Archive for the ‘Eye Issues’ Category

Ocular Complications of Cat Scratch Disease

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

Ocular complications of cat scratch disease.


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.



This study states what the rest of us all know – there is a lack of research on Bartonella yet it is everywhere:

And please know you don’t have to be exposed to cats to get it:

You also don’t have to be immunocompromised to get it:

Infectious Keratitis Caused by Rare and Emerging Micro-Organisms

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

Infectious Keratitis Caused by Rare and Emerging Micro-Organisms.


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.



Keratitis is inflammation in the cornea.  The following symptoms were found here:


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:

And here we see Bartonella affecting cats with keratitis as well as conjunctivitis, uveitis, blepharitis, and chorioretinitis:

For more:



Development & Spontaneous Resolution of a Full-thickness Macular Hole in Bartonella Neuroretinitis

2019 Jul 9;15:100515. doi: 10.1016/j.ajoc.2019.100515. eCollection 2019 Sep.

The development and spontaneous resolution of a full-thickness macular hole in bartonella henselae neuroretinitis in a 12-year-old boy.



To describe an unusual case of Bartonella henselae neuroretinitis complicated by macular hole (MH) development.


A full-thickness macular hole developed in a 12-year-old boy in association with serology-confirmed Bartonella henselae neuroretinitis. Following a period of observation, the MH closed without intervention.


MH may occur as a complication of neuroretinitis secondary to Cat-Scratch Disease.



This great article by Galaxy Labs reveals that Bartonella loves the eyes:



Multimodal Imaging of Two Unconventional Cases of Bartonella Neuroretinitis

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




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


Two cases were retrospectively reviewed.


  • 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).


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.


For more:  Bartonella, like Lyme, can be persistent causing chronic infection.


Atypical Papillitis: An Isolated Manifestation of Lyme Disease (Which isn’t Isolated)

2019 Jun 5:1120672119855210. doi: 10.1177/1120672119855210. [Epub ahead of print]

Atypical papillitis: An isolated manifestation of Lyme disease.


Lyme disease is a rare condition caused by the bacterium Borrelia burgdorferi. Despite typical symptoms including fever, headache, fatigue, and a characteristic skin rash, sometimes we cannot find those due to the lack of physician consultation in those early stages. If this disease is left untreated, infection could spread to the nervous system causing neuroborreliosis, an atypical and complicated manifestation of this disease. We present the case of an atypical papillitis, probably caused by this bacterium. We suspected this because of the results on the indirect test bloods and the improvement of the symptoms after treatment. This entity should be considered as a possible diagnosis of atypical optical neuropathies, particularly if it occurs in an endemic area.



Lyme disease is NOT A RARE CONDITION.

Neuroborreliosis is NOT ATYPICAL. It is the inevitable outcome without treatment.

Note that they state the “atypical” papillitis is probably due to Lyme and they make that decision based upon a blood test as well as improvement after treatment.

This is a great example of how doctors should be treating Lyme/MSIDS clinically. They also shouldn’t be fearful of treating this clinically. Due to abysmal serology testing, doctors should understand that testing positive is not a prerequisite, but if symptoms add up, they should treat clinically and look at results.  As they say, “the proof’s in the pudding.”

Lyme/MSIDS should be considered in any neuropathy. It is a well known symptom. 

According to the National Eye institute, papillitis is a twenty dollar word for optic nerve inflammation.

Lyme loves the eyes and nerves and causes wide spread inflammation.


  • loss of vision
  • pain in the eye
  • interference with accurate color vision (dyschromatopsia)


  • Diseases that result in damage to the lining of nerves (demyelinating diseases) such as multiple sclerosis and encephalomyelitis; viral or bacterial infections such as polio, measles, pneumonia, or meningitis
  • nutritional or metabolic disorders such as diabetes, pernicious anemia, and hyperthyroidism
  • secondary complications of other diseases
  • reactions to toxic substances such as methanol, quinine, salicylates, and arsenic
  • trauma

Being in an endemic area has NOTHING to do with this.

Ticks are everywhere, and happily transmitting diseases as they travel. These types of limiting statements by ignorant researchers have been used against patients for decades. Doctors desperately need to study this and stop believing and repeating ancient mythology.

For more on Lyme & eye issues:  The authors described patients with tick-transmitted diseases presenting with the following ophthalmologic findings:

  • Follicular conjunctivitis
  • Periorbital edema and mild photophobia
  • Bell’s palsy, cranial nerve palsies and Horner syndrome
  • Argyll Robertson pupil
  • Keratitis
  • Optic neuritis, papilledema, papillitis and neuroretinitis
  • Myositis of extraocular muscles and dacryoadenitis
  • Episcleritis, anterior and posterior scleritis
  • Anterior, intermediate, posterior and panuveitis
  • Retinal vasculitis, cotton wool spots and choroiditis
  • Retinitis, macular edema and endophthalmitis

I sent all of this information to the first author. Hopefully, she will read it.


Retinal Vessel Occlusion Caused by Bartonella Infection

. 2018 Nov 19; 33(47): e297.
Published online 2018 Oct 29. doi: 10.3346/jkms.2018.33.e297
PMCID: PMC6236082
PMID: 31044568

A Case of Retinal Vessel Occlusion Caused by Bartonella Infection

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A 29-year-old female visited the emergency room with sudden visual loss in the right eye started on the same day. She had been suffering from fever for two days. A best-corrected visual acuity (BCVA) was 0.5/0.7 in the Snellen chart. Fundus examination (Fig. 1) showed multiple retinal hemorrhages. Severe vascular sheaths around the optic disc area were present in the right eye. Candle-wax-dripping sign in the superior hemisphere were found in the left eye.

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On systemic examination, erythema of the lower extremities (Fig. 1C) and right inguinal lymph node enlargement were discovered. With systemic doxycycline (100 mg) and gentamicin (90 mg) administration, fever subsided after three days. Bartonella infection was confirmed after 10 days with in-house indirect immunofluorescent assay (IFA) analysis (immunoglobulin G; cutoff points for seropositive titer at 1:64). Lymph node biopsy showed necrotizing granulomatous lymphadenitis (Fig. 1D). On the same day, the BCVA decreased to hand motion in the right eye. When asked, she could not specify when the vision loss began. The candle-wax-dripping sign in the left eye had progressed to vascular sheath with flame-shaped hemorrhages. Fluorescein angiography shows a rack of filling of the retinal arteries. Blocked fluorescence by retinal hemorrhage was found in the whole area of right eye and in the superotemporal quadrant of left eye. Inner-retinal hyper-reflectivity of the right eye and cystoid macular edema in the left eye were revealed (Fig. 2). The impression was central retinal artery and vein occlusion for the right eye and branch retinal artery and vein occlusion for the left eye, associated with severe vasculitis secondary to Bartonella infection. The patient was treated with a systemic methylprednisolone 500 mg, anticoagulant (Enoxaparin sodium 60 mg) and Rifampin (300 mg). Three month after disease onset, the BCVA in the right eye improved to 0.1. For photographs and medical records that consisted possible identification of the patient, a consent form was obtained from the patient for use of publication.

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The authors thank Professor Jin-Soo Lee, Department of Internal Medicine, Inha University School of Medicine, for his help with the in-house IFA analysis.


Funding: This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation of Korea (NRF), funded by the Korean government, the Ministry of Science and ICT (MSIP) (NRF-2017M3A9E2056458).

Disclosure: The authors have no potential conflicts of interest to disclose.

Contributed by

Author Contributions: Conceptualization: Woo M, Kim SW. Investigation: Woo M, Ahn S. Writing – original draft: Woo M. Writing – review & editing: Ahn S, Song JY, Kim SW.


1. Kwon HY, Im JH, Lee SM, Baek JH, Durey A, Park SG, et al. The seroprevalence of Bartonella henselae in healthy adults in Korea. Korean J Intern Med. 2017;32(3):530–535. [PMC free article][PubMed] []

Human Bartonellosis: An Underappreciated Public Health Problem?

Trop. Med. Infect. Dis. 2019, 4(2), 69;

Human Bartonellosis: An Underappreciated Public Health Problem?

Published: 19 April 2019
(This article belongs to the Special Issue Recent Advancements on Arthropod-Borne Infectious Diseases)


Bartonella spp. bacteria can be found around the globe and are the causative agents of multiple human diseases. The most well-known infection is called cat-scratch disease, which causes mild lymphadenopathy and fever. As our knowledge of these bacteria grows, new presentations of the disease have been recognized, with serious manifestations. Not only has more severe disease been associated with these bacteria but also Bartonella species have been discovered in a wide range of mammals, and the pathogens’ DNA can be found in multiple vectors. This review will focus on some common mammalian reservoirs as well as the suspected vectors in relation to the disease transmission and prevalence. Understanding the complex interactions between these bacteria, their vectors, and their reservoirs, as well as the breadth of infection by Bartonella around the world will help to assess the impact of Bartonellosis on public health. View Full-Text

Figure 1  The Clinical Manifestations of Bartonellosis
Excerpt from full-text
Known diseases caused by Bartonella infections include:
  • Carrion’s disease
  • cat-scratch disease
  • chronic lymphadenopathy
  • trench fever
  • chronic bacteraemia
  • culture-negative endocarditis
  • bacilliary angiomatosis
  • bacilliary peliosis
  • vasculitis
  • uveitis [1,2,4,6,7,9,10,11].
Recently, Bartonella infections have been linked to more diverse manifestations such as:
  • hallucinations
  • weight loss
  • muscle fatigue
  • partial paralysis
  • pediatric acute-onset neuropsychiatric syndrome (PANS)
  • other neurological manifestations [6,8,10].

A few case studies have also documented Bartonella in tumors, particularly vasoproliferative and those of mammary tissue [12,13,14]. The potential involvement of this pathogen in breast tumorigenesis is both disconcerting and warrants significantly more research.

Bartonella spp. are zoonotic pathogens transmitted from mammals to humans through a variety of insect vectors including the sand fly, cat fleas, and human body louse [4,5]. New evidence suggests that ticks, red ants, and spiders can also transmit Bartonella [15,16,17,18]. Bed bugs have been implicated in the transmission cycle of B. quintana and have been artificially infected [19]. B. quintana was found in bed bug feces for up to 18 days postinfection [19]. The diversity of newly discovered Bartonella species, the large number and ecologically diverse animal reservoir hosts, and the large spectrum of arthropod vectors that can transmit these bacteria among animals and humans are major causes for public health concern.

Regarding ticks….

3.2. Arachnids (Spiders and Ticks)

Over the last 10 years, the topic of ticks transmitting Bartonella species has been widely debated. Evidence exists to support the transmission of Bartonella through many different species of ticks.

Ixodid ticks, also known as hard ticks, appear to be the main type of tick associated with these bacteria. Tick cell lines have been used to show that Bartonella can replicate and survive within:

  • Amblyoma americanum (Lone Star Tick)
  • Rhipicephalus sanguineus (Brown Dog Tick)
  • Ixodes scapularis cells [77] (Deer Tick)

In California, questing ticks of

  • Ixodes pacificus (Western Black legged Tick)
  • Dermacentor occidentalis (Pacific Coast Tick)
  • Dermacentor variabilis (American Dog Tick)

were collected when in the adult and nymphal stages and tested for Bartonella by PCR for the citrate synthase gene. [78]. All types of ticks were found to contain Bartonella DNA, although in varying percentages and locations. These data alone do not prove that ticks can transmit Bartonella spp. Bacteria; however, the results do show Bartonella DNA occurring naturally in these wild ticks.

In Palestine,

  • Hyalomma spp. (Genus of hard-bodied tick) found in Asia, Europe, & North and South Africa.
  • Haemphysalis spp. (The Asian Long-horned tick is an example)
  • Rhipicephalusspp. (Hard-bodied tick native to tropical Africa)

ticks were collected from domestic animals and tested by PCR for the Bartonella intergenic transcribed spacer (ITS) region [38]. These ticks were infected with 4 strains of Bartonella: B. rochalimae, B. chomelii, B. bovis, and B. koehlerae [38]. While this study tested a collection of ticks found on domestic animals, the results suggest that individuals in close contact with these animals should be aware of the potential for transmission through tick bites.

In a sampling of ticks (Ixodes scapularis and Dermacentor variabilis) and rodents (Peromyscus leucopus) from southern Indiana, the midgut contents of the tick species and rodent blood were analyzed by 16S sequencing. Bartonella was present in a moderate percentage (26% in D. variabilis and 13.3% in I. scapularis) of larvae and nymphs of both tick species, even those scored as unengorged, but was present in the majority (97.8%) of the rodents tested [79].
A survey of ticks from 16 states in the U.S. revealed that the overall prevalence of Bartonella henselae in Ixodes ticks was 2.5% [80].
Interestingly, the highest rate of both Borrelia spp. (63.2%) and B. henselae (10.3%) was found in Ixodes affinis ticks collected from North Carolina.
Ixodes ricinus has been the focus of studies that support tick transmission of Bartonella spp. in Europe. This is because I. ricinus is an important vector for tick-borne diseases in Europe [81]. I. ricinus have been collected in the larval, nymphal, and adult stages in Austria [82]. The analyses revealed that 2.1% of all ticks were infected with Bartonella spp., with the highest rate in ticks derived from Vienna (with a 7.5% infection rate), and that adult ticks had a higher prevalence than other stages [82].
B. henselae, B. doshiae, and B. grahamii DNA were amplified, and this was the first study to find Bartonella-infected ticks in Austria [82].
A recent One Health perspective review on Bartonella indicated that the overall presence of Bartonella in ticks (combining evidence from multiple surveillance studies) was approx. 15% [83].
B. henselae DNA has also been isolated from I. ricinus removed from an infected cat. However, whether the cat gave the tick Bartonella or vice versa cannot be established, so the vector competence of these ticks for transmission cannot be determined [30].
A lab in France has studied the relationship between I. ricinus and Bartonella transmission. One study focused on the ability of ticks to maintain infection from one life stage to the next and tested a vertical transmission from adults to eggs. The authors used B. henselae and found that a transstadial transmission was possible and that a transovarial transmission was not likely [84]. The researchers also supplied evidence to support the vector competency of I. ricinus by amplifying B. henselae DNA from the salivary glands of infected ticks and by amplifying DNA from blood 72 h after infected ticks fed through an artificial system [84]. Although the evidence strongly suggests the ability of ticks to transmit these bacteria, the system employed artificial means for feeding; therefore, one major critique has been that it is not representative of a natural blood meal from a host.
To address this issue, another experiment was performed to the assess vector competency of I. ricinus to transmit Bartonella birtlesii [85]. Mice were infected with B. birtlesii through an intravenous injection via a tail vein, and once mice were infected, naïve ticks were fed on the mice and kept for 3 months to molt. Nymphal ticks were shown to transmit B. birtlesii to naïve mice, and adult ticks were shown to infect blood through a feeder method [85]. B. birtlesii was identified in the blood of the recipient mice through PCR and immunofluorescence [85]. This evidence strongly supports the transmission of these bacteria by ticks. However, the limitation is that this only supports I. ricinus’ ability to transmit a very specific strain of Bartonella, B. birtlesii, which is not linked to human disease.
Concerns such as these related to vector competence and transmission can only be quelled by repeated studies utilizing multiple strains of Bartonella and differing tick species.
An interesting case study provided evidence of spiders transmitting Bartonella. A mother and two sons suffered from neurological symptoms following bites suspected from woodlouse hunter spiders [18]. Bartonella henselae DNA was amplified from the blood of the family as well as from a woodlouse and a woodlouse hunter spider near the family’s home [18]. It cannot be determined if the family contracted the bacteria from the woodlouse or the woodlouse hunter spider or if the lice and spiders contracted the bacteria from the family. This case study points to the importance for diagnosticians to test for bacterial infections after suspected arachnid bites. It also emphasizes the lack of knowledge on the possible vectors that transmit Bartonella as well as the range of manifestations by infection with Bartonella.



I think we can safely state that Bartonella IS an under appreciated health problem.