Listeriosis of the eye

Listeriosis is an acute infectious disease from a group of zoonoses. It is characterized by a variety of pathways, infection of the lymph nodes, central nervous system, mononucleosis of white blood, often a state of septicemia. In general, listeriosis proceeds as an infectious mononucleosis.

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Causes and Epidemiology of Listeriosis of the Eyes

Listeriosis is caused by monocytogenic listeria, Gram-positive coccoid rod.

The source of listeriosis is domestic and wild animals, birds and rodents. Penetration of rods into the human body occurs through the mucous membrane of the mouth, throat, respiratory tract, small intestine, through conjunctiva and damaged skin, with the use of contaminated food, water, inhalation of wool particles and down, less often by contact.

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Pathogenesis of listeriosis of the eye

Listeria lymphatic pathways penetrate the lymph nodes. When a barrier breaks through the lymphatic tissue, the listeria spreads hematogenically into the parenchymal organs and the brain, where, as in the lymph nodes, they form lymphocyte diffuse or nested granulomas with necrosis in the center (listeriomas). Dissemination of rods is accompanied by the formation of endotoxin and biologically active substances, which causes an intoxication of the body.

In the course of the disease, specific antibodies are produced that provide immunity. There are also allergic reactions.

Symptoms of Listeriosis

The incubation period is from 3 to 45 days. Characteristic polymorphism of clinical manifestations: acute, subacute or chronic course. Distinguish the following forms of listeriosis: anginal-septic, nervous, typhoid, glazozhelezisty. Mixed forms are often noted. As a rule, the process is generalized. Local is the iron-and-iron form.

The disease is often observed in children, sometimes in newborns, which indicates the infection or illness of the mother. In such cases, listeriosis may be the cause of embryopathy.

At the beginning of the disease, a brief increase in body temperature, sometimes up to 40 ° C, malaise.

The symptomatology of listeriosis is determined by the form of the process. The course is usually severe, especially in generalized forms, sometimes fatal.

Listeriosis can be complicated by pneumonia, subacute endocarditis.

Symptoms of listeriosis of the eyes

With the penetration of listeria into the conjunctiva, the gland-iron form of listeriosis develops. More often older children, less often adults, get sick when they come in contact with infected animals (dogs, cats, rabbits, etc.). Electron microscopy studies indicate intracellular parasitism of listeria in the mucosa of the eyes. This leads to the development of conjunctivitis with mild hyperemia and infiltration, mainly in the upper or lower transitional fold with significant follicular changes. Sometimes among vascularized follicles yellowish granulomas with a diameter of up to 3-5 mm with necrosis in the center are found. Appear mucopurulent discharge, edema of the eyelids, narrowing of the eye gap. A characteristic feature is one-sided defeat.

On the relevant side, pre-limbs, less often submandibular lymph nodes are involved in the process. There is an increase in them, painfulness during palpation. This clinical form of oculoglandular origin is described in the literature as the Parino syndrome. Listeriosis is one of the etiological factors of this syndrome. The disease begins with a short fever, accompanied by mononuclear leukocytosis of peripheral blood.

The eye-ferruginous form of listeriosis proceeds favorably, but its duration is sometimes several months.

Very rarely, with listeriosis, marginal keratitis develops. More often at the lower edge of the cornea, corresponding to the lesion of the conjunctiva, a dirty gray infiltrate appears, which tends to spread inward and leads even to the perforation of the cornea.

Equally rare are non-granulomatous irites, due to toxic effects and allergic reactions. Described are disseminated chorioretinitis in patients with generalized forms of listeriosis. Yellowish white or grayish white foci (small and medium sizes - from 1/4 to 1 PD) with a small pigmentation are located mainly on the periphery of the fundus, sometimes in the macular or paramacular area, usually one eye. The defeat of the choroid is associated with hematogenous dissemination of listeria. The possibility of listeriosis etiology of uveitis in children is not ruled out. The outcome of listeriosis lesions of the eye is usually favorable.

Diagnosis of listeriosis eye lesions should be carried out taking into account anamnesis (contact with animals, especially in their disease), the features of the clinic, characteristic of one of its forms.

Perhaps the development of Parino syndrome. This is characteristic of the detection of lymphocytic infiltration of the conjunctiva of the arches and listeria in it. Especially typical are angiitis and an increase in the number of blood monocytes at the onset of the disease. The positive results of laboratory diagnostic methods serve as confirmation of the listeriosis nature of the process.

The most reliable selection of listeria during sowing of purulent discharge from any inflammatory focus, including conjunctiva, at the beginning of listeriosis. In cerebrospinal fluid and blood, listeria is found throughout the feverish period.

To obtain a culture of listeria, biological tests are also carried out on white mice. A keratoconjunctival diagnostic test is also proposed for rabbits: after applying the listeria culture, keratoconjunctivitis with mononuclear infiltration inherent in listeriosis develops on the conjunctiva.

Affordable and sufficiently reliable is the reaction of agglutination and indirect passive hemagglutination (RNGL). Antibodies in serum are detected in the 2nd pedigree of listeriosis, positive titers 1: 320 and above. The reaction must be taken into account in the dynamics of the process. Laboratory diagnostics of listeriosis is carried out in the departments of especially dangerous infections of the republican, regional and regional sanitary-epidemiological stations. From the 7th-11th day of the disease, a skin-allergic test with intradermal administration of 0.1 ml of listeriosis antigen can be used. It is performed after taking serological tests into account. Differentiation from the gland-glandular form of tularemia is carried out on the basis of negative results of serological methods of investigation, as well as negative skin-allergic test with tularin.

Treatment of eye listeriosis

Patients with listeriosis are subject to hospitalization in any department, depending on the clinical form, since human infection from a person does not occur.

Widely used antibacterial drugs, detoxification and symptomatic therapy. Antibacterial agents use antibiotics tetracycline and levomitsetinovogo series in conventional therapeutic dosages in combination with sulfonamides. For the purpose of detoxification, intravenous drip injection of hemodez, polyglucin, rheopolyglucin, 5-10% glucose solution, perfusion of blood or plasma is prescribed. In severe process, corticosteroid hormones are used in a dose of up to 40 mg per day, ascorbic acid up to 500 mg, cocarboxylase up to 80-100 mg. Use complex B vitamins in the average therapeutic doses. In addition, prescribe antihistamines and other hyposensitizing drugs (suprastin, dimedrol, calcium chloride, calcium gluconate, etc.).

Symptomatic therapy for listeriosis eye diseases consists in instilling disinfectant solutions, excluding cauterizing drugs. A 30% solution of sulfacyl sodium, 0.3% levomycetin solution, 2% boric acid is used. Apply corticosteroids, especially with uveitis, mydriatica with irites and keratitis.

Prevention of listeriosis eye diseases is primarily to prevent infections. In this plan, measures should be taken to identify sick animals, to control wild rodents. It is necessary to control food. It is very important to observe the rules of personal hygiene, especially when dealing with animals, timely diagnosis of listeriosis in sick people, their hospitalization and treatment. In order to prevent newborn listeriosis, early diagnosis of it in pregnant women and targeted therapy are necessary.