Ocular Characteristics Due to Bartonella Henselae Infection: A Retrospective Cohort Study in China.

Abstract

Purpose: To characterize the ocular manifestations of Bartonella henselae infection in Chinese patients.

Methods: We retrospectively investigated the ocular manifestations due to Bartonella henselae infection at Zhongshan Ophthalmic Centers in China between July 2019 and February 2025. Patients with presumptive ocular cat-scratch disease (CSD) confirmed by serum anti-B. henselae IgG titers ≥ 1:256 (via indirect immunofluorescence assay), compatible ocular findings, and possible exposure history were enrolled. Data on demographics, ocular features (visual acuity, anterior/posterior segment findings), systemic symptoms, exposure history, treatment regimens and outcomes were collected.

Results: Fourteen patients (median age 15.5 years; 71.4% male) were enrolled. Pediatric cases (n = 7) accounted for 50%, who showed aggressive bilateral involvement (6/7, 85.7%). Optic disc edema was the predominant manifestation (18/20 eyes, 90%), followed by vitreous cells (65%), anterior chamber cell (50%) and retinal vascular leakage (50%). Initial best-corrected visual acuity (BCVA) ≥0.5 was observed in 40% of eyes, rising to 85% after treatment. Systemic antibiotics were given to all the patients, and corticosteroids were added in 12 (85.7%) patients afterward.

Conclusion: This study identifies optic disc edema as the hallmark ocular phenotype of Bartonella Henselae infection in China. Pediatric patients exhibit aggressive bilateral involvement and diffuse retinal vascular leakage. These findings suggest that ocular CSD may represent an under-recognized cause of pediatric uveitis in Chinese populations. Therapeutic outcomes in this cohort positively indicated that combined antibiotic and anti-inflammatory regimens may improve visual acuity. Further prospective multicenter studies are warranted to further validate these observations.