Update on Bartonella neuroretinitis

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.

Keywords: Bartonella henselae; Cat scratch disease; Neuroretinitis; Optic neuritis; Serology.

Fig. 1

(A) Fundus photograph of the right eye of a 44-year-old patient with a serologically confirmed cat scratch disease (CSD) shows a marked optic disc edema associated with a complete macular star and exudative retinal detachment. Early-phase (B) and late-phase (C) Fluorescein angiograms show progressive leakage and staining of the optic disc (D) Fundus photograph taken 4 weeks later shows a partial resolution of the macular hard exudates, with the appearance of new exudates around the optic disc.

Fig. 2

Fundus photograph of the left eye of a patient with cat scratch disease (CSD) shows a prominent vascularized optic nerve head mass associated with peripapillary exudative retinal detachment (Courtesy, Andre Curi).

Fig. 3

Cat scratch disease (CSD) neuroretinitis in the right eye of a 19-year-old woman. (A) Fundus photograph shows optic disc edema with a partial macular star associated with a white retinal lesion (arrow) (B) Early-phase fluorescein angiogram shows hypofluorescence of the retinal lesion (arrow) (C) Late-phase fluorescein angiogram shows optic disc leakage and staining of the retinal lesion (arrow) (D) Swept-source OCT shows a marked retinal thickening nasally (white asterisk) associated with a macular serous retinal detachment (Courtesy, Walid Zbiba).

Fig. 4

Swept-Source OCT angiography showing peripapillary telangiectatic vessels in a patient with cat scratch disease (CSD)-associated neuroretinitis.