Cat scratch disease

Bartonella henselae or Bartonella quintana are infections that may occur in the weeks after being scratched by a cat. Patients may or may not also have fever and lymph node swelling.

The classic presentation inside the eye is a “neuroretinitis.” The optic nerve and the macula (the center of the retina) are both inflamed and swollen. Less commonly, patients may have focal areas of retinitis that may irritate the retinal veins and cause retinal vein obstruction (1, 2). Dr. Dahr has even seen the very rare instance of cat scratch disease causing a macular hole.

Cat scratch disease is an important disease to diagnose as, if untreated, significant vision loss can occur. The diagnosis is based on the appearance of the inflammation inside the eye combined with a positive antibody blood test. Often the patient can recall being scratched by a cat in the preceding months.

Treatment is usually with antibiotics: doxycycline and azithromycin are both good agents. Dr. Dahr’s usual regimen is Doxycycline, one 100 mg tablet by mouth twice a day for one month. Usually antibiotic treatment alone suffices to calm the inflammation and swelling, but occasionally steroids may be used as well. Dr. Dahr will follow you closely during that month with several visits to make sure you are responding to the medicine.

Patients may need an evaluation with an internist or other doctor to check for effects of the cat scratch disease in other parts of the body.

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