Presumed ocular bartonellosis

Background-The spectrum of diseases caused by Bartonella henselae continues to expand and ocular involvement during this infection is being diagnosed with increasing frequency. Methods-The clinical features and visual prognosis for 13 patients with int raocular inflammatory disease and laboratory evidence of bartonellosis were investigated. There were nine patients with neuroretinitis and four with p anuveitis with positive antibody titres against B henselae determined by an enzyme immunoassay (IgG exceeding 1:900 and/or IgM exceeding 1:250). Results-Positive IgG levels were found for eight patients and positive IgM levels for five. Despite animal exposure of 10 patients, only two (IgG posi tive) cases had systemic symptoms consistent with the diagnosis of cat scra tch disease. Pathological fluorescein leakage of the optic disc was observe d in all affected eyes. At 6 months' follow up, 3/18 (17%) affected eyes ha d a visual acuity of less than 20/100, owing to optic disc atrophy and cyst oid macular oedema. 12 patients (17 eyes) were treated with antibiotics; vi sual acuity improved two or more Snellen lines for 9/17 (53%) eyes. Conclusions-The possibility of B henselae infection should be considered in patients with neuroretinitis and panuveitis (especially in cases with asso ciated optic nerve involvement) even in the absence of systemic symptoms ty pical for cat scratch disease.