rifampin and Cat-Scratch-Disease

We reviewed 19 cases of hepatosplenic cat-scratch disease at Texas Children's Hospital (Houston). The range of the patients' ages was 2 years 4 months to 11 years 8 months. The chief complaint was fever for all patients. The duration of fever before diagnosis was 7 to 56 days (mean, 22 days). Abdominal pain was present in 13 patients (68%). Thirteen children were treated with rifampin alone, and three received rifampin therapy plus gentamicin or trimethoprim-sulfamethoxazole. Once rifampin therapy was initiated alone or in combination, improvement was noted within 1 to 5 days (mean, 2.6 days) for patients who had had prolonged fever the duration of which before rifampin therapy averaged 3 weeks. The most common dosage and duration for our patients were 20 mg/[kg x d] every 12 hours and 14 days, respectively. Rifampin should be considered in the initial antimicrobial treatment of hepatosplenic cat-scratch disease.

Topics: Animals; Anti-Bacterial Agents; Cat-Scratch Disease; Cats; Child; Child, Preschool; Humans; Liver Diseases; Rifampin; Splenic Diseases

BACKGROUND Cat scratch disease (CSD) is a self-limited infection caused by Bartonella henselae that causes lymphadenitis, fevers, skin changes at the inoculation site, headache, nausea, and ocular symptoms. Bartonella neuroretinitis is a form of CSD that presents with ocular symptoms, such as a central scotoma, rather than the typical lymphadenopathy of CSD. Bartonella neuroretinitis is the most common cause of infectious neuroretinitis leading to painless vision loss. Symptoms can mimic the more common optic neuritis, which can lead to under-diagnosis. Early diagnosis of Bartonella neuroretinitis and initiation of appropriate treatment is crucial to prevent vision loss and shorten recovery time. CASE REPORT A 47-year-old man presented to the Emergency Department with nonspecific symptoms of headache, fevers, and visual changes. He was noted to have adopted a cat 2 months prior to presentation. A dilated fundus examination revealed grade 3 optic disc edema with small disc hemorrhages bilaterally without lymphadenopathy, and Bartonella henselae serologies returned positive for the disease. The patient was treated with doxycycline and rifampin at discharge. At his follow-up outpatient ophthalmology visit, the patient had symptomatically improved vision, with dilated fundus examination supporting reduced optic disc edema in the right eye. CONCLUSIONS Early recognition and treatment of Bartonella neuroretinitis is essential to prevent vision loss and shorten recovery time. The current standard of treatment is doxycycline and rifampin for 4 to 6 weeks, and a growing body of literature indicates the supplementation of corticosteroids with these antibiotics.

Topics: Bartonella; Bartonella henselae; Cat-Scratch Disease; Doxycycline; Humans; Papilledema; Retinitis; Rifampin

Severe vision loss from Bartonella neuroretinitis can be best treated to improve visual outcomes with a combination of systemic corticosteroids and antibiotics. Topical ketorolac 0.5% and difluprednate 0.05% are presented as a new adjunct therapy to potentially improve visual outcomes.. This case illustrates severe posterior pole complications that can occur with cat scratch disease disseminated to the eye. Combination therapy with antibiotics and corticosteroids results in better visual outcomes. Topical treatment might further enhance visual outcome by preventing inflammatory damage without significant immunosuppression.. A 17-year-old male teenager presented with right eye vision loss. He had been hospitalized 2 weeks prior for optic neuritis and treated with intravenous methylprednisolone. After 3 days, vision had improved from 20/200 to 20/40. After positive serology for Bartonella henselae was obtained, he was released and treated with oral rifampin, doxycycline, and prednisone. Sixteen days later, he regressed to 20/200, and many more ophthalmic complications were observed. After discontinuation of rifampin, oral prednisone was continued for an additional 2 weeks, and doxycycline was continued for approximately 3 weeks. Topical drops ketorolac 0.5% twice a day and difluprednate 0.05% four times a day were used for more than 6 weeks before tapering after vision returned to normal.. Bartonella neuroretinitis associated with pre-retinal hemorrhage, vitritis, and subretinal hemorrhage can be successfully treated with a combination of systemic medications and topical drops. Monotherapy with doxycycline is effective and well tolerated. Rifampin can cause rapid metabolization and reduction in plasma levels of both prednisone and doxycycline and should be avoided with combined therapy. Oral prednisone and topical difluprednate are recommended to quell initial inflammation during the first few weeks. The anti-inflammatory effects of doxycycline and topical ketorolac used for longer duration may be beneficial in preventing tissue damage without systemic immunosuppression and result in better visual outcomes.

Topics: Anti-Bacterial Agents; Cat-Scratch Disease; Chorioretinitis; Doxycycline; Drug Therapy, Combination; Humans; Ketorolac; Male; Prednisone; Retinitis; Rifampin

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Bartonella henselae; Bone Marrow; Cat-Scratch Disease; Child, Preschool; Female; Femur; Humans; Magnetic Resonance Imaging; Osteomyelitis; Pelvis; Rifampin; Treatment Outcome

We report the case of a 53-year-old healthy man, presenting with confusion. The patient had been clinically diagnosed with cat-scratch disease (CSD) and prescribed a 10-day course of doxycycline orally. Approximately a week after he had completed the treatment, he was admitted to our department with confusion. Neurological examination revealed expressive dysphasia with no motor or sensory deficits. Cerebrospinal fluid (CSF) examination showed only increased content. Imaging with CT and MRI of the brain did not reveal any abnormalities, and funduscopy was normal. Serology confirmed

Topics: Anti-Bacterial Agents; Aphasia; Bartonella henselae; Brain; Brain Diseases; Cat-Scratch Disease; Doxycycline; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Tomography, X-Ray Computed

Topics: Adult; Anti-Bacterial Agents; Bartonella henselae; Cat-Scratch Disease; Doxycycline; Fever; Humans; Lymphadenopathy; Male; Retinitis; Rifampin

Topics: Adolescent; Anti-Bacterial Agents; Bartonella henselae; Cat-Scratch Disease; Diagnosis, Differential; Doxycycline; Female; Follow-Up Studies; Humans; Macular Edema; Retinitis; Rifampin; Vision Disorders; Visual Acuity

Topics: Anti-Bacterial Agents; Cat-Scratch Disease; Child; Clarithromycin; Drug Therapy, Combination; Female; Humans; Magnetic Resonance Imaging; Parotitis; Rifampin

Topics: Adult; Anti-Bacterial Agents; Bartonella; Cat-Scratch Disease; Doxycycline; Drug Combinations; Eye Infections, Bacterial; Female; Humans; Papilledema; Retinitis; Rifampin; Tomography, Optical Coherence

To report a case series of six patients suffering from branch retinal artery occlusion due to Bartonella henselae infection, in order to raise awareness to this etiology in the differential diagnosis of retinal artery occlusion.. A retrospective case series of patients with branch retinal artery occlusion due to ocular cat scratch disease who presented at four tertiary medical centers in Israel, Turkey and Saudi Arabia between the years 2008-2014. Data retrieved from the medical records included demographic data, exposure, complaints, visual acuity, clinical findings and imaging, laboratory assessment, treatment, disease course and visual outcome.. The study group consisted of six patients who presented with branch retinal artery occlusion with or without neuroretinitis. One patient had multiple artery occlusions. Diagnosis of cat scratch disease was established based on positive serology and accompanying systemic symptoms, after ruling out other causes of retinal artery occlusion. Treatment included various regimens of antibiotics and systemic steroids. Visual outcome depended upon the obstructed artery.. Cat scratch disease may cause retinal artery occlusion in infected patients, leaving them with a permanent visual field defect. When retinal artery occlusion occurs as an early sign of the disease, prompt recognition may prevent further events. Thorough history and relevant tests may be of great value.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Bartonella henselae; Cat-Scratch Disease; Ciprofloxacin; Doxycycline; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Fluorescein Angiography; Humans; Immunoglobulin M; Male; Middle Aged; Retinal Artery Occlusion; Retrospective Studies; Rifampin

Topics: Animals; Anti-Bacterial Agents; Bartonella henselae; Cat-Scratch Disease; Cats; Diagnosis, Differential; Doxycycline; Environmental Exposure; Humans; Liver; Male; Middle Aged; Rifampin; Serologic Tests; Spleen; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adolescent; Anti-Bacterial Agents; Antibodies, Bacterial; Bartonella henselae; Cat-Scratch Disease; Doxycycline; Drug Therapy, Combination; Eye Infections, Bacterial; Humans; Immunoglobulin G; Immunoglobulin M; Male; Optic Neuritis; Rifampin; Tomography, Optical Coherence; Vision Disorders

We report a case of bilateral multifocal retinochoroiditis and bilateral optic disc edema in a patient with cat-scratch disease from Bartonella henselae. The patient initially had negative serologic testing. Repeat testing showed a markedly increased IgG and IgM convalescent titer and the development of a branch retinal artery and vein occlusion. In patients for whom there is a high clinical suspicion of cat-scratch disease, a convalescent titer should be obtained 2-3 weeks following a negative initial result.

Topics: Adult; Anti-Bacterial Agents; Bartonella henselae; Cat-Scratch Disease; Chorioretinitis; Diagnosis, Differential; Doxycycline; Eye Infections, Bacterial; Humans; Immunoglobulin G; Immunoglobulin M; Male; Papilledema; Rifampin; Vision Disorders; Visual Acuity; Vitreous Body

Topics: Adult; Angiogenesis Inhibitors; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Bartonella henselae; Bevacizumab; Cat-Scratch Disease; Doxycycline; Fluorescein Angiography; Humans; Intravitreal Injections; Male; Retinal Vein Occlusion; Rifampin; Tomography, Optical Coherence; Treatment Outcome; Vision Disorders

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Bartonella henselae; Cat-Scratch Disease; Doxycycline; Drug Therapy, Combination; Eye Diseases; Eye Infections, Bacterial; Female; Fluorescein Angiography; Glucocorticoids; Humans; Immunoglobulin G; Optic Neuritis; Prednisone; Retinal Detachment; Retinitis; Rifampin; Tomography, Optical Coherence; Vision Disorders; Visual Acuity; Visual Fields; Vitrectomy; Vitreous Body

We present the case of a lung transplant recipient with disseminated infection with Bartonella henselae. In non-immunosuppressed humans, the organism typically causes a local infection that manifests itself as regional lymphadenopathy. The role of the host immune response to B henselae is critical in preventing progression to systemic disease. Only rare cases of bartonellosis in transplant recipients have been reported. We discuss aspects and difficulties of diagnosis and treatment of bartonellosis in a lung transplant recipient who suffered from a severe multisystem involvement of this disease. In our case, the initial response to therapy was unsatisfying and necessitated an extended anti-infective combination therapy, which eventually was successful.

Topics: Adult; Anti-Bacterial Agents; Bartonella henselae; Cat-Scratch Disease; Ciprofloxacin; Clarithromycin; Doxycycline; Drug Therapy, Combination; Female; Humans; Lung; Lung Transplantation; Magnetic Resonance Imaging; Rifampin; Treatment Outcome

Topics: Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Bartonella henselae; Cat-Scratch Disease; Cats; Child; Humans; Liver Diseases; Male; Rifampin; Splenic Diseases; Treatment Outcome

The characteristic clinical presentation of cat scratch disease is subacute regional lymphadenopathy; nevertheless, 5-25% of Bartonella henselae infections may present an atypical or systemic form, with potential eye involvement. We describe three clinical cases of ocular bartonellosis in two adolescents and one young adult, who had close contact with cats; all of them presented persistent fever ranging from 15 to 21 days, and two of them developed a sudden unilateral loss of visual acuity associated with optic neuritis. The other patient presented retinal choroiditis and unilateral retinal microgranulomas, with normal visual acuity. Patients received macrolides as sole antimicrobial or in association with rifampin, and one patient was additionally treated with systemic corticoids. The outcome was favorable in two patients; one patient developed a permanent visual deficit. Ocular bartonellosis must be suspected in patients with close contact to cats or with cat scratches whom develop persistent fever and sudden loss of visual acuity.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Bartonella henselae; Cat-Scratch Disease; Child; Choroid Diseases; Eye Infections, Bacterial; Female; Humans; Male; Optic Neuritis; Retinal Diseases; Rifampin; Visual Acuity

Systemic cat scratch disease (CSD) is often associated with prolonged fever and microabscesses in the liver and/or spleen. We report a case of systemic CSD with hepatic, splenic and renal involvement in an aboriginal child in Taiwan. A previously healthy 9-year-old girl had an intermittent fever for about 17 days, and complained of abdominal pain, headache and weight loss. Abdominal computed tomography showed multiple tiny hypodense nodular lesions in the spleen and both kidneys. Laparotomy revealed multiple soft, whitish-tan lesions on the surface of the liver and spleen. Histopathologic examination of a biopsy specimen of the spleen showed necrotizing granulomatous inflammation with central necrosis surrounded by epithelioid cells and occasional Langhans' giant cells, strongly suggestive of Bartonella henselae infection. History revealed close contact with a cat. B. henselae DNA was detected by polymerase chain reaction in the tissue specimen, and the single antibody titer against B. henselae was greater than 1:2048. These results confirmed the diagnosis of visceral CSD caused by B. henselae. The patient's symptoms resolved after treatment with rifampin and tetracycline. This case illustrates the need for inclusion of systemic CSD in patients with fever of unknown origin and abdominal pain.

Topics: Animals; Bartonella henselae; Cat-Scratch Disease; Cats; Child; Female; Fever of Unknown Origin; Humans; Polymerase Chain Reaction; Rifampin; Tetracycline

Erythema nodosum rarely occurs in childhood and can be caused by cat scratch disease, as a result of agent Bartonella henselae. We report the case of a teenager who presented erythema nodosum and bilateral inguinal adenitis. Cat scratch disease diagnosis was confirmed by anti-Bartonella henselae serologies. Despite an appropriate antibiotic therapy, evolution was unfavourable with adenitis abcédation requiring surgical drainage.. Erythema nodosum in children must let think to cat scratch disease among others etiologies.

Topics: Abscess; Administration, Oral; Adolescent; Anti-Bacterial Agents; Antibodies, Bacterial; Bartonella henselae; Cat-Scratch Disease; Drainage; Erythema Nodosum; Fluorescent Antibody Technique, Indirect; Follow-Up Studies; Groin; Humans; Immunoglobulin G; Male; Rifampin; Time Factors; Treatment Outcome

Topics: Antibiotics, Antitubercular; Biopsy; Cat-Scratch Disease; Fever; Granuloma; Humans; Infant; Male; Rifampin; Spleen; Splenomegaly

Topics: Aortic Valve; Bartonella henselae; Cat-Scratch Disease; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Valve Diseases; Humans; Male; Middle Aged; Mitral Valve; Rifampin; Ultrasonography

We report for the first time three siblings with cat-scratch disease occurring simultaneously. Case 1 was an 8-year-old boy with enlarged supraclavicular lymph nodes and fever. Case 2 was the 11-year-old sister whose presentation was a prolonged febrile illness. Case 3 was a 13-year-old male adolescent with adenitis of the neck and thigh. All three patients were treated with rifampin with improvement of their symptoms.

Topics: Adolescent; Bartonella henselae; Cat-Scratch Disease; Child; Female; Humans; Male; Prognosis; Rifampin; Risk Assessment; Severity of Illness Index; Siblings; Treatment Outcome

Topics: Animals; Bartonella henselae; Cat-Scratch Disease; Cats; Child; Clarithromycin; Epstein-Barr Virus Infections; Herpesvirus 4, Human; Humans; Immunoglobulin G; Immunoglobulin M; Rifampin; Sepsis; Serologic Tests

Topics: Bartonella henselae; Cat-Scratch Disease; Doxycycline; Drug Therapy, Combination; Eye Infections, Bacterial; Humans; Optic Neuritis; Retinitis; Rifampin

To report atypical clinical features of Bartonella henselae neuroretinitis treated with combination antibiotics.. Case report.. A 20-year-old man with a positive B. henselae titer developed a unilateral neuroretinitis, a large peripapillary angiomatous lesion, branch artery occlusion with ischemic maculopathy, and vision loss that failed to improve with clindamycin. Treatment with doxycycline and rifampin led to rapid clinical improvement. The severe vision loss in this case is atypical.. Ocular findings associated with B. henselae infection may include retinal angiomatous lesion and branch retinal artery occlusion. Doxycycline and rifampin were successful in treating the infection.

Topics: Adult; Antibodies, Bacterial; Bartonella henselae; Blindness; Cat-Scratch Disease; Doxycycline; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Eye Infections, Bacterial; Fluorescein Angiography; Fundus Oculi; Hemangioma, Capillary; Humans; Male; Optic Neuritis; Retinal Artery Occlusion; Retinal Neoplasms; Retinal Vessels; Retinitis; Rifampin; Visual Acuity

This study aimed to report the long-term outcomes of patients treated with an antibiotic drug combination for Bartonella henselae neuroretinitis.. The study design was a retrospective case series.. Seven consecutive patients with neuroretinitis and cat scratch disease participated.. Patients underwent medical and ophthalmic evaluations. Blood cultures were obtained, and B. henselae antibody titers were measured. Tuberculosis, Lyme, toxoplasmosis, syphilis, and sarcoidosis were excluded. Patients received oral doxycycline 100 mg and rifampin 300 mg twice daily for 4 to 6 weeks and were observed for an average of 16 months (range, 10-24 months). Formal electrophysiologic testing was performed in three patients after resolution of neuroretinitis.. The changes in ocular inflammation and visual function associated with treatment were recorded. Follow-up examinations and electrophysiologic testing documented sequelae.. Patients presented following cat exposure with fever, malaise, and blurred vision. Decreased visual acuity (ranging from 20/40 to counting fingers) frequently was associated with dyschromatopsia and afferent pupillary defects. Ophthalmoscopic analysis showed signs of neuroretinitis, including nerve fiber layer hemorrhages, cotton-wool spots, multiple discrete lesions in the deep retina, and stellate macular exudates. B. henselae infection was confirmed with positive blood cultures or elevated immunofluorescent antibody titers or both. Therapy appeared to promote resolution of neuroretinitis, restoration of visual acuity, and clearance of bacteremia. After 1 to 2 years, two eyes had residual disc pallor, afferent pupillary defects, retinal pigmentary changes, and mildly decreased visual acuity. Electrophysiologic studies showed that when compared to the fellow eye, affected eyes had subnormal contrast sensitivity, abnormal color vision, and abnormal visually evoked potentials. Conversely, electroretinograms were normal in all subjects.. B. henselae is a cause of neuroretinitis in cat scratch disease. Compared to historic cases, doxycycline and rifampin appeared to shorten the course of disease and hasten visual recovery. Long-term prognosis is good, but some individuals may acquire a mild postinfectious optic neuropathy.

Topics: Adult; Antibodies, Bacterial; Bartonella henselae; Cat-Scratch Disease; Color Perception; Contrast Sensitivity; Doxycycline; Drug Therapy, Combination; Electroretinography; Evoked Potentials, Visual; Eye Infections, Bacterial; Female; Fluorescein Angiography; Fundus Oculi; Humans; Male; Optic Neuritis; Retinitis; Retrospective Studies; Rifampin; Visual Acuity

Topics: Adult; Animals; Antibiotics, Antitubercular; Antibodies, Bacterial; Bartonella henselae; Cat-Scratch Disease; Cats; Ceftriaxone; Cephalosporins; Encephalitis; Eye Infections, Bacterial; Humans; Magnetic Resonance Imaging; Male; Optic Neuritis; Retinitis; Rifampin

Topics: Antibiotics, Antitubercular; Cat-Scratch Disease; Child; Child, Preschool; Diagnosis, Differential; Fever of Unknown Origin; Humans; Liver Abscess; Male; Rifampin; Spleen; Splenic Diseases; Ultrasonography

Topics: Antibodies, Bacterial; Bartonella henselae; Cat-Scratch Disease; Child; Fever; Humans; Male; Polymerase Chain Reaction; Rifampin; RNA, Bacterial; RNA, Ribosomal, 16S

Topics: Antibodies, Bacterial; Cat-Scratch Disease; Child, Preschool; Female; Fluorescent Antibody Technique; Follow-Up Studies; Humans; Liver Diseases; Rickettsieae; Rifampin; Splenic Diseases

Topics: Cat-Scratch Disease; Ciprofloxacin; Humans; Rifampin