Clinical Characteristics and Visual Outcomes of Cat Scratch Disease

To describe the clinical presentation, ocular complications, treatment, and visual outcomes in a series of 17 patients from New Zealand with neuroretinitis secondary to Bartonella henselae.

Retrospective cross-sectional single-center study from 2001 to 2024. Data was extracted from a clinical database of all patients treated for B. henselae over the past 23 years. Statistical analysis was performed using IBM SPSS Statistics ver. 26.0.

Seventeen patients (19 eyes) were included with 11 (65%) being female. The mean age at presentation was 28.3 ± 12.3 years (range, 13-60 years). The mean presenting visual acuity (Early Treatment Diabetic Retinopathy Study testing) was 50 ± 23 (range, 4-90). The mean final visual acuity was 78 ± 12 (range, 45-90). Eleven patients (65%) had cats or kittens at home, with only one (6%) recounting a history of being scratched. Eight patients (47%) demonstrated the characteristic macular star at presentation, with all eventually developing macular star within a mean of 6 days. Four patients (24%) had macular oedema, three (18%) had vasculitis, two (12%) had uveitis, two (12%) had disc granuloma, and one (6%) had multifocal chorioretinitis. Six patients (35%) were treated with rifampicin and doxycycline, one (6%) with rifampicin and azithromycin, two (12%) with doxycycline only, two (12%) with co-trimoxazole monotherapy, and one patient (6%), who was breast-feeding, was treated with erythromycin. Four patients (24%) did not have receive any treatment.

The characteristic macular star is not always manifest at initial presentation for patients with neuroretinitis secondary to B. henselae, nor is there always a preceding history of cat exposure. Not all patients require treatment to have a good visual outcome, and the immune status of the patient is important.