title: Listeria monocytogenes endophthalmitis - case report and review of risk factors and treatment outcomes.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  We 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.
  
  
  CONCLUSIONS
  Early 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.
authors.affiliation: University Eye Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany. Bajor.Anna@mh-hannover.de.
authors.forename: Anna
authors.initials: A
authors.lastname: Bajor
authors.affiliation: University Eye Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Luhr
authors.affiliation: University Eye Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Brockmann
authors.affiliation: Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Suerbaum
authors.affiliation: University Eye Hospital, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Framme
authors.affiliation: Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Sedlacek
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002386:Cataract / Q000175:diagnosis / Q000209:etiology; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D005260:Female; D006801:Humans; D008089:Listeria monocytogenes / Q000302:isolation & purification; D008088:Listeriosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008266:Macula Lutea / Q000000981:diagnostic imaging; D008875:Middle Aged; D012307:Risk Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Dark hypopyon; Endogenous; Endophthalmitis; Listeria monocytogenes; Uveitis