Clinical Case Of Cat-Scratch Disease With Ophthalmic Signs

Cat scratch disease (Bartonellosis) is a bacterial infectious disease spread by cats. It was first described in 1889 by Parinaud. The main etiological cause of the disease is Bartonella henselae – Gram-negative-bacteria, which comes into blood from scratches of domestic or wild cats, especially kittens. The disease in cats spreads with flea bites.

In the USA, 22-25 thousands of patients require outpatient medical care every year due to cat scratch disease, and 2-2,5 thousands of patients need inpatient treatment. In general, the global statistics of the number of cases of this disease is unknown, but the World Health Organization experts consider it very significant.

37-year-old woman came to the ophthalmology emergency department with complaints about blurred vision, pain, lacrimation, photophobia, feeling of a foreign body, discomfort when blinking in the right eye, scratches on the left hand and left lymphadenitis, mild fever. She reported being scratched by kitten 2 days before while she was playing with it. She was also bitten by this kitten several times per month.

Visual acuity (VA) of the right eye was 0,8 (VA was checked subjectively using the Snellen chart from a distance of 5 meters; the best corrected VA was taken into account).VA of the left eye was 1,0.

On the examination of the right eye, we have seen: swollen eyelids, hyperemic conjunctiva, enlarged conjunctival follicles, lacrimation, linear abrasion of the cornea from 8 to 3 hours, involving limbus, anterior chamber was of medium depth with transparent contents, round pupil with active reaction to light, painless ciliary body. The lens wass transparent. The red reflex was present. Fundus – without any pathology. The serological tests shown high levels of IgM to Bartonella henselae.

Patient was treated with Ofloxacin eye drops, Dexpanthenol eye gel, peribulbar Dexamethasone injections, oral Doxycycline, Nimesulide, Vitamin C.

In 3 days VA of the right eye was 1,0. Eyelids were calm, conjunctiva – pale pink, cornea – transparent, smooth, shiny, no signs of limbal wound present. Other structures – within the normal limits.

Cat-scratch disease is characterized by presence of rash, fever, lymphadenopathy. Eyes are affected in 5-10% of cases, most often in the form of neuroretinitis. Possible conjunctivitis with conjunctival granuloma and preauricular lymphadenopathy (Parinaud’s syndrome) may appear. In typical cases, the diagnosis is exclusively clinical and epidemiological, based on the presence of contact with cats, scratches, skin changes and regional lymphadenitis.

To prevent cat scratch disease, people should avoid cat scratches, especially from kittens or stray cats. This is extremely important for people with weakened immune systems. And to choose appropriate flea prevention products for your cats.