Optical neurorretinitis by Bartonella Henselae - case report

Introduction: Cat scratch disease is an infection caused by Bartonella henselae, usually transmitted to humans through cat scratch or bite. The most common clinical manifestation is lymphadenitis, but 5 to 10% of patients with cat scratch disease may have ocular involvement. Objectives and methodology: This work aims to report a case of Neuroretinitis optica by Bartonella Henselae. Data were collected through analysis of medical records with the patient’s consent. Results / Case report: Female, 22 years old, born in Joinville, presented, acutely, decreased visual acuity in RE, without pain on eye movement. She reported flu with fever in the previous month and denied recent vaccination. Visual acuity was 20/40 in RE and the fundus revealed papilla edema, hemorrhage and uveitis (+ / 4 +). In laboratory tests there were no changes. Serology for toxoplasmosis revealed a slight increase in IgM and the other serologies were negative. Sulfamethoxazole 800 mg / trimethoprim 160 mg started 12/12 hs and prednisone 80 mg / day, without improvement. Evolved with worsening and visual acuity (20/100) in OD. Retinography showed vascular narrowing, papillary blurring, decreased foveal brightness and macular edema, configuring optic neuritis D, with no changes in the LE. The neurological evaluation did not find any findings other than visual changes. The CSF study, cranial and orbit MRs were normal. At that time, the patient reported having had contact with a dead kitten. Serology was positive for Bartonella (IgM 1/100). Doxycycline 100mg started at 12 / 12h. After 15 days, a stellate macula and a slight improvement in papilla edema were observed. The patient evolved with full recovery. Conclusion: B.henselae is the main etiological agent of DAG. Kittens are the main reservoirs of B.henselae. Contact with mucous membranes or conjunctivae may be involved. Cat scratch disease (GAD) has two clinical presentations. Typical GAD is characterized by subacute regional lymphadenopathy; atypical GAD is the designation for numerous manifestations involving several organs, and occurs in 10- 15% of cases, being responsible for Parinaud’s oculoglandular syndrome.

Parinaud’s Oculoglandular Syndrome: A Case in an Adult with Flea-Borne Typhus and a Review

Parinaud’s oculoglandular syndrome (POGS) is defined as unilateral granulomatous conjunctivitis and facial lymphadenopathy. The aims of the current study are to describe a case of POGS with uveitis due to flea-borne typhus (FBT) and to present a diagnostic and therapeutic approach to POGS. The patient, a 38-year old man, presented with persistent unilateral eye pain, fever, rash, preauricular and submandibular lymphadenopathy, and laboratory findings of FBT: hyponatremia, elevated transaminase and lactate dehydrogenase levels, thrombocytopenia, and hypoalbuminemia. His condition rapidly improved after starting doxycycline. Soon after hospitalization, he was diagnosed with uveitis, which responded to topical prednisolone. To derive a diagnostic and empiric therapeutic approach to POGS, we reviewed the cases of POGS from its various causes since 1976 to discern epidemiologic clues and determine successful diagnostic techniques and therapies; we found multiple cases due to cat scratch disease (CSD; due to Bartonella henselae) (twelve), tularemia (ten), sporotrichosis (three), Rickettsia conorii (three), R. typhi/felis (two), and herpes simplex virus (two) and single cases due to tuberculosis, paracoccidioidomycosis, Yersinia enterocolitica, Pasteurella multocida, Chlamydia trachomatis, Epstein–Barr virus, and Nocardia brasiliensis. Preauricular lymphadenopathy is a common clinical clue for POGS and is unusual in viral and bacterial conjunctivitis. For POGS, the major etiological consideration is B. henselae, which is usually diagnosed by the indirect immunofluorescence serologic technique. Although CSD POGS is usually self-limited, oral azithromycin may hasten resolution. However, other possible etiologies of POGS may also arise from cat or cat flea contact: sporotrichosis, tularemia, Pasteurella multocida, or FBT. If there is no cat contact, other epidemiologic and clinical findings should be sought, because several of these conditions, such as tularemia, paracoccidioidomycosis, and tuberculosis, may have grave systemic complications. Although there are usually no long-term ocular sequelae if POGS is properly diagnosed, it still may cause prolonged ocular discomfort and require multiple physician contacts.

Ocular complications of cat scratch disease

Cat scratch disease (CSD) in humans is caused by infection with Bartonella henselae or other Bartonella spp. The name of the disease reflects the fact that patients frequently have a history of contact (often involving bites or scratches) with infected cats. Patients with CSD typically develop lesions at the site where the skin is broken together with regional lymphadenopathy but may go on to exhibit systemic symptoms and with deep-seated infections at a range of sites including the eye. Patients with CSD may present with a range of inflammatory eye conditions, including Parinaud’s oculoglandular syndrome, neuroretinitis, multifocal retinitis, uveitis and retinal artery occlusion. Bartonella spp. are fastidious bacteria that are difficult to culture from clinical specimens so microbiological diagnosis is frequently made on the basis of positive serology for anti-Bartonella antibodies or detection of bacterial DNA by PCR. Due to the lack of clinical trials, the evidence base for optimal management of patients with CSD-associated eye infections (including the role of antibiotics) is weak, being derived from single reports or small, uncontrolled case series.

Tuberculosis manifested as Parinaud’s oculoglandular syndrome

A 5-year-old male patient presented to the Sekuru Kaguvi Eye Hospital (SKH) with a painful discharging right eye (RE) for 1 year. Two months prior to presentation, he developed a non-productive cough, night sweats and loss of weight. On examination, a granulomatous follicular conjunctivitis and a corneal phlyctenule were noted in the RE, as well as ipsilateral preauricular lymphadenopathy. In collaboration with the paediatricians, a diagnosis of Parinaud’s oculoglandular syndrome (POGS) as a manifestation of tuberculosis was made. This is the first reported case of POGS and tuberculosis in Zimbabwe.