1. Cat-scratch disease: ocular manifestations and treatment outcome.
- Author
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Habot-Wilner Z, Trivizki O, Goldstein M, Kesler A, Shulman S, Horowitz J, Amer R, David R, Ben-Arie-Weintrob Y, Bakshi E, Almog Y, Sartani G, Vishnevskia-Dai V, Kramer M, Bar A, Kehat R, Ephros M, and Giladi M
- Subjects
- Adolescent, Adult, Aged, Antibodies, Bacterial analysis, Bartonella henselae genetics, Bartonella henselae immunology, Cat-Scratch Disease complications, Cat-Scratch Disease drug therapy, Child, DNA, Bacterial analysis, Eye Infections, Bacterial drug therapy, Eye Infections, Bacterial microbiology, Female, Fluorescein Angiography methods, Fundus Oculi, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Vision Disorders diagnosis, Vision Disorders physiopathology, Young Adult, Anti-Bacterial Agents therapeutic use, Bartonella henselae isolation & purification, Cat-Scratch Disease diagnosis, Eye Infections, Bacterial diagnosis, Glucocorticoids therapeutic use, Vision Disorders etiology, Visual Acuity
- Abstract
Purpose: To characterize cat-scratch disease (CSD) ocular manifestations and visual outcome and evaluate the effect of systemic antibiotics and corticosteroids on final visual acuity (VA)., Methods: Multicentre retrospective cohort study. Medical records of 86 patients with ocular disease (107 eyes) of 3222 patients identified in a national CSD surveillance study were reviewed., Results: Mean age was 35.1 ± 14.2 years. Median follow-up was 20 weeks (range 1-806 weeks). Of 94/107 (88%) eyes with swollen disc, 60 (64%) had neuroretinitis at presentation, 14 (15%) developed neuroretinitis during follow-up, and 20 (21%) were diagnosed with inflammatory disc oedema. Optic nerve head lesion, uveitis, optic neuropathy and retinal vessel occlusion were found in 43 (40%), 38 (36%), 34 (33%) and 8 (7%) eyes, respectively. Good VA (better than 20/40), moderate vision loss (20/40-20/200) and severe vision loss (worse than 20/200) were found in 26/79 (33%), 35/79 (44%) and 18/79 (23%) eyes at baseline and in 63/79 (80%), 11/79 (14%) and 5/79 (6%) eyes at final follow-up, respectively (p < 0.001). Significant VA improvement (defined as improvement of ≥3 Snellen lines at final follow-up compared to baseline) occurred in 12/24 (50%) eyes treated with antibiotics compared with 14/16 (88%) eyes treated with antibiotics and corticosteroids (p = 0.02). Multivariate logistic regression was suggestive of the same association (odds ratio 7.0; 95% CI 1.3-37.7; p = 0.024)., Conclusion: Optic nerve head lesion is a common and unique manifestation of ocular CSD. Most patients improved and had final good VA. Combined antibiotics and corticosteroid treatment was associated with a better visual outcome., (© 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)
- Published
- 2018
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