97th DOG Annual Meeting 1999
OCULAR MANIFESTATION OF BARTONELLA HENSELAE INFECTION
M. Pünder1, A. Sander2, T. Ness1
Purpose: Neuroretinitis and Parinaud oculoglandular syndrome are caused by bartonella henselae, the germ of cat scratch desease. We report the clinical manifestations of bartonella infection based on the retrospective review of the records of eight patients.
Case reports: The age of the patients ranged from 10 to 30 years. All had contact to cats. Serologic findings in all 8 patients revealed a bartonella henselae infection by a typical IgG course and /or by the detection of IgM antibodies. Only one female patient suffered from typical Parinaud oculoglandular syndrom with follicular conjunctivitis and regional lymphadenopathy. Symptoms disappeared within three months. Ptosis of the affected eye was the only sequel. The ocular findings in the other seven patients were completely different. All of them had reduced visual acuity in one eye. Three of the seven patients reported of a flue-like illness 1 to 2 weeks prior the onset of ocular symptoms. Ophthalmoscopic findings included disc edema (7/7), macula star figure (5/7), mild vitritis (5/7) and intraretinal infiltrates (3/7). Associated findings were impaired colour vision and relative afferent pupillary defect in all patients. Fluorescein angiography showed late leakage of the optic disc and the retinal vessels. After treatment with acithromycin or doxycyclin visual acuity recovered and symptoms resolved in four of seven patients. In two patients the clinical course was self limiting without any therapy. One patient was lost for follow up.
Conclusion: Unilateral neuroretinitis is the most common ocular manifestation of an infection with bartonella henselae. It typically occurs in young adults with contact to cats. As the prognosis is fairly good we cannot proof the efficiency of antibiotic therapy.
1 Universitäts-Augenklinik Freiburg
2 Institut für Medizinische Mikrobiologie und Hygiene der Universität