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Listeriosis of the eye
Last reviewed: 04.07.2025
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Listeriosis is an acute infectious disease from the group of zoonoses. It is characterized by multiple routes of infection, damage to the lymph nodes, central nervous system, mononucleosis of white blood cells, and often a state of septicemia. In general, listeriosis occurs as infectious mononucleosis.
[ Causes and epidemiology of ocular listeriosis
Listeriosis is caused by Listeria monocytogenes, a gram-positive cocci-shaped bacillus.
The source of listeriosis are domestic and wild animals, birds and rodents. Penetration of the bacilli into the human body occurs through the mucous membrane of the mouth, pharynx, respiratory tract, small intestine, through the conjunctiva and damaged skin, when consuming contaminated food products, water, inhaling particles of wool and fluff, less often by contact.
Pathogenesis of ocular listeriosis
Listeria penetrates the lymph nodes via the lymphatic pathways. When the lymphatic tissue barrier is broken, listeria spreads hematogenously to the parenchymatous organs and the brain, where, multiplying as in the lymph nodes, they form lymphocytic diffuse or nested granulomas with necrosis in the center (listeriomas). Dissemination of the rods is accompanied by the formation of endotoxin and biologically active substances, which causes intoxication of the body.
During the disease, specific antibodies are produced, providing immunity. Allergic reactions also occur.
Symptoms of Listeriosis
The incubation period is from 3 to 45 days. Polymorphism of clinical manifestations is characteristic: acute, subacute or chronic course. The following forms of listeriosis are distinguished: angina-septic, nervous, typhoid, oculoglandular. Mixed forms are often noted. As a rule, the process is generalized. The oculoglandular form is local.
The disease is often observed in children, sometimes in newborns, which indicates infection or illness of the mother. In such cases, listeriosis can be the cause of embryopathies.
At the onset of the disease, a short-term increase in body temperature, sometimes up to 40 °C, and malaise are observed.
The symptoms of listeriosis are determined by the form of the process. The course is usually severe, especially in generalized forms, sometimes with a fatal outcome.
Listeriosis can be complicated by pneumonia and subacute endocarditis.
Symptoms of Listeria Eye Infections
When Listeria penetrates the conjunctiva, the oculoglandular form of listeriosis develops. Older children are more often affected, and adults are less often, becoming infected through contact with infected animals (dogs, cats, rabbits, etc.). Electron microscopic studies indicate intracellular parasitism of Listeria in the mucous membrane of the eye. This leads to the development of conjunctivitis with moderate hyperemia and infiltration mainly in the upper or lower transitional fold with significant follicular changes. Sometimes, yellowish granulomas up to 3-5 mm in diameter with necrosis in the center are found among the vascularized follicles. Mucopurulent discharge, eyelid edema, and narrowing of the palpebral fissure appear. A characteristic feature is the unilaterality of the lesion.
On the corresponding side, the preauricular and, less frequently, submandibular lymph nodes are involved in the process. They are enlarged and painful to palpation. This clinical form of oculoglandular origin is described in the literature as Parinaud's syndrome. Listeriosis is one of the etiologic factors of this syndrome. The disease begins with a short-term fever, accompanied by mononuclear leukocytosis of the peripheral blood.
The oculo-glandular form of listeriosis proceeds favorably, but its duration sometimes lasts several months.
Very rarely, listeriosis develops marginal keratitis. More often, at the lower edge of the cornea, corresponding to the conjunctival lesion, a dirty-gray infiltrate appears, which tends to spread deeper and even leads to corneal perforation.
Non-granulomatous iritis caused by toxic effects and allergic reactions is also rare. Disseminated chorioretinitis has been described in patients suffering from generalized forms of listeriosis. Yellowish-white or grayish-white lesions (small and medium-sized - from 1/4 to 1 PD) with slight pigmentation are located mainly on the periphery of the fundus, sometimes in the macular or paramacular region, usually in one eye. Choroidal damage is associated with hematogenous dissemination of listeria. The possibility of listeriosis etiology of uveitis in children is not excluded. The outcome of listeriosis eye lesions is usually favorable.
Diagnosis of listeriosis eye lesions should be carried out taking into account the anamnesis (contact with animals, especially when they are sick), clinical features characteristic of one of its forms.
Development of Parinaud syndrome is possible. In this case, detection of lymphocytic infiltration of the fornices conjunctiva and listeria in it is typical. Angiitis and an increase in the number of blood monocytes at the onset of the disease are especially typical. Positive results of laboratory diagnostic methods serve as confirmation of the listeriosis nature of the process.
The most reliable isolation of listeria is by sowing purulent discharge from any inflammatory focus, including the conjunctiva, at the onset of listeriosis. Listeria are found in the cerebrospinal fluid and blood throughout the febrile period.
To obtain a listeria culture, biological tests are also performed on white mice. A keratoconjunctival diagnostic test on rabbits is also proposed: after applying a listeria culture to the conjunctiva, keratoconjunctivitis with mononuclear infiltration, characteristic of listeriosis, develops.
The agglutination and indirect passive hemagglutination test (IPHT) is available and quite reliable. Antibodies in the blood serum are detected on the 2nd day of listeriosis, positive titers are 1:320 and higher. The reaction should 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 republican, regional and provincial sanitary and epidemiological stations. From the 7th to 11th day of the disease, a skin-allergic test with intradermal administration of 0.1 ml of listeriosis antigen can be used. It is carried out after taking into account serological studies. Differentiation from the oculoglandular form of tularemia is carried out on the basis of negative results of serological research methods, as well as a negative skin-allergic test with tularin.
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Treatment of listeriosis of the eyes
Patients with listeriosis are subject to hospitalization in any department depending on the clinical form, since infection from person to person does not occur.
Antibacterial drugs, detoxification and symptomatic therapy are widely used. Antibacterial agents include tetracycline and chloramphenicol antibiotics in standard therapeutic doses in combination with sulfonamides. For the purpose of detoxification, intravenous drip administration of hemodez, polyglucin, rheopolyglucin, 5-10% glucose solution, blood or plasma perfusion are prescribed. In severe cases, 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. Vitamins of the B complex are used in average therapeutic doses. In addition, antihistamines and other hyposensitizing drugs are prescribed (suprastin, diphenhydramine, calcium chloride, calcium gluconate, etc.).
Symptomatic therapy for listeriosis eye diseases consists of instillation of disinfectant solutions, excluding cauterizing drugs. A 30% solution of sodium sulfacyl, a 0.3% solution of chloramphenicol, and a 2% boric acid are used. Corticosteroids are used, especially for uveitis, and mydriatics for iritis and keratitis.
Prevention of listeriosis eye diseases consists primarily in preventing infections. In this regard, measures should be taken to identify sick animals and control wild rodents. Food control is necessary. Compliance with personal hygiene rules, especially when in contact with animals, timely diagnosis of listeriosis in sick people, their hospitalization and treatment are of great importance. In order to prevent listeriosis in newborns, early diagnosis in pregnant women and targeted therapy are necessary.