Listeria monocytogenes endophthalmitis – case report and review of risk factors and treatment outcomes

Abstract

BackgroundThe majority of cases of endophthalmitis are caused by exogenous pathogens; only 5–10 % are of endogenous origin. One cause of these rare cases of endogenous endophthalmitis is Listeria monocytogenes. Twenty-six cases of endophthalmitis due to this pathogen have been published over the last twenty years. The aim of this review is to summarize the main risk factors and common clinical findings of endogenous endophthalmitis due to Listeria monocytogenes.Case presentationWe report on a 62-year-old female presenting with a sterile hypopyon iritis with secondary glaucoma and an underlying rheumatoid disease. In microbiological analysis we identified Listeria monocytogenes. Further we searched through all published cases for typical signs, risk factors, details of medical and surgical treatment and outcome of endogenous endophthalmitis due to this rare pathogen.Ocular symptoms in almost all of these published cases included pain, redness of the eye, and decreased vision. Main clinical features included elevated intraocular pressure and fibrinous anterior chamber reaction, as well as a dark hypopyon. While the infection is typically spread endogenously, neither an exogenous nor endogenous source of infection could be identified in most cases. Immunocompromised patients are at higher risk of being infected than immunocompetent patients. The clinical course of endophthalmitis caused by Listeria monocytogenes had different visual outcomes. In some cases, the infection led to enucleation, blindness, or strong visual loss, whereas most patients showed a tendency of visual improvement during therapy.ConclusionEarly diagnosis and treatment initiation are crucial factors in the outcome of endogenous endophthalmitis caused by Listeria monocytogenes. This possible differential diagnosis should be kept in mind while treating patients with presumable sterile hypopyon and anterior uveitis having a high intraocular pressure. A bacterial source should be considered with a prompt initiation of systemic antibiotic treatment, mainly in immunocompromised patients, who develop endogenous anterior uveitis. An appropriate microbiological sampling is essential to detect atypical microorganisms and to choose an effective antibiotic treatment.

Listeriosis outbreak likely due to contaminated liver pâté consumed in a tavern, Austria, December 2018

“…The only case without a proven connection to liver pâté of company X was the case with endophthalmitis; only 43 cases of endophthalmitis attributed to an L. monocytogenes infection have been reported in the literature so far [5,19-21]. While we were unable to elucidate any connection of this patient to company X, the case confirmed regular consumption of liver pâté so it is possible that the meat product may have been produced at company X.…”

Listeria Monocytogenes Endophthalmitis after Intermediate Uveitis and ppV for Retinal Detachment

“…Exogenous infection in a young immunocompetent patient has also been described [6]. Patients with systemic infections may develop endophthalmitis because of the possibility of subtherapeutic levels of antibiotics within the eye [9].…”

Navigating a Curious Case of Unilateral Keratouveitis in Pakistan

“…Among the different causes of infectious keratouveitis are HSV, bacterial, fungal and acanthamoeba including non infectious causes which are scleritis and peripheral ulcerative keratitis. A rare cause of keratouveitis is endogenous Listeria monocytogenes endophthalmitis [ 5 ]. The mean annual incidence and prevalence rates (per 100,000 population in Finland) of idiopathic anterior uveitis were 17.1 and 48.5, respectively [ 6 ].…”