The diagnosis of CSD is based on supportive clinical findings and serologic testing. Indirect fluorescence assay (IFA) and enzyme-linked immunosorbent assay (ELISA) testing can detect serum antibodies to Bartonella henselae. An antibody titer that exceeds 1:64 suggests recent Bartonella infection. Polymerase chain reaction (PCR) testing can also detect the presence of Bartonella infection in serum.

There are no specific guidelines for the treatment of CSD or the associated ocular manifestations as there are no randomized, controlled trials to assess the multiple therapeutic options. Many physicians will not offer therapy for mild to moderate systemic CSD. Various antimicrobial agents have demonstrated efficacy against infections caused by Bartonella henselae including erythromycin, chloramphenicol, rifampin, gentamicin, trimethoprim–sulfamethoxazole, doxycycline, and ciprofloxacin [7, 11].

In those who receive treatment, doxycycline is the antimicrobial agent most commonly used (there are case reports using doxycycline 100 mg orally BID and as high as 250 mg orally QID). An alternative therapy is Ciprofloxacin 500 mg orally BID. The duration of treatment is typically 10–14 days. In patients with Bartonella henselae infection with compromised visual acuity from neuroretinitis, there are case reports/series recommending doxycycline 100 mg every 12 h along with rifampin 300 mg every 12 h [10]. The benefit of systemic corticosteroids is unknown.

The genus Bartonella comprises approximately 20 species of gram negative, intracellular organisms that can cause human disease. Bartonella henselae is the most common cause of ocular associated manifestations with 5–25 % of those infected demonstrating some degree of ocular inflammation [15]. There are no clear guidelines for therapy but most patients who are treated receive Doxycycline 100 mg BID for 10–14 days. The role of systemic corticosteroids is unknown.