The Continuing Ophthalmic Challenge of Bartonella henselae

Abstract

Purpose: To better understand the history and epidemiology of Bartonella henselae infections of the eye and adnexa, and their relationship to cat scratch disease (CSD). We also assess B. henselae infection as a public health threat.Methods: We reviewed the available literature concerning B. henselae infections of the eye and CSD, and attempted calculation of the incidence and prevalence of both B. henselae eye infections and CSD from the database of the Rochester Epidemiology Project.Results: It took nearly a century of determined effort to reveal that Henri Parinaud's oculoglandular syndrome (POGS) (1889) and Leber's stellate retinitis (1916) were the result of B. henselae infection and are subtypes of CSD. These ocular infections remain of clinical, epidemiologic, and public health concern to ophthalmologists with many unanswered questions. Their incidence and prevalence have yet to be accurately determined. Our attempt to achieve this through the Rochester Epidemiology Project database suggests a major obstacle is inconsistent with nonunanimous diagnostic terminology and coding.Conclusions: Modern serologic testing and molecular diagnostic techniques offer ophthalmologists the opportunity to make B. henselae infection of the eyes an area of "precision medicine." For this to happen, greater awareness and teaching about this disease, updated terminology, and a greater clinical and research effort are required.

Cat scratch disease: What to do with the cat?

“…Bartonella species are known to cause several pathologies in both humans and animals 8 This fastidious, pleomorphic, gram-negative rod can be found in the blood of the domestic cat 9 and, in ophthalmological practice, is often encountered in CSD-induced neuroretinitis 10 and Parinaud's oculoglandular disease. 11 Bartonella henselae is classically associated with these pathologies; however, there are other causative species of Bartonella that can be spread by a variety of mammals and arthropod vectors. 12 B. henselae is known to inhabit the digestive tract of the cat flea, and is therefore present and infectious via flea feces, and is present in flea salivary glands.…”

“…However, they do not stipulate fully the circumstances which should prompt testing, and they stress that treatment of a pet is appropriate only if that animal is symptomatic (ie fever, signs of anemia, vasoproliferative lesions, endocarditis and more). 11 These vague “guidelines” allow most veterinarians to choose what to do depending on numerous circumstances, including the type of pet, the type of practice (urban or rural), the requests from pet owners, and their own beliefs. Importantly, these recommendations seem to be out of step with what is currently known about transmission and the spectrum of human and animal disease.…”

Vector-Borne Zoonotic Lymphadenitis – the Causative Agents, Epidemiology, Diagnostic Approach and Therapeutic Possibilities – An Overview

“…Visceral organ-related CSD can lead to persistent fever of unknown origin, abdominal discomfort, and/or weight loss [82][83][84]. Ocular presentations include the Parinaud oculo-glandular syndrome, characterized by preauricular lymphadenopathy and the presence of conjunctival granulomas that usually remain confined to the palpebral conjunctiva [85]. The reason why some individuals with CSD experience localized infection while others develop disseminated disease remains unknown.…”