Archive for the ‘Eye Issues’ Category

Cat Scratch Disease Imitating A Toxocara Granuloma of the Optic Disk

https://pubmed.ncbi.nlm.nih.gov/29176527/

CAT SCRATCH DISEASE IMITATING A TOXOCARA GRANULOMA OF THE OPTIC DISK

Affiliations expand

Abstract

Purpose: The study reports an unusual presentation of a young female patient presenting with a granulomatous posterior pole mass and profound vision loss secondary to infection with Bartonella henselae.

Methods: A single case report in a child.

Results: An 8-year-old female presented with a recent history of flu-like illness associated with profound vision loss, panuveitis and leukocoria in the left eye. She was found to have a posterior granulomatous mass associated with an exudative retinal detachment presumed as a toxocara granuloma. Magnetic Resonance Imaging ruled out retinoblastoma. Lab work done was negative for toxocariasis and positive for Bartonella henselae titers. She was treated for Cat Scratch Disease (CSD) with steroids and azithromycin. With treatment, the inflammation and exudative retinal detachment resolved, however, the patient had no improvement in visual acuity.

Conclusions: Young patients presenting with leukocoria need a full work up, which includes ruling out retinoblastoma. CSD can present as a granulomatous mass similar to toxocariasis, which can rarely lead to debilitating and irreversible vision loss.

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For more:  https://madisonarealymesupportgroup.com/category/bartonella-treatment/

https://madisonarealymesupportgroup.com/2019/09/07/keep-an-eye-out-for-bartonella/

https://madisonarealymesupportgroup.com/2017/04/06/ocular-bartonellosis/

 

Bartonella Neuroretinitis

https://pubmed.ncbi.nlm.nih.gov/32546517/

. 2020 Jun 16;practneurol-2020-002586.

doi: 10.1136/practneurol-2020-002586.Online ahead of print.

Bartonella Neuroretinitis (Cat-Scratch Disease)

Abstract

We report a patient with cat-scratch disease presenting with meningitis and neuroretinitis. This condition, caused by Bartonella henselae, has a worldwide distribution and is among the most common infective causes of neuroretinitis. Bartonella neuroretinitis is a rare but under-recognised mimic of optic neuritis; it should be suspected in a patient with an infective prodrome whose fundus shows optic disc oedema and a macular star. A low-positive initial serological test for Bartonella henselae does not exclude cat-scratch disease if there is high clinical suspicion, and repeat testing is recommended to look for titre rise.

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**Comment**

A negative test does not exclude Bartonella either.

For more:  https://madisonarealymesupportgroup.com/category/bartonella-treatment/

https://madisonarealymesupportgroup.com/2019/05/05/good-news-for-bartonella-patients-identification-of-fda-approved-drugs-with-higher-activity-than-current-front-line-drugs/

https://madisonarealymesupportgroup.com/2019/09/07/keep-an-eye-out-for-bartonella/

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

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

‘Rare’ Case of Optic Neuropathy Caused by Lyme Disease

https://www.ncbi.nlm.nih.gov/pubmed/32190461

2020 Feb 7;12(2):e6906. doi: 10.7759/cureus.6906.

A Rare Cause of Optic Neuropathy.

Abstract

Lyme disease is a multisystem infection caused by Borrelia burgdorferi that mainly affects the joints, the heart, and the nervous system. Neurological complications usually manifest in untreated patients and present as meningitis, cranial neuropathies, and radiculoneuritis. The authors present the case of a 48-year-old male who developed loss of vision in the right eye over a period of two months. On physical examination a relative afferent pupillary defect of the right eye was noted. Visual evoked potential test revealed delayed P100 latency bilaterally, confirming a bilateral optic neuropathy. The analysis of the cerebrospinal fluid (CSF) showed a lymphocytic meningitis. After an extensive work-up, a diagnosis of Lyme neuroborreliosis with meningitis and optic neuritis was made. The patient was treated with antibiotics and showed gradual improvement. The follow-up brain MRI revealed a mild T2 hyperintensity on the right optic nerve with gliosis, sequelae of the inflammatory process.

Lyme disease should always be considered in patients from endemic areas with nonspecific symptoms. The diagnosis of neuroborreliosis is challenging, but prompt identification and treatment can prevent the development of complications and sequelae.

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**Comment**

Again, just because there isn’t thousands of cases in the literature – doesn’t mean this is rare.  It’s only rare because so many go undiagnosed and testing misses over half of all patients.  If you type in eye or optic in the search bar on this website, you will quickly determine eye issues with Lyme is not rare at all.

https://madisonarealymesupportgroup.com/2019/02/01/erratic-eye-jerks-in-child-with-lyme/

https://madisonarealymesupportgroup.com/2018/08/17/case-of-optic-neuritis-secondary-to-lyme-disease/

https://madisonarealymesupportgroup.com/2017/07/21/growing-list-of-eye-problems-in-lyme-disease/

https://madisonarealymesupportgroup.com/2017/07/30/tick-inside-eye/

https://madisonarealymesupportgroup.com/2019/06/29/atypical-papillitis-an-isolated-manifestation-of-lyme-disease-which-isnt-isolated/

https://madisonarealymesupportgroup.com/2018/09/29/lyme-patients-check-your-vision/

https://madisonarealymesupportgroup.com/2020/01/13/infectious-keratitis-caused-by-rare-and-emerging-micro-organisms/

Lyme isn’t the only offender:  https://madisonarealymesupportgroup.com/2019/04/08/case-series-bartonella-ocular-manifestations/  Bartonella commonly causes eye issues.

Ocular Complications of Cat Scratch Disease

https://www.ncbi.nlm.nih.gov/pubmed/32122915/

2020 Mar 2. pii: bjophthalmol-2019-315239. doi: 10.1136/bjophthalmol-2019-315239. [Epub ahead of print]

Ocular complications of cat scratch disease.

Abstract

Cat scratch disease (CSD) in humans is caused by infection with Bartonella henselae or other Bartonella spp. The name of the disease reflects the fact that patients frequently have a history of contact (often involving bites or scratches) with infected cats. Patients with CSD typically develop lesions at the site where the skin is broken together with regional lymphadenopathy but may go on to exhibit systemic symptoms and with deep-seated infections at a range of sites including the eye. Patients with CSD may present with a range of inflammatory eye conditions, including Parinaud’s oculoglandular syndrome, neuroretinitis, multifocal retinitis, uveitis and retinal artery occlusion. Bartonella spp. are fastidious bacteria that are difficult to culture from clinical specimens so microbiological diagnosis is frequently made on the basis of positive serology for anti-Bartonella antibodies or detection of bacterial DNA by PCR. Due to the lack of clinical trials, the evidence base for optimal management of patients with CSD-associated eye infections (including the role of antibiotics) is weak, being derived from single reports or small, uncontrolled case series.

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**Comment**

This study states what the rest of us all know – there is a lack of research on Bartonella yet it is everywhere:  https://madisonarealymesupportgroup.com/2020/02/19/bartonella-infection-everywhere-but-we-dont-know-about-it/

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

https://madisonarealymesupportgroup.com/category/bartonella-treatment/

https://madisonarealymesupportgroup.com/2019/01/02/bartonella-in-entire-canadian-family/

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

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

And please know you don’t have to be exposed to cats to get it:  https://madisonarealymesupportgroup.com/2018/07/10/bartonella-henselae-neuroretinitis-in-patients-without-cat-scratch/

You also don’t have to be immunocompromised to get it:  https://madisonarealymesupportgroup.com/2019/12/18/multifocal-hepatic-abscess-in-immunocompetent-patient-due-to-bartonella-henselae-case-report-with-review-of-literature/

Infectious Keratitis Caused by Rare and Emerging Micro-Organisms

https://www.ncbi.nlm.nih.gov/pubmed/31870176

2019 Dec 23. doi: 10.1080/02713683.2019.1708407. [Epub ahead of print]

Infectious Keratitis Caused by Rare and Emerging Micro-Organisms.

Abstract

Purpose:  To provide a comprehensive review on rare and emerging micro-organisms causing infectious keratitis.

Material and Methods:  A literature search was performed using PubMed Medline, Cochrane Library Database, EMBASE and Scopus (1960 onwards), using the terms: keratitis caused by rare pathogens; mycotic keratitis; fungal keratitis; bacterial keratitis; infectious keratitis; infective keratitis; atypical fungal keratitis; fungal keratitis caused by rare organisms; fungal keratitis caused by rare ocular pathogen; atypical bacterial keratitis; bacterial keratitis caused by rare organisms; bacterial keratitis caused by rare ocular pathogen. All relevant articles were included in this review.

Results:  A total of 1232 articles matched our search strategy of which 124 articles were included in this mini-review. The rare and emerging bacteria causing keratitis include atypical mycobacteria, Nocardia spp., Chrysebacterium spp., Delftia acidovorans, Kocuria spp., Enterococcus spp., Bartonella henslae, Achromobacter spp. and others. The rare and emerging fungi causing keratitis include Pythium spp., Alternaria spp., Acremonium spp., Cladosporium spp., Curvularia spp., Bipolaris spp., Microsporidia spp., Pseudallescheria spp., Colletotrichum spp., and others. The clinical presentation of these cases is variable. While a few organisms produce characteristic clinical features, rest present similar to bacterial or fungal keratitis with variable response to routine treatment. A strong degree of suspicion is therefore essential for its diagnosis. Special investigations like polymerase chain reaction, gene sequencing, mass spectroscopy and enzyme-linked immunosorbent assay are required for accurate identification of these organisms. Culture-sensitivity is extremely useful as drug resistance to routinely used anti-microbial drugs is common. Prognosis is usually poor for keratitis with Pythium spp., Pseudallescheria spp., Arthrographis spp., Purpureocillium spp., Kociria spp. and Achromobacter spp.

Conclusion:  Keratitis caused by rare and emerging micro-organisms must be suspected in cases where the infection runs an unusual course or shows poor response to standard anti-microbial drugs. Early diagnosis and timely treatment hold the key for good outcome.

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**Comment**

Keratitis is inflammation in the cornea.  The following symptoms were found here:  https://www.mayoclinic.org/diseases-conditions/keratitis/symptoms-causes/syc-20374110

Symptoms

Signs and symptoms of keratitis include:

  • Eye redness
  • Eye pain
  • Excess tears or other discharge from your eye
  • Difficulty opening your eyelid because of pain or irritation
  • Blurred vision
  • Decreased vision
  • Sensitivity to light (photophobia)
  • A feeling that something is in your eye

Great read on Lyme disease also causing keratitis:  https://lymediseaseguide.net/is-lyme-disease-affecting-your-sight-ophthalmological-symptoms-of-lyme-disease-part-one

And here we see Bartonella affecting cats with keratitis as well as conjunctivitis, uveitis, blepharitis, and chorioretinitis:  https://www.northwestanimaleye.com/bartonella-infection.pml

For more:  https://madisonarealymesupportgroup.com/2017/05/20/bartonella-endocarditis-opportunistic-infection-in-cancer-patients-and-eye-inflammation/

https://madisonarealymesupportgroup.com/2017/04/06/ocular-bartonellosis/

https://madisonarealymesupportgroup.com/2019/11/27/development-spontaneous-resolution-of-a-full-thickness-macular-hole-in-bartonella-neuroretinitis/

https://madisonarealymesupportgroup.com/2019/09/07/keep-an-eye-out-for-bartonella/

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