Bartonella henselae neuroretinitis in cat scratch disease -: Diagnosis, management, and sequelae
Bartonella henselae neuroretinitis in cat scratch disease -: Diagnosis, management, and sequelae
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DOI：
10.1016/s0161-6420(98)93028-7
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发表时间：
1998-03-01
期刊：
影响因子：
13.7
通讯作者：
Schwab, IR
中科院分区：
文献类型：
--
作者：
Reed, JB;Scales, DK;Schwab, IR
目的：本研究旨在报告使用抗生素药物组合治疗汉赛巴尔通体神经视网膜炎的患者的长期结局。设计：研究设计是一个回顾性病例系列。参与者：七名连续患有神经视网膜炎和猫抓病的患者参与。干预措施：患者接受医疗和眼科评估。获得血培养，和B。测定汉赛氏抗体滴度。肺结核、莱姆病、弓形虫病、梅毒和结节病被排除。患者接受口服强力霉素100 mg和利福平300 mg，每日2次，4至6周，平均观察16个月（范围，10-24个月），正式的电生理测试后，在3例neuroretinitis.Main结果测量：与治疗相关的眼部炎症和视功能的变化进行了记录。随访检查和电生理测试记录的symptoms.Results：患者出现以下猫暴露与发烧，不适，视力模糊。视力下降（范围从20/40到数手指）通常与色觉障碍和传入瞳孔缺陷有关。检眼镜检查显示神经视网膜炎的体征，包括神经纤维层损伤、棉絮斑、视网膜深部多处离散病变和星状黄斑渗出物。B。汉赛原虫感染通过阳性血培养或升高的免疫荧光抗体滴度或两者来证实。治疗似乎可以促进神经视网膜炎的消退、视力的恢复和菌血症的清除。1 ~ 2年后，2只眼出现残余视盘、传入性瞳孔缺损、视网膜色素改变和视力轻度下降。电生理学研究表明，与对侧眼相比，患眼对比敏感度低于正常，色觉异常，视觉诱发电位异常。相反，所有受试者的视网膜电图均正常。结论：B。汉赛氏菌是猫抓病中神经视网膜炎的一个原因。与历史病例相比，多西环素和利福平似乎缩短了病程，加速了视力恢复。长期预后良好，但有些人可能会获得轻度感染后视神经病变。
Objective: This study aimed to report the long-term outcomes of patients treated with an antibiotic drug combination for Bartonella henselae neuroretinitis.Design: The study design was a retrospective case series.Participants: Seven consecutive patients with neuroretinitis and cat scratch disease participated.Interventions: Patients underwent medical and ophthalmic evaluations. Blood cultures were obtained, and B. henselae antibody titers were measured. Tuberculosis, Lyme, toxoplasmosis, syphilis, and sarcoidosis were excluded. Patients received oral doxycycline 100 mg and rifampin 300 mg twice daily for 4 to 6 weeks and were observed for an average of 16 months (range, 10-24 months), Formal electrophysiologic testing was performed in three patients after resolution of neuroretinitis.Main Outcome Measures: The changes in ocular inflammation and visual function associated with treatment were recorded. Follow-up examinations and electrophysiologic testing documented sequelae.Results: Patients presented following cat exposure with fever, malaise, and blurred vision. Decreased visual acuity (ranging from 20/40 to counting fingers) frequently was associated with dyschromatopsia and afferent pupillary defects. Ophthalmoscopic analysis showed signs of neuroretinitis, including nerve fiber layer hemorrhages, cotton-wool spots, multiple discrete lesions in the deep retina, and stellate macular exudates. B. henselae infection was confirmed with positive blood cultures or elevated immunofluorescent antibody titers or both. Therapy appeared to promote resolution of neuroretinitis, restoration of visual acuity, and clearance of bacteremia. After 1 to 2 years, two eyes had residual disc parlor, afferent pupillary defects, retinal pigmentary changes, and mildly decreased visual acuity. Electrophysiologic studies showed that when compared to the fellow eye, affected eyes had subnormal contrast sensitivity, abnormal color vision, and abnormal visually evoked potentials. Conversely, electroretinograms were normal in all subjects.Conclusions: B. henselae is a cause of neuroretinitis in cat scratch disease. Compared to historic cases, doxycycline and rifampin appeared to shorten the course of disease and hasten visual recovery. Long-term prognosis is good, but some individuals may acquire a mild postinfectious optic neuropathy.