BARTONELLA HENSELAE NEURORETINITIS IN CAT-SCRATCH DISEASE - DIAGNOSIS, MANAGEMENT, AND SEQUELAE

Objective: This study aimed to report the long-term outcomes of patien ts treated with an antibiotic drug combination for Bartonella henselae neuroretinitis.Design: The study design was a retrospective case seri es. Participants: Seven consecutive patients with neuroretinitis and c at scratch disease participated. Interventions: Patients underwent med ical and ophthalmic evaluations. Blood cultures were obtained, and B. henselae antibody titers were measured. Tuberculosis, Lyme, toxoplasmo sis, syphilis, and sarcoidosis were excluded. Patients received oral d oxycycline 100 mg and rifampin 300 mg twice daily for 4 to 6 weeks and were observed for an average of 16 months (range, 10-24 months), Form al electrophysiologic testing was performed in three patients after re solution of neuroretinitis. Main Outcome Measures: The changes in ocul ar inflammation and visual function associated with treatment were rec orded. Follow-up examinations and electrophysiologic testing documente d sequelae. Results: Patients presented following cat exposure with fe ver, malaise, and blurred vision. Decreased visual acuity (ranging fro m 20/40 to counting fingers) frequently was associated with dyschromat opsia and afferent pupillary defects. Ophthalmoscopic analysis showed signs of neuroretinitis, including nerve fiber layer hemorrhages, cott on-wool spots, multiple discrete lesions in the deep retina, and stell ate macular exudates. B. henselae infection was confirmed with positiv e blood cultures or elevated immunofluorescent antibody titers or both . Therapy appeared to promote resolution of neuroretinitis, restoratio n of visual acuity, and clearance of bacteremia. After 1 to 2 years, t wo eyes had residual disc parlor, afferent pupillary defects, retinal pigmentary changes, and mildly decreased visual acuity. Electrophysiol ogic studies showed that when compared to the fellow eye, affected eye s had subnormal contrast sensitivity, abnormal color vision, and abnor mal visually evoked potentials. Conversely, electroretinograms were no rmal in all subjects. Conclusions: B. henselae is a cause of neuroreti nitis in cat scratch disease. Compared to historic cases, doxycycline and rifampin appeared to shorten the course of disease and hasten visu al recovery. Long-term prognosis is good, but some individuals may acq uire a mild postinfectious optic neuropathy.