Archive for the ‘Bartonella’ Category

Keep an Eye Out For Bartonella

https://www.galaxydx.com/bartonella-and-the-eyes/

By Galaxy Lab

written on September 4, 2019

Keep an “Eye” Out for Bartonella Infections

Patients with Bartonella species infection (bartonellosis) complain of a variety of nonspecific vision problems that can affect every function of the eye. Making diagnosis and treatment decisions even more difficult, these problems can be caused by a variety of other pathogens and diseases. Fortunately, many peer-reviewed case publications, especially in ophthalmology journals, are available that describe both common and uncommon eye symptoms caused by bartonellosis.

Documented links between Bartonella species infection and vision problems focus on Bartonella henselae (cat scratch disease) and Bartonella quintana (trench fever). B. henselae is associated with contact with animals and vectors, especially cats and fleas, while B. quintana is associated with body lice. Additional species implicated include B. elizabethae and B. grahamii.

Overview

The eye consists of structures that focus light on nerve receptors at the back of the eye, nerves that feed into the optic nerve which connects to the brain, and a blood supply that connects through a central artery and vein into the body’s blood circulation. Bartonellosis can affect each of these parts of the eye.

    A diagram of the eye (Source: NIH).

Patients with bartonellosis-related eye problems may have symptoms in other organs as well that can help clarify whether the eye symptoms are caused by bartonellosis. Ophthalmologists and other physicians look for these additional signs because all of the eye conditions that can be caused by bartonellosis can be caused by a variety of bacteria and viruses, as well as other health conditions including autoimmune disorders.

It can be difficult to narrow down the possible causes of bartonellosis. Sometimes patients can’t remember any events that would have exposed them to Bartonella species. Other times the event, such as a cat scratch, may have occurred weeks to a month or more before symptoms appear and the patient may not think there is a connection. It can take detailed questioning by physicians to identify the possibility of Bartonella species exposure.

Structural Eye Symptoms

The most common way bartonellosis is seen in the eye is called Parinaud oculoglandular syndrome (POGS). About five percent of patients with acute cat scratch disease have this syndrome, which is characterized by follicular conjunctivitis (pink eye) with swollen lymph nodes nearby. It is often accompanied by a fever, and there may be bumps on the eyelid. Other symptoms known to be caused by bartonellosis, such as endocarditis (swelling of the inner lining of the heart), may also indicate that bartonellosis should be suspected.

 

Conjunctivitis results in easily seen inflammation of the usually white part of the eye (Source: CDC).

Inflammation of the middle layer of the structure that surrounds the eyeball is called uveitis. Uveitis causes redness of the eye and can cause light sensitivity, pain and floaters. Uveitis is sometimes associated with bartonellosis.

While case reports of eye symptoms caused by bartonellosis generally describe a sudden-onset condition, one case report describes a woman who had symptoms of bartonellosis in various body organs for more than five years, including chronic conjunctivitis (pink eye). She had multiple tests and treatments over that time including a Bartonella species test that was positive but considered nonspecific. It was only after other treatments didn’t work that antibiotics were administered. The antibiotics resolved her various symptoms.

Neurological Eye Symptoms

Neuroretinitis, an inflammation of the optic nerve head, occurs in about 2% of people with cat scratch disease (acute Bartonella henselae infection). Two-thirds of cases of neuroretinitis are caused by bartonellosis.

Neuroretinitis is usually characterized by sudden, complete vision loss and swelling that creates a star pattern in the macula (the light-sensitive tissue at the back of the eye that feeds information into the optic nerve). Though this is the typical case of neuroretinitis caused by bartonellosis, it can vary greatly. It can cause changes such as seeing odd shapes or colors Furthermore, case reports have included people who lose their vision with no other symptoms, have blurry vision with a headache, and more.

Treatment can usually, but not always, restore vision, but it can take months to resolve and there can still be long-term consequences. Complications can also occur. In one case, a child was diagnosed with neuroretinitis. Treatment was started six weeks after the diagnosis, but his vision in one eye got worse. After treatment, a full-thickness macular hole was discovered. The hole was monitored and resolved after six months.

Vascular Eye Symptoms

The eye has an important network of tiny blood vessels that provide nourishment to the tissue, but unnecessary growth of new capillaries can lead to a range of symptoms such as vision problems. Vasoproliferation (irregular growth of new blood vessels) may be more common in immunocompromised people, such as those being treated with chemotherapy products. These symptoms can be observed on the skin and in the liver and spleen and may also occur in the eye.

Tiny blood vessels in the eyes supply nutrients to cells. In the above image, larger retinal blood vessels can be seen (Source: NIH).

Vasoproliferative symptoms seem to be caused by vascular endothelial growth factor (VEGF) stimulated by bartonellosis. More research on the relationship between VEGF and bartonellosis is needed. Meanwhile, anti-VEGF agents have been used to treat vasoproliferative eye symptoms.

Conclusion

Bartonellosis can affect every part of the eye, and symptoms can be sudden and severe. Diagnosis and treatment decisions are complicated by other pathogens and diseases that can cause similar symptoms. It is important for patients and physicians to be aware of any prior animal or insect exposure that may indicate Bartonella infection. Considering additional systemic symptoms of bartonellosis may also help to clarify the diagnosis.  

Learn more about bartonellosis and the testing that Galaxy Diagnostics offers here.

References

Kalogeropoulos, C. et al. (2011). Bartonella and intraocular inflammation: A series of cases and review of literature. Clinical Ophthalmology, 5, 817-829. doi:10.2147/OPTH.S20157 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130920/

Accorinti, M. (2009). Ocular bartonellosis. International Journal of Medical Sciences, 6(3), 131-132. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659486/

Rolain, J-M., & Raoult, D. (2012). Bartonella infections. In L. Goldman & A. I. Schafer (Eds.), Goldman’s Cecil medicine (24th ed., ch. 323, pp. 1906-1910). Philadelphia, PA: Elsevier Saunders. https://www.sciencedirect.com/topics/medicine-and-dentistry/parinauds-oculoglandular-syndrome

Spinella, A. et al. (2012). Beyond cat scratch disease: A case report of Bartonella infection mimicking vasculitic disorder. Case Reports in Infectious Diseases, 2012, article 354625. http://dx.doi.org/10.1155/2012/354625 https://www.hindawi.com/journals/criid/2012/354625/

Woo, M. et al. (2018). A case of retinal vessel occlusion caused by Bartonella infection. Journal of Korean Medical Science, 33(47), e297. doi:10.3346/jkms.2018.33.e297 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236082/

Fairbanks, A. M. et al. (2019). Treatment strategies for neuroretinitis: Current options and emerging therapies. Current Treatment Options in Neurology, 21(8), 36. doi:10.1007/s11940-019-0579-0 https://www.ncbi.nlm.nih.gov/pubmed/31278547

Michel, Z. et al. (2019). Multimodal imaging of two unconventional cases of Bartonella neuroretinitis [epub ahead of print]. Retinal Cases & Brief Reports. doi:10.1097/ICB.0000000000000893 https://www.ncbi.nlm.nih.gov/pubmed/31348120

Gunzenhauser, R. C. et al. (2019). The development and spontaneous resolution of a full-thickness macular hole in Bartonella henselae neuroretinitis in a 12-year-old boy. American Journal of Ophthalmology Case Reports, 15, 100515. doi:10.1016/j.ajoc.2019.100515 https://www.ncbi.nlm.nih.gov/pubmed/31341998

Toumanidou, V. et al. (2017). Neuroretinitis secondary to Bartonella henselae in a patient with myelinated retinal nerve fibers: Diagnostic dilemmas and treatment. Ocular Immunology and Inflammation, 27(3), 396-398. doi:10.1080/09273948.2017.1409357 https://www.ncbi.nlm.nih.gov/pubmed/29283743

Semes, L. P. (2018, March 23). Optic disc swelling early sign of cat-scratch neuroretinitis [sic]. OptometryTimes.com. Available at: https://www.optometrytimes.com/editors-choice-opt/optic-disc-swelling-early-sign-cat-scratch-neruoretinitis

Mabra, D. et al. (2018). Ocular manifestations of bartonellosis. Current Opinion in Ophthalmology, 29(6), 582-587. doi:10.1097/ICU.0000000000000522 https://www.ncbi.nlm.nih.gov/pubmed/30124532

Beckerman, Z. et al. (2019). Rare presentation of endocarditis and mycotic brain aneurysm [epub ahead of print]. The Annals of Thoracic Surgery. doi:10.1016/j.athoracsur.2019.06.073 https://www.ncbi.nlm.nih.gov/pubmed/31425670

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**Comment**

Another great article by Galaxy Lab. Please read the following article for more information on Bartonella, as various strains are suspected to be transmitted by ticks, mites, various flies and spiders, and other modes, and it is far more prevalent than thought:  https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/  Fifteen species of gram-negative aerobic Bartonella are known to infect humans; however Dr. Ricardo Maggi’s statement is quite telling, “This case reinforces the hypothesis that any Bartonella species can cause human infection.”  

For more on Bartonella and the eyes:  https://madisonarealymesupportgroup.com/2019/04/08/case-series-bartonella-ocular-manifestations/

https://madisonarealymesupportgroup.com/2018/09/06/ocular-manifestations-of-bartonellosis/

 

Rare Presentation of Endocarditis & Mycotic Brain Aneurysm

2019 Aug 16. pii: S0003-4975(19)31173-7. doi: 10.1016/j.athoracsur.2019.06.073. [Epub ahead of print]

Rare Presentation of Endocarditis and Mycotic Brain Aneurysm.

Author information

1
Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care. Electronic address: zbeckerman@austin.utexas.edu.
2
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care.
3
Department of Pediatrics, University of Texas Dell Medical School, Dell Children’s Medical Center, Austin, Texas.
4
Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care; Department of Pediatrics, University of Texas Dell Medical School, Dell Children’s Medical Center, Austin, Texas.

Abstract

Bartonella endocarditis can be a very elusive diagnosis. The clinical manifestations can vary and, at times, include multiorgan involvement. This case report describes two patients presenting with multiorgan failure, cerebral mycotic aneurysms and valvular endocarditis secondary to Bartonella infection. The complex diagnosis, decision making, and surgical management are described.

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**Comment**

It’s unfortunate that once again the study authors choose the word “rare” regarding Bartonella and/or any tick-borne infection manifestations, as even the most hardened critics admit these pathogens are prevalent and can have highly variable presentations. It would have been much more appropriate that the authors would state it’s the first time these particular findings have been published rather than give people the impression something occurs rarely.

Lyme patients and the doctors treating this appropriately are acutely aware of potential heart involvement:  https://madisonarealymesupportgroup.com/2019/06/04/how-vector-borne-diseases-impact-heart-health/

https://madisonarealymesupportgroup.com/2018/06/03/heart-problems-tick-borne-disease/

https://madisonarealymesupportgroup.com/2017/01/04/endocarditis-consider-bartonella/

https://madisonarealymesupportgroup.com/2017/05/11/bartonella-henselae-in-children-with-congenital-heart-disease/

Again, please keep in mind that current 2-tiered CDC testing is based on blood tests that misses half of all cases and do not look for the organism but the body’s immune response (antibodies):  https://madisonarealymesupportgroup.com/2018/12/16/laboratory-testing-for-lyme-disease/  Current CDC guidelines were created for surveillance purposes only but are being used diagnostically. All patients should be informed that they can still be infected despite a negative test. 

Also, please be aware of the conflicts of interest regarding patents on testing:  https://madisonarealymesupportgroup.com/2019/06/28/who-owns-the-elisa-patents/

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There are going to be patients with heart symptoms that have an underlying tick-borne illness but test negatively (seronegative). These people are falling through the cracks of the medical symptom yet could be greatly helped with appropriate antimicrobial treatment. If you suspect you are one of these people or suspect others, please give the validated Horowitz questionnaire to them to take to their practitioner:  https://madisonarealymesupportgroup.com/2017/09/05/empirical-validation-of-the-horowitz-questionnaire-for-suspected-lyme-disease/ It also takes an open mind and trained eye to diagnose these patients, and it can be Lyme, Baronella, or any one of many pathogens transmitted by ticks:  https://madisonarealymesupportgroup.com/2019/08/22/early-diagnosis-necessitates-lyme-savvy-doctors/  I hope doctors are waking up to the growing need for education regarding the growing link between tick-borne illness and heart issues.

 

 

 

 

 

Endocarditis Caused by Bartonella Quintana, A Rare Case in the U.S.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667705/

. 2019; 17: e00533.
Published online 2019 Apr 6. doi: 10.1016/j.idcr.2019.e00533
PMCID: PMC6667705
PMID: 31384552

Endocarditis caused by Bartonella Quintana, a rare case in the United States

Abstract

Bartonella quintana is a relatively rare cause of endocarditis in the United States (USA). Historically it was linked with trench fever, but cardiac involvement seems to be more prevalent recently. There are some known risk factors associated with Bartonella quintana endocarditis such as human immunodeficiency virus (HIV) infection, alcoholism, homelessness and poor hygiene. We report a case of 37-year-old African man, with culture negative endocarditis, emboli and rising B. quintana and B. henselae IgG titers. B. quintana DNA was subsequently detected from the mitral valve sample with 16S rRNA gene and ribC primer sets. Eventually, blood culture for B. quintana was positive after 21 days. Patient was successfully treated with doxycycline and gentamicin. There have been a few cases of B. quintana endocarditis in the USA and most of them were associated with HIV infection, homelessness or alcoholism. The case reported here highlights the importance of high clinical suspicious for Bartonella species in blood culture negative endocarditis in the USA in appropriate setting and will help to increase awareness among physicians for early diagnosis and treatment.

___________________

**Comment**

A few points of interest:

  • Patient’s chief complaints:  progressive shortness of breath, chest painoccasional non-drenching night sweats, fatigue, unintentional ten pound weight loss, and intermittent sharp chest pain radiating to the neck
  • Past medical history significant for latent tuberculosis infection and treatment completed 3 months prior to the presentation
  • While living in the Democratic Republic of Congo before migrating to Indiana, patient had a cow at his home and used to drink raw cow’s milk
  • Had Janeway Lesions on hands & feet http://www.healthgala.info/2017/08/Janeway-lesion-Pictures-Definition-Symptoms-Causes-Treatment.html

Janeway lesion Pictures, Definition, Symptoms, Causes, Treatment

Janeway lesion Pictures, Definition, Symptoms, Causes, Treatment

  • Was considered immunocompetent 

For more:  https://madisonarealymesupportgroup.com/2017/01/04/endocarditis-consider-bartonella/

https://madisonarealymesupportgroup.com/2018/09/28/bartonella-infective-endocarditis-with-dissemination-a-case-report-literature-review/

https://madisonarealymesupportgroup.com/2019/08/12/tick-borne-pathogens-bartonella-spp-borrelia-burgdorferi-sensu-lato-coxiella-burnetii-rickettsia-spp-may-trigger-endocarditis/

https://madisonarealymesupportgroup.com/2019/04/25/case-of-endocarditis-caused-by-bartonella-after-mitral-valve-repair/

https://madisonarealymesupportgroup.com/2018/07/10/infective-endocarditis-associated-with-bartonella-henselae-a-case-series/

https://madisonarealymesupportgroup.com/2019/04/24/human-bartonellosis-an-underappreciated-public-health-problem/

 

 

 

 

 

Animal Health & Nutrition Forum – “Pets & Parasites: Diseases Transmitted by Fleas and Ticks and Their Impact on Animal and Human Health”

https://www.ncbiotech.org/events/pets-and-parasites-diseases-transmitted-fleas-and-ticks-and-their-impact-animal-and-human

“Pets and Parasites: Diseases transmitted by fleas and ticks and their impact on animal and human health” – An Animal Health and Nutrition Forum

Fleas and ticks are the most common ectoparasites (external parasites) of dogs and cats worldwide. In addition to just being a nuisance, fleas are responsible for flea allergy dermatitis and Bartonellosis while ticks are important vectors of diseases that affect humans and animals. The geographic distribution of ticks is changing due to climate change, de-foresting, and the changing living and migrating patterns of deer, birds, and rodents. Ticks are in virtually all parts of the United States, including some urban areas, and many parts of the world. Tick-transmitted diseases include: Lyme disease, Ehrlichiosis, Anaplasmosis, Rocky Mountain Spotted Fever, Babesiosis, and Hepatozoonosis.

Featured Speakers:

Dr. Edward B. Breitschwerdt
Edward B. Breitschwerdt,
Ph.D., NCSU College of
Veterinary Medicine
Dr. Kerrie Powell
Kerrie Powell, Ph.D.,
Cambrex

 

 

 

The AH&N EG forum will discuss Bartonellosis as well as outline the discovery and development of molecules that treat flea and tick infestations on companion animals.

 

 

Agenda

4:30 p.m. – 5:00 p.m. Registration

5:00 p.m. – 6:00 p.m. Presentations

6:00 p.m. – 7:00 p.m. Networking & Refreshments

Directions/Parking

Parking is free

Registration

RSVP is required to reserve your seat.

  • NCBiotech
    15 TW Alexander Drive
    RTP, NC  27709
  • FREE

An Unexpected Case of Bartonella Alsatica Prosthetic Vascular Graft Infection

https://www.dovepress.com/an-unexpected-case-of-bartonella-alsatica-prosthetic-vascular-graft-in-peer-reviewed-article-IDR

An unexpected case of Bartonella alsatica prosthetic vascular graft infection

Authors Puges M, Ménard A, Berard X, Geneviève M, Pinaquy JB, Edouard S, Pereyre S, Cazanave C

Published 7 August 2019 Volume 2019:12 Pages 2453—2456

DOI https://doi.org/10.2147/IDR.S206805

Abstract: Bartonella alsatica is a wild rabbit pathogen causing bacteremia rarely reported in humans, with only three cases published so far, including one lymphadenitis and two endocarditis cases. Here, we report the case of a 66-year-old man who suffered from acute renal failure due to a membranoproliferative glomerulonephritis. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) showed diffuse FDG uptake around the aortobifemoral graft with no indication of infection. A white blood cell scan showed an accumulation of labeled neutrophils on the left femoral part of the graft. The patient underwent surgery and an abscess around the left iliac part of the graft was found intraoperatively. Intraoperative samples were all negative, but 16S rRNA gene-based PCR was positive, and the sequence was positioned among the Bartonella species cluster. Specific PCRs targeting groEL/hsp60, rpoB and gltA genes were performed and led to the identification of B. alsatica. Accordingly, indirect immunofluorescence serological analyses were positive for Bartonella henselae and Bartonella quintana. The patient had a history of regularly hunting wild rabbits. He was treated with 100 mg of doxycycline twice a day for six months and his renal function significantly improved with no sign of persistent infection. This case highlights the contribution of serology assays and molecular-based methods in prosthetic vascular graft infection diagnosis.________________

For more: https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/

https://madisonarealymesupportgroup.com/2019/02/27/advanced-imaging-found-bartonella-around-pic-line/

https://madisonarealymesupportgroup.com/2019/05/09/bartonella-transmitted-to-children-at-birth-causing-chronic-infections/

https://madisonarealymesupportgroup.com/2019/06/06/high-titers-of-bartonella-found-in-patients-with-musculoskeletal-complaints/

https://madisonarealymesupportgroup.com/2019/04/24/human-bartonellosis-an-underappreciated-public-health-problem/

Tick-borne Pathogens Bartonella spp., Borrelia Burgdorferi Sensu Lato, Coxiella Burnetii & Rickettsia Spp. May Trigger Endocarditis

https://www.ncbi.nlm.nih.gov/pubmed/31374162/

2019 Jul;28(7):957-963. doi: 10.17219/acem/94159.

Tick-borne pathogens Bartonella spp., Borrelia burgdorferi sensu lato, Coxiella burnetii and Rickettsia spp. may trigger endocarditis.

Abstract

BACKGROUND:

Infections caused by tick-borne pathogens such as Bartonella spp., Borrelia burgdorferi s.l., Coxiella burnetii and Rickettsia spp. are capable of causing serious lesions of the mitral and aortic valves, leading to a need for valve replacement.

OBJECTIVES:

The aim of the study was to determine whether such cases are sporadic or frequent. An additional goal was to establish effective diagnostic methods to detect these infections.

MATERIAL AND METHODS:

The study involved 148 patients undergoing valve replacement. Blood samples were drawn for serological testing. Samples of the removed mitral and aortic valves were tested with PCR and immunohistochemical staining.

RESULTS:

Specific antibodies to

  • Bartonella spp. were detected in 47 patients (31.7%) and in 1 of the healthy controls (1%) (p < 0.05)
  • B. burgdorferi spirochetes were found in 18 of the patients (12.2%) and in 6 blood donors from the control group (5.8%) (p < 0.1)
  • Rickettsia spp. were detected in 12 (8.1%) 
  • C. burnetii phase I and II antigens in the serum of 1 patient. All the participants in the control group were seronegative to C. burnetii and Rickettsia spp. antigens.
  • PCR tests for detection of Bartonella spp., B. burgdorferi s.l., C. burnetii and Rickettsia spp. DNA in the valve samples were all negative.

Inflammation foci with mononuclear lymphoid cells in the aortic and mitral valves were seen in sections stained with hematoxiline and eozine. In sections dyed using the indirect immunofluorescence method with hyperimmune sera, Bartonella spp. and Rickettsia spp. were found.

CONCLUSIONS:

The results obtained indicate that laboratory diagnostics for patients with heart disorders should be expanded to include tests detecting tick-borne zoonoses such as bartonelloses, Lyme borreliosis, rickettsioses and Q fever.

________________

**Comment**

This article shows that tick borne pathogens are common with patients needing heart valve replacements. Unfortunately, testing still isn’t accurate. Finding antibodies, authorities would argue, doesn’t mean a person has symptoms; however, this issue desperately needs further research as finding antibodies does indicate the presence of pathogens.

A point to be made about the low percentage of those testing positive for Lyme might be due to the fact they only tested one strain: Borrelia burgdorferi sensu lato.  There are 300 strains worldwide and 100 in the U.S. (and counting).

Bartonella is similar in the fact that a recent article pointed out that a 14-year-old boy with PANS caused by Bartonella henselae infection was NOT seropositive. Only one of the three blood samples tested positive before culturing and only two tested positive after culturing. A single blood draw might have missed confirming a diagnosis of bartonellosis.

How many doctors are going to hunt these infections to ground? How many have the time and doggedness it requires to find them? It’s far more likely they will take the results from a singular test, close the book, and move onto the next patient.

We desperately need accurate tests that pick up ALL the pathogens.

 

 

 

Multimodal Imaging of Two Unconventional Cases of Bartonella Neuroretinitis

https://www.ncbi.nlm.nih.gov/pubmed/31348120

2019 Jul 16. doi: 10.1097/ICB.0000000000000893. [Epub ahead of print]

MULTIMODAL IMAGING OF TWO UNCONVENTIONAL CASES OF BARTONELLA NEURORETINITIS.

Abstract

PURPOSE:

To report two cases of cat-scratch fever with atypical posterior segment manifestations.

METHODS:

Two cases were retrospectively reviewed.

RESULTS:

  • A 27-year-old woman presented with painless blurring of central vision in her left eye. Clinical examination revealed a small focal area of retinitis within the macula associated with a subtle macular star. Spectral-domain optical coherence tomography showed a hyper-reflective inner retinal lesion in addition to subretinal and intraretinal fluid as well as hyperreflective foci within the outer plexiform layer. Serology was positive for anti-B. henselae IgM (titer 1:32).
  • A 34-year-old woman presented with painless loss of vision in both eyes associated with headaches and pain with extraocular movement. Spectral-domain optical coherence tomography depicted subretinal fluid, intraretinal fluid, and hyperreflective deposits within the outer plexiform layer. A focal collection of vitreous cell was observed overlying the optic nerve in the left eye. Bilateral disk leakage was identified on fluorescein angiography. Serology revealed high-titer anti-B. henselae antibodies (IgM titers 1:32, IgG titers 1:256).

CONCLUSION:

Our cases highlight the necessity of recognizing more unusual posterior segment presentations of ocular bartonellosis. Multimodal retinal imaging including spectral-domain optical coherence tomography may help better characterize lesions.

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For more:  https://madisonarealymesupportgroup.com/2019/07/28/treatment-strategies-for-neuroretinitis-due-to-bartonella-current-options-emerging-therapies/

https://madisonarealymesupportgroup.com/2018/07/10/bartonella-henselae-neuroretinitis-in-patients-without-cat-scratch/

https://madisonarealymesupportgroup.com/2017/07/21/bartonella-and-neuroretinitis/

https://madisonarealymesupportgroup.com/2018/05/10/bartonella-neuroretinitis-not-atypical/

https://madisonarealymesupportgroup.com/2019/04/08/case-series-bartonella-ocular-manifestations/

https://madisonarealymesupportgroup.com/2019/02/27/advanced-imaging-found-bartonella-around-pic-line/  Bartonella, like Lyme, can be persistent causing chronic infection.