Ophthalmic manifestations of cat scratch disease

Cat scratch disease (CSD) is a worldwide distributed zoonosis caused by Bartonella henselae and other Bartonella spp. The reservoirs of Bartonella are domestic animals, especially cats, and the transmission to humans is thought to occur from a cat scratch or even through the cat flea Ctenocephalides felix. With more and more pet owners, the physicians should keep in mind signs and symptoms of CSD. A widespread infection may occur in 5-14% of cases, and ocular involvement, called ocular bartonellosis, is a quite common consequence of disseminated CSD. Although the most typical manifestations of ocular Bartonellosis are Parinaud's oculoglandular syndrome, neuroretinitis and retinochoroiditis, many other ophthalmic conditions have been reported. The diagnosis of CSD is often based on history of contact with a cat and high serum titers of immunoglobulin G antibodies against B. henselae. Polymerase chain reaction could be helpful for CSD diagnosis when serology is negative but clinical findings are suggestive for the disease. Multimodal imaging, including fundus autofluorescence, fluorescein and indocyanine green angiography, optical coherence tomography (OCT) and OCT angiography, can be used for diagnosis and monitoring of ocular Bartonellosis. Since CSD is more often a self-limited infection in immunocompetent individuals, no antibiotic treatment is usually needed. However, when a therapy is prescribed, doxycycline is the most used antibiotic. The aim of this article is to review the current literature relating to epidemiology, systemic and ocular manifestations, diagnosis, treatment and prognosis of bartonellosis, in order to give the ophthalmologists a useful tool for daily practice.