Diagnosis and Treatment of Listeria monocytogenes Endophthalmitis: A Systematic Review

ABSTRACT

Purpose: Describe patient characteristics, treatment, and vision outcomes of Listeria monocytogenes endophthalmitis, an exceedingly rare form of listeriosis.

Methods: L. monocytogenes endophthalmitis cases in human adults, located through Medline (32) and from disease surveillance centers (11). L. monocytogenes conjunctivitis and keratitis were excluded.

Results: Most cases occurred in 2000–2015 (22/43), and almost all in Europe or North America (40/43). Patients were a median 61 years, 57% male (24/42) and half were immunosuppressed. Median days from entering care to diagnosis was 8 (IQR = 5–17). Only four were exogenous infections. L. monocytogenes was identified in 31/35 of anterior eye fluid samples (89%). Antibiotic regimens varied markedly (mostly ≥3 drugs). At diagnosis, most were blind in the affected eye (85%, 28/33), only a third regained normal vision (12/36). Older patients had poorer outcomes.

Conclusions: Cases increased over time. Diagnostic delays were common and visual impairment often refractory to treatment, especially in older adults. The condition’s rarity and variation in treatment makes it difficult to identify optimum therapy.

Keywords:

• Endophthalmitis
• Listeria monocytogenes
• ocular inflammation
• systematic review

ACKNOWLEDGMENTS

We acknowledge the invaluable assistance of Devind Peter and staff at the Wits Health Sciences Library, as well as Ashar Dhana and Langelihle Mlotshwa in locating articles for the review. MFC thanks colleagues and family for their support over the course of his case of the condition. The authors are grateful to Hanno Olinger, Jonas I. Liechti and Nicole Schmidt who translated the German and French articles. We acknowledge the CDC Listeria Initiative, Atlanta, GA: US Department of Health and Human Services, CDC as the data source for cases in the review (data received on 10/27/2015). The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

SUPPLEMENTAL MATERIAL

Supplemental data for this article can be accessed on the publisher’s website.

DECLARATION OF INTEREST

One of the authors of the review (MFC) had a case of Listeria endophthalmitis. There are no other competing interests to declare. The authors alone are responsible for the content and writing of the article.