s)
- Manolya Kara
- Department of Pediatric Infectious Diseases, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Gul Nihal Ozdemir
- Department of Pediatric Hematology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Mehmet Tasdemir
- Department of Pediatric Nephrology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Serap Ata
- Department of Pediatrics, Memorial Atasehir Hospital, Istanbul, Turkey
| | - Belma Karini
- Department of Ophthalmology, Memorial Sisli Hospital, Istanbul, Turkey
| | - Eldar Valiyev
- Department of Radiology, Liv Hospital Ulus, Istanbul, Turkey
| | - Ilknur Tugal Tutkun
- Department of Opthalmology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Gulsen Kose
- Department of Pediatric Neurology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Ozan Ozkaya
- Department of Pediatric Rheumatology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
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7
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Mirabet Mas J, Morell Daniel M, Martín Begué N, Melendo Pérez S. Bartonella henselae neuroretinitis: a case report. An Pediatr (Barc) 2023:S2341-2879(23)00097-2. [PMID: 37164827 DOI: 10.1016/j.anpede.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/24/2022] [Indexed: 05/12/2023] Open
Affiliation(s)
- Júlia Mirabet Mas
- Servicio de Pediatría, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | | | - Nieves Martín Begué
- Servicio de Pediatría, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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8
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Choi JH, Thomas P, Gray JM, Miller-Handley H, Kurowski EM, Vukovic AA. Hepatic Lesions in an Immunocompetent Child Previously Treated for Cat Scratch Disease With Azithromycin. Clin Pediatr (Phila) 2023; 62:191-194. [PMID: 36016489 DOI: 10.1177/00099228221118602] [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: 11/16/2022]
Affiliation(s)
- Jason H Choi
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Phillip Thomas
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James M Gray
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hilary Miller-Handley
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Internal Medicine, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Eileen M Kurowski
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Adam A Vukovic
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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9
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Altman MT, Mullin RE, Felder K, Starkey J, Vaz LE, Scruggs BA. An Eye-Opening Case of Persistent Headaches and Fever in a Teenager. Clin Pediatr (Phila) 2022; 62:492-497. [PMID: 36199235 DOI: 10.1177/00099228221123828] [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: 11/15/2022]
Affiliation(s)
- Marcus T Altman
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Rachael E Mullin
- Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, USA
| | - Kimberly Felder
- Division of Pediatric Infectious Diseases, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, USA
| | - Jay Starkey
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Louise E Vaz
- Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, USA.,Division of Pediatric Infectious Diseases, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, USA
| | - Brittni A Scruggs
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA.,Vitreoretinal Surgery, Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
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10
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Mirabet Mas J, Morell Daniel M, Martín Begué N, Melendo Pérez S. Neurorretinitis por Bartonella henselae: a propósito de un caso. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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11
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Sucasas Costa P, Rocha Alvarenga L, Carnot Iori GF, de Toledo Lima T, Marques Fortes P. Periorbital Cellulitis in a Previously Healthy Boy: Scratch and Win. Clin Infect Dis 2022; 75:1265-1267. [PMID: 36179341 DOI: 10.1093/cid/ciab788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Paulo Sucasas Costa
- Department of Pediatrics, School of Medicine, Hospital das Clinicas, Universidade Federal de Goias, Brazil
| | - Lucas Rocha Alvarenga
- Department of Pediatrics, School of Medicine, Hospital das Clinicas, Universidade Federal de Goias, Brazil
| | | | - Talita de Toledo Lima
- Department of Ophtalmology, School of Medicine, Hospital das Clinicas, CEROF, Universidade Federal de Goias, Brazil
| | - Patricia Marques Fortes
- Department of Pediatrics, School of Medicine, Hospital das Clinicas, Universidade Federal de Goias, Brazil
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12
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Cute Cats, Disastrous Nightmare. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2022. [DOI: 10.1097/ipc.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Zhu M, Zhang S, Shi Q, Sun X, Zhang X, Wang H, Liu Y, Sun M. Swollen inguinal lymph nodes with low fever and night sweat: diagnosis and treatment of case of cat-scratch disease lymphadenitis with sinus formation. Heliyon 2022; 8:e10448. [PMID: 36097471 PMCID: PMC9463371 DOI: 10.1016/j.heliyon.2022.e10448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/19/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
A 52-year-old woman complained of inguinal lymph node enlargement, low fever and night sweats for 20 days. After pathological biopsy and metagenomic sequencing, she was diagnosed as having Bartonella henselae infection. Her lymph nodes were accompanied by multiple ulcers in the affected area and sinus formation. Azithromycin was administered according to the Sanford Guide to Antimicrobial Therapy 2020, combined with wound repair and partial resection of inguinal lymph nodes. The patient showed good recovery after the operation. In all, lymphadenitis associated with B. henselae infection is difficult to diagnose. Lymphadenitis with suppuration and sinus formation needs multidisciplinary consultation. When the causal pathogen is unknown, metagenomic sequencing is recommended for a definite diagnosis.
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14
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Ng CC, Ng J, McDonald HR, Cunningham ET. Bartonella henselae-associated recurrent, bilateral segmental periphlebitis. Am J Ophthalmol Case Rep 2022; 26:101475. [PMID: 35321248 PMCID: PMC8935419 DOI: 10.1016/j.ajoc.2022.101475] [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: 12/06/2021] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To describe a patient with atypical Bartonella henselae (B. henselae)-associated ocular inflammation that manifested with recurrent, bilateral segmental periphlebitis. Observations A 32-year-old White man presented with multiple paracentral scotomata in each eye. Examination revealed mild vitreous cell, segmental sheathing of the retinal veins, and inflammation of the paravenous retina in each eye. Multimodal imaging, including optical coherence tomography as well as widefield fundus autofluorescence, fluorescein angiography, and indocyanine green angiography, was consistent with bilateral, segmental retinal periphlebitis with paravenous inflammation and retinochoroidal scarring. Serology showed elevated B. henselae antibody titers, but was otherwise unrevealing, and the patient was diagnosed with presumed B. henselae-associated ocular inflammation. Treatment with systemic doxycycline (100 mg PO BID) for four weeks improved the patient's symptoms and posterior uveitis. However, after an asymptomatic period of nearly one year, his bilateral pericentral scotomata recurred and posterior segment examination confirmed new foci of retinal periphlebitis in each eye. Re-treatment with doxycycline (100 mg PO BID) for four weeks again yielded improvement, but one month after completing his antibiotic course, his visual symptoms recurred, and we observed additional areas of periphlebitis and paravenous retinitis with associated branch retinal vein occlusions in each eye. This time a dual antibiotic regimen of doxycycline (100 mg PO BID) and rifampin (300 mg PO BID) was administered for three months, with improvement. Over the next eight years, the patient experienced no further disease relapse, and the previous sites of retinal periphlebitis eventually developed perivenous fibrosis with paravenous retinochoroidal scarring. Conclusion Rarely, patients with B. henselae-associated ocular inflammation develop segmental retinal periphlebitis with or without retinal vein occlusion. This form of ocular bartonellosis can recur, requiring multiple courses of antimicrobial therapy.
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Affiliation(s)
- Caleb C. Ng
- Retina Consultants of Orange County, Fullerton, CA, USA
- West Coast Retina Medical Group, San Francisco, CA, USA
| | - Joshua Ng
- West Coast Retina Medical Group, San Francisco, CA, USA
| | - H. Richard McDonald
- West Coast Retina Medical Group, San Francisco, CA, USA
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | - Emmett T. Cunningham
- West Coast Retina Medical Group, San Francisco, CA, USA
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
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15
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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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Karti O, Ataş F, Saatci AO. Posterior Segment Manifestations of Cat-scratch Disease: A Mini-review of the Clinical and Multi-modal Imaging Features. Neuroophthalmology 2021; 45:361-371. [PMID: 34720266 DOI: 10.1080/01658107.2021.1939393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Bartonella henselae, an intracellular gram-negative bacillus, is usually transmitted from infected cats to humans by direct or indirect contact. The bacterium mainly infects erythrocytes and endothelial cells thereby leading to so called cat-scratch disease (CSD) and may present with various localised and/or systemic manifestations. The eye is the most commonly affected organ in disseminated CSD and ocular bartonellosis has been reported in 5-10% of CSD patients. The most well-known clinical feature of ocular bartonellosis is neuroretinitis but various sight-threatening posterior segment lesions involving the optic nerve, retinal vasculature, retinal and choroidal tissues may occur during the disease course. This mini-review aims to overview both the clinical and multi-modal imaging characteristics of posterior ocular segment manifestations of CSD.
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Affiliation(s)
- Omer Karti
- Department of Ophthalmology, Democracy University, İzmir, Turkey
| | - Ferdane Ataş
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
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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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Cat scratch disease neuroretinitis: A case report. Ann Med Surg (Lond) 2021; 69:102722. [PMID: 34457255 PMCID: PMC8377531 DOI: 10.1016/j.amsu.2021.102722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Cat scratch disease (CSD) is a ubiquitous infectious disease caused by a Gram-negative intracellular bacillus, Bartonella henselae. Neuroretinitis is a classical but rare manifestation of CSD. Case presentation A 20-year-old woman presented with a 5-day-history of reduced vision in the left eye (LE). Two weeks before eye symptoms, she complained from fever, fatigue and arthromyalgia which resolved spontaneously. In the LE, visual acuity (VA) was 7/10, fundus photography showed optic disc edema with macular exudates arranged in incomplete macular star. Serologic test for Bartonella henselae using indirect immunofluorescent assay (IFA) was highly positive (1:2560 UI/L) for immunoglobulin G (Ig G). The diagnosis of CSD associated neuroretinitis has been made and the patient was treated with doxycycline, rifampicin and oral prednisolone. Twelve months after the end of therapy, VA was 10/10, fundus photography and Macular OCT were normal. Discussion In CSD, neuroretinitis occurs 2–3 weeks after systemic symptoms. The clinical features of CSD are not specific hence the need for bacteriological diagnosis which is based mainly on serologic testing by the detection of Ig G and Ig M by IFA or ELISA. The treatment of CSD-associated neuroretinitis is not standardized. Antibiotics active against intracellular bacteria, with or without systemic corticosteroids, should be prescribed especially in severe cases. The outcome of Bartonella henslae neuroretinitis is usually favourable. Conclusion Despite rarely reported in Tunisia, CSD should be considered in patients with presence of typical neuroretinitis with macular star and of a history of contact with cats. Cat scratch disease is usually a self-limited lymphadenitis. Neuroretinitis is a rare but classic manifestation of cat scratch disease. Neuroretinitis occurs in 1–2% of patients with cat scratch disease. Diagnosis confirmation is based on serologic testing. The prognosis is usually good.
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Mambretti M, Erba S, Scialdone A, Brucato AL, Casalino G. Intraretinal hyperreflective material in the early stage of Bartonella neuroretinitis. Clin Exp Optom 2021; 105:344-345. [PMID: 34315358 DOI: 10.1080/08164622.2021.1941784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Stefano Erba
- ASST Fatebenefratelli Sacco, Oftalmico Hospital, Milan, Italy
| | | | - Antonio Luca Brucato
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, Università di Milano, Milan, Italy
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Fukuda K, Mizobuchi T, Kishimoto T, Miura Y, Nishiuchi T, Yoshida K, Fukushima A. Clinical profile and visual outcome of intraocular inflammation associated with cat-scratch disease in Japanese patients. Jpn J Ophthalmol 2021; 65:506-514. [PMID: 33797675 DOI: 10.1007/s10384-021-00835-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/28/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate intraocular inflammation in Japanese patients with cat-scratch disease (CSD). STUDY DESIGN Retrospective clinical chart review. PATIENTS AND METHODS The cases of 15 consecutive patients (19 affected eyes) in Kochi Prefecture, Japan who were serologically positive for Bartonella henselae or Bartonella quintana infection in association with intraocular inflammation were reviewed. The clinical manifestations, ocular complications, and treatment modalities were recorded. The clinical charts and photographic records were also reviewed for evidence of optic disc lesions, macular star, foci of chorioretinitis, and other findings. RESULTS Thirteen patients reported fever before or at the time of the initial presentation. Ten of 11 patients with decreased visual acuity manifested neuroretinitis, and the remaining patient showed retinochoroiditis with macular involvement. One patient with a visual field defect manifested branch retinal artery occlusion. Three patients without visual disturbance presented with fever of unknown cause. Discrete white retinal or retinochoroidal lesions were the most common findings (84% of eyes, 87% of patients), followed by retinal hemorrhage (63% of eyes, 80% of patients), optic disc lesions (63% of eyes, 73% of patients), serous retinal detachment (53% of eyes, 67% of patients), and macular star (47% of eyes, 60% of patients). CONCLUSION White retinal or retinochoroidal foci were the most common ocular posterior segment manifestations of CSD in this patient population. A diagnosis of CSD should be suspected in patients with fever and chorioretinal white spots, and the absence of neuroretinitis or macular star does not exclude the possibility of intraocular inflammation in CSD.
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Affiliation(s)
- Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi, 783-8505, Japan.
| | - Tomoka Mizobuchi
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi, 783-8505, Japan
| | - Tatsuma Kishimoto
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi, 783-8505, Japan
| | - Yusaku Miura
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi, 783-8505, Japan
| | - Takashi Nishiuchi
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi, 783-8505, Japan
| | | | - Atsuki Fukushima
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi, 783-8505, Japan
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