This primary ocular lesion persists for a few weeks and then heals without scarring. Unilateral involvement of the preauricular node, sometimes accompanied by ipsilateral cervical adenopathy, is the other component of this syndrome. Disseminated infection may involve the liver, spleen, lymph nodes, bone marrow, lower respiratory tract, and eye with necrotizing, granulomatous pathology. The most common neurologic manifestations are headache, obtundation, and coma, which appear one to five weeks after initial symptoms. The onset is often abrupt and marked by fever and convulsions.
Patients usually improve rapidly within several days.
Although transient neurologic abnormalities, such as weakness of an extremity or Babinski's sign, are seen, recovery is almost always complete. The electroencephalogram almost always shows diffuse abnormalities during the acute phase of CNS involvement. Two other caveats should be kept in mind. These levels may persist for a year or longer. In addition, most currently available IFA tests for Bartonella do not reliably distinguish among antibodies directed against the various Bartonella species, although only B. henselae is associated with cat-scratch disease.