Xing Fanfan, Lo Simon K F, Lau Susanna K P, Woo Patrick C Y
Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.
Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
Front Med (Lausanne). 2022 Apr 29;9:888038. doi: 10.3389/fmed.2022.888038. eCollection 2022.
Targeted therapies are widely used for treatment of autoimmune diseases as well as solid organ and hematological malignancies. Various opportunistic infections have been described in patients on targeted therapies. Although case reports or a few case series of listeriosis have been reported to be associated with targeted therapy, most of the cases were related to anti-tumor necrosis factor-α monoclonal antibody. In this study, we describe the epidemiological and clinical profiles of listeriosis in a tertiary hospital in Shenzhen, a Southern Chinese metropolitan city in China. During the 9-year-and-6-month study period, a total of five cases of listeriosis were recorded and all of them had bacteremia. All five patients had predisposing factors, including corticosteroid ( = 3), targeted therapy ( = 2), pregnancy ( = 2) and anti-interferon gamma autoantibody ( = 1). The two patients who had targeted therapy during their course of cancer treatment received inhibitors of the epidermal growth factor receptor (EGFR)/human epidermal growth factor receptor 2 (HER2) pathway. The first one was a 52-year-old woman with metastatic adenocarcinoma of the lung. She was given gefitinib (EGFR tyrosine kinase inhibitor), osimertinib (third-generation EGFR tyrosine kinase inhibitor) and afatinib (tyrosine kinase inhibitor that can bind to EGFR, HER2 and HER4). The second one was a 40-year-old woman with carcinoma of the breast with brain metastasis. She was given trastuzumab (anti-HER2 monoclonal antibody) and lapatinib (dual tyrosine kinase inhibitor of the EGFR/HER2 pathway). These two patients represent the second and third reports of listeria infections associated with EGFR/HER2 pathway inhibitors in the literature. Targeted therapy is an important predisposing factor for listeriosis. Listeria infection is an important differential diagnosis in patients on targeted therapy who present with sepsis and/or central nervous system infection, and the use of antibiotic regimens that cover listeria is crucial for empirical treatment. Avoidance of high-risk food items in these patients is important for the prevention of listeriosis.
靶向治疗广泛应用于自身免疫性疾病以及实体器官和血液系统恶性肿瘤的治疗。接受靶向治疗的患者中已出现各种机会性感染。尽管已有病例报告或少数病例系列报道李斯特菌病与靶向治疗有关，但大多数病例与抗肿瘤坏死因子-α单克隆抗体有关。在本研究中，我们描述了中国南方大都市深圳一家三级医院中李斯特菌病的流行病学和临床特征。在9年零6个月的研究期间，共记录了5例李斯特菌病病例，所有病例均有菌血症。所有5例患者都有易感因素，包括使用皮质类固醇（3例）、靶向治疗（2例）、妊娠（2例）和抗干扰素γ自身抗体（1例）。在癌症治疗过程中接受靶向治疗的2例患者使用了表皮生长因子受体（EGFR）/人表皮生长因子受体2（HER2）通路抑制剂。第一例是一名52岁的肺转移性腺癌女性。她接受了吉非替尼（EGFR酪氨酸激酶抑制剂）、奥希替尼（第三代EGFR酪氨酸激酶抑制剂）和阿法替尼（可与EGFR、HER2和HER4结合的酪氨酸激酶抑制剂）治疗。第二例是一名40岁的乳腺癌伴脑转移女性。她接受了曲妥珠单抗（抗HER2单克隆抗体）和拉帕替尼（EGFR/HER2通路双酪氨酸激酶抑制剂）治疗。这2例患者代表了文献中与EGFR/HER2通路抑制剂相关的李斯特菌感染的第二和第三例报告。靶向治疗是李斯特菌病的一个重要易感因素。李斯特菌感染是接受靶向治疗且出现败血症和/或中枢神经系统感染患者的重要鉴别诊断，使用覆盖李斯特菌的抗生素方案进行经验性治疗至关重要。避免这些患者食用高风险食品对预防李斯特菌病很重要。
