Cat scratch disease: Posterior segment manifestations

doi:10.1016/S0161-6420(99)90452-9

Ophthalmology

Volume 106, Issue 8, 1 August 1999, Pages 1546-1553

Presented in part at the American Academy of Ophthalmology annual meeting, San Francisco, California, October 1997.

https://doi.org/10.1016/S0161-6420(99)90452-9 Get rights and content

Abstract

Objective

To evaluate the posterior segment findings seen in ocular cat scratch disease.

Design

Retrospective case series.

Participants

There were 24 patients (35 eyes) with choroidal, retinal, or optic disc manifestations of Bartonella infection evaluated at the authors’ institutions over a 6-year period.

Main outcome measures

Clinical and photographic records were reviewed for evidence of disc edema, macular star, foci of retinitis or choroiditis, choroidal masses, optic nerve masses, vascular-occlusive events, or other findings.

Results

Discrete white retinal or choroidal lesions, 50 to 3000 μm in diameter, were the most common posterior segment findings in this series of patients (83% of eyes, 83% of patients). Optic disc swelling was the second most common finding (46% of eyes, 63% of patients) followed by a macular star (43% of eyes, 63% of patients). Vascular-occlusive events were also seen (14% of eyes, 21% of patients), and the site of occlusion was found to be intimately associated with the aforementioned retinal lesions. Final visual acuity was 20/25 or better in 26 (74%) of 35 eyes and was similar in both treated and untreated patients.

Conclusion

Isolated foci of retinitis or choroiditis were the most common ocular manifestation of cat scratch disease in the authors’ patient population, but an array of posterior segment findings may occur.

Section snippets

Patients and methods

We reviewed clinical and photographic records from patients examined at our institutions over a 6-year period (1990–1996) with a presumptive diagnosis of cat scratch disease. Twenty-seven patients had posterior segment findings identified as cat scratch disease. Three patients were excluded from further study. Two of these had no supportive laboratory evidence of Bartonella infection and had poor historical information, making the diagnosis of cat scratch disease suspect. One other patient was

Results

Our series of patients is summarized in Table 1, Table 2. The mean age was 31 years (range, 9–57 years). Fifteen females and nine males were affected. The left eye was exclusively involved in 6 patients, the right eye was exclusively involved in 7 patients, and both eyes were involved in 11 patients. Twenty-two patients had a definite exposure to cats or kittens, and in the remaining 2 patients, no definite exposure was identified (although both of these patients had supportive laboratory

Discussion

In 1916, Theodor Leber24 described a series of patients with decreased vision and a “stellate maculopathy.” There was no predisposing cause, and for years, Leber’s idiopathic stellate maculopathy was the diagnosis used to describe the condition affecting these patients. The term neuroretinitis evolved to include the common finding of disc edema with the macular star. The swollen optic disc has been shown to have abnormally permeable capillaries deep within the disc, which leak lipid-rich

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^☆: Supported in part by NIH P30 Ey06360 (Departmental Core Grant) and Research to Prevent Blindness, Inc., New York, New York.

View full text

Cat scratch disease: Posterior segment manifestations☆

Abstract

Objective

Design

Participants

Main outcome measures

Results

Conclusion

Section snippets

Patients and methods

Results

Discussion

Lancet

Infect Dis Clin North Am

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

La maladie des griffes de chat

Bull Mem Soc Med Hosp Paris

Cat scratch diseasea bacterial infection

Science

Cat-scratch disease. Isolation and culture of the bacterial agent

JAMA

Proposal of Afipia gen. nov., with Afipia felis sp. nov. (formerly the cat scratch disease bacillus), Afipia clevelandensis sp. nov. (formerly the Cleveland Clinic Foundation strain), Afipia broomeae sp. nov., and three unnamed genospecies

J Clin Microbiol

Case 22-1992—pathogenesis of cat scratch disease

N Engl J Med

Syndrome of Rochalimaea henselae adenitis suggesting cat scratch disease

Ann Intern Med

Proposals to unify the genera Bartonella and Rochalimaea, with descriptions of Bartonella quintana comb. nov., Bartonella vinsonii comb. nov., Bartonella henselae comb. nov., and Bartonella elizabethae comb. nov., and to remove the family Bartonellaceae from the order Rickettsiales

Int J Syst Bacteriol

Cat scratch disease in Connecticutepidemiology, risk factors, and evaluation of a new diagnostic test

N Engl J Med

Rochalimaea henselae infection. A new zoonosis with the domestic cat as a reservoir

JAMA