The clinical spectrum of ocular bartonellosis: a retrospective study at a tertiary centre in Malaysia

Abstract

Background Cat scratch disease (CSD) is a systemic illness caused by the gram-negative bacillus, Bartonella henselea, which can occasionally involve the ocular structures. The objective of this study is to evaluate the various clinical presentations of ocular bartonellosis at our institution. A retrospective review of the clinical records of 13 patients (23 eyes) with ocular manifestations of Bartonella infections over a 3-year period between January 2016 to December 2018 was undertaken at our institution. Results The diagnosis was made based on clinical findings and in addition, with the support of the evidence of Bartonella hensalae IgG and/or IgM. Small retinal white lesions were the most common ocular findings in this series of patients (82.6% of eyes, 76.9% of patients). Neuroretinitis was the second most common finding (47.8% of eyes, 69.2% of patients), followed by exudative retinal detachment involving the macula (34.8% of eyes, 53.8% of patients) and Parinaud’s oculoglandular syndrome (17.4% of eyes, 23.1% of patients). Other findings like isolated optic disc oedema without macular star (8.7% of eyes, 15.4% of patients) and vitritis (4.3% of eyes, 7.7% of patients) were also observed. Ten patients (76.9%) had bilateral ocular involvement. Most of the patients were young, immunocompetent and had systemic symptoms like fever prior to their ocular symptoms. The visual acuity (VA) at initial presentation ranged from 6/6 to hand movement (mean, 6/20), and at final visit 6/6 to 6/60, (mean, 6/9). 91.7% of patients were treated with antibiotics. Only 2 patients received oral corticosteroids together with antibiotics due to very poor vision on presentation. The visual prognosis of ocular bartonellosis is generally good with 16 (88.9%) of 23 eyes having VA of 6/12 or better at final follow-up visit. Conclusion Small foci of retinal white lesions were the most common manifestation of ocular bartonellosis in this series, followed by neuroretinitis, though an array of other ocular findings may also occur. Therefore, we should consider bartonella infection as a possible differential diagnosis in those patients.

Serological review of Bartonella henselae and Bartonella quintana infection among Malaysian patients with unknown causes of febrile illnesses

“…(Tan et al, 2017). A retrospective review of the medical records of 13 Malaysian immunocompetent patients reported fever prior to ocular presentation (Tey et al, 2020). Although these studies suggest that Bartonella infection might not be rare among patients with ocular manifestations, there is no report yet on the investigation of Bartonella infection among febrile patients in West Malaysia.…”

Rats in the city: implications for zoonotic disease risk in an urbanizing world

“…These habitats are frequently used by people in and around Kuching for recreational and foraging activities, which suggests potential local 'hot-spots' for zoonotic transmission. To our knowledge, only ocular bartonellosis has been reported in Malaysia, which is associated with B. henselea, a species that was not identified here (Blasdell et al 2019a, Tey et al 2020. However, as with many other rodent-borne diseases, Bartonella infections generally result in undifferentiated febrile illnesses that are often misdiagnosed, and as a result, the public health impacts of this pathogen are not well understood (Saisongkorh et al 2009, Regier et al 2016.…”

The Clinical Profile of Cat-Scratch Disease’s Neuro-Ophthalmological Effects

“…Tey et al [ 143 ] found that 10 out of 13 patients (76.9%) exhibited posterior segment symptoms, whereas three (23.1%) had Parinaud’s oculoglandular syndrome, lacking the participation of the posterior segment. Eighty-two percent of the eyes had small foci of retinal white lesions.…”