Endophthalmitis Caused by Listeria monocytogenes

Abstract

Listeria monocytogenes was isolated from the aqueous chamber of an immunodepressed patient with acute hypertensive uveitis, who developed a dark hypopyon and pigment dispersion. No extraocular septic focus was found. Treatment was successful with intravitreal vancomycin, anterior chamber irrigation with vancomycin, orally administered ciprofloxacin, and topical fortified vancomycin. CASE REPORTA 62-year-old man presented to the emergency department with pain, redness, and decreased vision in the left eye. The patient had a history of laryngeal carcinoma, for which he had undergone laryngectomy and had been treated with radiation therapy and steroids. Examination of the eye on admission revealed acute hypertensive uveitis, and treatment with corticosteroids was begun but did not provide significant improvement. The patient developed a dark hypopyon with pigment dispersion and uveal ectropion. A differential diagnosis was made between endogenous endophthalmitis and a neoplastic process of the ciliary body (either primary ciliary body melanoma or metastatic melanoma from larynx carcinoma). Results from laboratory studies were unremarkable, except for the leukocyte count (14,030/mm 3 with 77% polymorphonuclear neutrophils). The chest X ray was normal. Blood cultures were negative. An ultrasound scan of the eye showed dispersion of echoes, and no evidence of retinal detachment was noted. B-scan ultrasonography revealed inflammatory deposition and pigmentary epithelium detachment. No proliferation was detected in the stromal iris.Anterior chamber paracentesis was performed and submitted for culture and histopathology. Cytological examination showed polymorphonuclear leukocytes and no evidence of neoplastic cells. Because the patient reported a history of penicillin allergy, combined treatment with oral administration of ciprofloxacin (750 mg twice a day), anterior chamber irrigation with vancomycin, and intravitreal vancomycin (1 mg) was started. Topical fortified vancomycin (1 g) and corticotherapy were also applied. The patient's condition improved with treatment. Within 7 days, the hypopyon disappeared and the intraocular pressure decreased. However, visual acuity was limited to appreciation of hand motion, because of a severe corneal edema and a cataract which developed in the patient's left eye.A small amount of fluid obtained by aspiration from the anterior chamber was directly plated onto blood agar and chocolate agar and distributed into aerobic and anaerobic blood culture bottles processed by the BACTEC 9050 system (Becton Dickinson Microbiology Systems, Cockeysville, Md.). Gram staining was performed and no organisms were observed. After a 24-h incubation of plates at 35°C in a 5% CO 2 -enriched atmosphere, catalase-positive, gram-positive coccobacilli grew, producing beta-hemolysis on blood agar. The isolate was identified as Listeria monocytogenes by both the Wider system (Francisco Soria Melguizo, S.A., Madrid, Spain) and the API Listeria system (bioMérieux, Marcy l'Etoile, France). Pure culture of L. mon...

Eye Infections due toListeria Monocytogenesin Three Cows and One Horse

“…In addition, it has been noted that most ruminant cases of listerial ocular infections appear to occur in the winter and early-spring months, when the animals are housed inside and fed silage. 7,14,16 Although single cases of listerial eye infections have been described previously, 1,7,14,16 this report represents a more comprehensive review of Listeria infections in animals reported in New York State to probe case histories and microbiological and molecular characteristics associated with L. monocytogenes infections of the eye.…”

“…Although only few records of naturally occurring ocular infections by L. monocytogenes exist, 1,5,7,13,14,16 the ability of L. monocytogenes to cause conjunctivitis and keratitis has been well established in experimental animals. 4,8,9,12 In fact, the development of conjunctivitis and corneal infection in rabbits was once used as a method of confirming the identification of an infectious culture as L. monocytogenes.…”

“…6,10,21 In addition to these more common manifestations of listerial infection, eye infections caused by L. monocytogenes have been documented in sheep, cattle, fallow deer, and humans. 1,5,14,16 Most ocular infections have common clinical signs, including swollen, hyperemic conjunctivae, epiphora, photophobia, clouding of the cornea, and scattered white corneal foci. 1,5,7,13,14,16 Listeria monocytogenes infections of farm animals are often linked to exposure to Listeriacontaminated silage.…”

“…1,5,14,16 Most ocular infections have common clinical signs, including swollen, hyperemic conjunctivae, epiphora, photophobia, clouding of the cornea, and scattered white corneal foci. 1,5,7,13,14,16 Listeria monocytogenes infections of farm animals are often linked to exposure to Listeriacontaminated silage. Growth and multiplication of L. monocytogenes naturally present on ensiled plant material are enhanced in poorly fermented silage with a high pH.…”

Endoftalmitis endógenas: revisión de una serie de casos y revaloración de una entidad ocular grave

“…En pacientes inmunodeprimidos o UDVP se aíslan Candida spp. 10 , Aspergillus spp con elevada mortalidad 17 y otros hongos filamentosos 18 , Listeria monocytogenes 19 o Bacillus cereus, principalmente en UDVP por contaminación de la solución utilizada para inyectarse la droga 1 .…”