Complications
Complications of endocarditis include congestive heart failure and systemic embolisation.
Patients should be referred immediately for cardiac/cardiovascular surgery consultation.
Occur 2 to 3 weeks after lymphadenopathy.
Bartonella encephalopathy is the most common form seen with cat-scratch disease, which may present with headache, mental status changes, seizures, or status epilepticus.[31]
Less common neurological complications include myelopathy, peripheral neuropathy, facial palsy, Guillain-Barre syndrome, transverse myelitis, and cerebral arteritis.[31]
Treatment consists of supportive and symptomatic treatment in addition to the definitive antibiotic therapy.
Thrombotic thrombocytopenic purpura, cardiolipin syndrome, and chronic haemolysis may occur.[31]
Treatment with antibiotics improves haematological changes. Blood and blood product transfusions are given as supportive measures.
Causes sudden loss of vision secondary to optic neuropathy, with optic neuritis and macular exudates. Neuroretinitis may take months to resolve, and have long-term sequelae such as problem with color vision.[31]
Treatment with a combination of doxycycline and rifampicin for 4 to 6 weeks has been reported to shorten the course of disease and produce a better visual outcome.[70] Suggestions have been made to use a combination of erythromycin plus rifampicin in children under the age of 8 years, for whom doxycycline is relatively contra-indicated.[31]
Although uncommon, Bartonella may cause lytic lesions of the bone and osteomyelitis as a result of the haematogenous spread. It is also associated with sero-negative arthritis in about 3% of the cases. One study found that the musculoskeletal manifestations were common (10%) in patients with cat-scratch disease, but <1% in that series were found to have osteomyelitis.[71]
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