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. 2025 Jun;39(3):205-212.
doi: 10.3341/kjo.2024.0129. Epub 2025 Apr 16.

Clinical Characteristics and Visual Outcomes of Cat Scratch Disease

Jane Shi  1 , Muhammad Raza Cheema  1
Affiliations

Clinical Characteristics and Visual Outcomes of Cat Scratch Disease

Jane Shi et al. Korean J Ophthalmol. 2025 Jun.

Abstract

Purpose: To describe the clinical presentation, ocular complications, treatment, and visual outcomes in a series of 17 patients from New Zealand with neuroretinitis secondary to Bartonella henselae.

Methods: Retrospective cross-sectional single-center study from 2001 to 2024. Data was extracted from a clinical database of all patients treated for B. henselae over the past 23 years. Statistical analysis was performed using IBM SPSS Statistics ver. 26.0.

Results: Seventeen patients (19 eyes) were included with 11 (65%) being female. The mean age at presentation was 28.3 ± 12.3 years (range, 13-60 years). The mean presenting visual acuity (Early Treatment Diabetic Retinopathy Study testing) was 50 ± 23 (range, 4-90). The mean final visual acuity was 78 ± 12 (range, 45-90). Eleven patients (65%) had cats or kittens at home, with only one (6%) recounting a history of being scratched. Eight patients (47%) demonstrated the characteristic macular star at presentation, with all eventually developing macular star within a mean of 6 days. Four patients (24%) had macular oedema, three (18%) had vasculitis, two (12%) had uveitis, two (12%) had disc granuloma, and one (6%) had multifocal chorioretinitis. Six patients (35%) were treated with rifampicin and doxycycline, one (6%) with rifampicin and azithromycin, two (12%) with doxycycline only, two (12%) with co-trimoxazole monotherapy, and one patient (6%), who was breast-feeding, was treated with erythromycin. Four patients (24%) did not have receive any treatment.

Conclusions: The characteristic macular star is not always manifest at initial presentation for patients with neuroretinitis secondary to B. henselae, nor is there always a preceding history of cat exposure. Not all patients require treatment to have a good visual outcome, and the immune status of the patient is important.

Keywords: Bartonella; Cat scratch disease; Retinitis; Uveitis.

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Conflict of interest statement

Conflicts of Interest

None.

Figures

Fig. 1
Fig. 1
The macular star, a result of proteinaceous leakage from the optic disc vasculature into the outer retina of the macular in a stellate configuration.
Fig. 2
Fig. 2
Optical coherence tomography image of subretinal fluid accumulating at the macular, a posterior segment manifestation of neuroretinitis.
See this image and copyright information in PMC

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