rifampin and Retinitis

Topics: Aged; Animals; Aqueous Humor; Cataract; Clinical Trials as Topic; Conjunctivitis; Cornea; Dacryocystitis; Eye Diseases; Glaucoma; Humans; Iritis; Keratitis; Middle Aged; Rabbits; Retinal Detachment; Retinitis; Rifampin; Uveitis, Anterior; Vitreous Body

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

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

Rapidly declining visual acuity from neuroretinitis should prompt aggressive diagnostic intervention to preserve eyesight. We present a young adult with human immunodeficiency virus (HIV) infection in whom neuroretinitis was the presenting feature of disseminated bartonellosis. Tissue biopsy was required to establish the diagnosis and directed therapy was associated with restored vision.

Topics: Adenine; Anti-Bacterial Agents; Anti-HIV Agents; Bartonella; Bartonella Infections; Biopsy; Deoxycytidine; Doxycycline; Drug Combinations; Efavirenz, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; HIV Infections; Humans; Lung; Male; Organophosphonates; Oxazines; Retinitis; Rifampin; Treatment Outcome; Young Adult

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: Adult; Aged; Chorioretinitis; Choroiditis; Eye Diseases; Female; Humans; Male; Middle Aged; Optic Neuritis; Retinitis; Rifampin; Tuberculosis, Ocular; Uveitis; Uveitis, Anterior