COVID-19 infection among healthcare workers in an oncology hospital

INTRODUCTION

Healthcare workers are at high risk for acquiring COVID-19 and transmitting it to the patients especially to cancer patients in whom the risk of severe COVID-19 is high. We determined the rate of COVID-19 infection among healthcare workers in an oncology hospital and their epidemiological characteristics.

METHODOLOGY

Data of infected workers from March 11, 2020, to February 28, 2022 were obtained via Infection Control Committee COVID-19 Surveillance Records and evaluated retrospectively.

RESULTS

During this period 58.34% of 2,355 workers were vaccinated with > 3 doses of COVID-19 vaccines. A total of 1,294 COVID-19 attacks developed in 1,181 (50.14%) workers; mean age was 38.08 ± 9.52 years, 744 (63%) were female. Re-infection occurred in 112 (9.5%) workers. Source of infection in 858 attacks (66.31%) was unknown. Hospitalization was needed in 24 (2%) and intensive care unit admission in 1 (0.08%), no death occurred. In the first attacks, 587 (49.70%) were unvaccinated; in re-infections 66 (58.92%) were ≥ 3 doses vaccinated. Hospitalizations were predominantly in the pre-Delta period (16/24: 66.7%, p < 0.05). Re-infections occurred mostly in the Omicron variant period (p < 0.05). Relationship between hospitalization and male gender, age ≥ 50 years, "doctor" profession and presence of chronic diseases were significant (p < 0.05).

CONCLUSIONS

During the study period, half of the healthcare workers in our hospital developed COVID-19 infection of whom 9.5% re-infected, predominantly during the Omicron variant period. Our findings highlight the importance of taking preventive measures and administering booster vaccine doses even after initial vaccination/infection.

Latent tuberculosis in adult hematopoietic stem cell transplantation recipients: Clinical experience from a previously endemic population

Hematopoietic stem cell transplantation (HSCT) recipients may be at an elevated risk of developing active tuberculosis infection due to suppression in the cellular immune system. Herein, we aimed to evaluate the prevalence of latent tuberculosis and active tuberculosis in patients with allogeneic and autologous HSCT. In this cohort, data were obtained retrospectively from patients' records. The patients who were followed up in the bone marrow transplantation unit of the University of Health Sciences Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital between January 2016 and December 2019 were screened for the study. And the HSCT recipients who had tuberculin skin test and/or QuantiFERON-TB gold (QFT-GIT) test results were included in the study. A total of 361 patients were included in the study, 227 patients had autologous HSCT, and 134 patients had allogeneic HSCT. QFT-GIT was performed in 10 patients with allogeneic HSCT, and it was found positive in only 1 patient. Tuberculin skin test ≥5 mm was accepted as positive and was accepted to have latent tuberculosis, and it was positive in 18.2% (41) of the patients with autologous HSCT and was positive in 21.6% (29) of the patients with allogeneic HSCT. There was no significant difference between the 2 groups (P = .429). Isoniazid (INH) prophylaxis was started in 16.7% of patients with autologous HSCT and 22.4% of patients with allogeneic HSCT. During follow-up, active tuberculosis did not develop in any patients in both groups. There was no statistically significant difference found between allogeneic and autologous HSCT recipients regarding the prevalence of latent tuberculosis. Active tuberculosis infection did not develop in any of the patients who started INH prophylaxis. INH prophylaxis seems to be very efficient in preventing the reactivation of latent tuberculosis in patients going through allogeneic HSCT and/or autologous HSCT.

Recovery of Symmetrical Peripheral Gangrene of Limbs in a Patient After Performing Hemoadsorption in Septic Shock

We report a 42-year-old patient who had Hodgkin lymphoma and developed bilateral symmetrical peripheral gangrene (SPG) in the feet and hands, which occurred during septic shock after autologous hematopoietic stem-cell transplantation. SPG is a rare but severe complication of disseminated intravascular coagulation (DIC) and is frequently associated with sepsis. The pathophysiology of SPG includes DIC-mediated intravascular thrombosis and thrombotic occlusion of microcirculation, resulting in low blood flow. Sepsis-induced hypotension has been suspected as one of the other causes of SPG, and it is thought to be aggravated by vasopressor treatments given for hypotension. Our patient first experienced coldness, paleness, and cyanosis in his body's acral parts, and then SPG later developed in both his feet and hands. Septic shock management was performed with cytokine hemoadsorption, broad-spectrum antibiotics, and massive fluid replacement rapidly. The patient fully recovered without the need for amputation. Hemoadsorption is an extracorporeal cytokine-adsorption method for removing excess cytokines. Prompt management of septic shock and early monitoring of peripheral ischemia are essential to avoid SPG.

Hepatitis C screening and referral for further investigation and treatment in a tertiary care hospital

INTRODUCTION

Hepatitis C virus infection is a major cause of cirrhosis and liver cancer worldwide. The knowledge of physicians about what should they do in case of any anti-HCV positivity in screening tests is of great importance. In this study the awareness and knowledge of physicians is evaluated by analyzing the rate of the referrals of anti-HCV positive patients to HCV RNA test and their treatment by different clinics.

METHODOLOGY

The patients tested for anti-HCV in internal medicine, surgery, gastroenterology and infectious disease clinics between 1 January and 31 December 2017 were evaluated retrospectively in a tertiary care hospital.

RESULTS

Anti-HCV testing was performed in 32,803 patients. Anti-HCV positivity was detected in 95 (0.28%) patients aged 88 years of age or younger (mean 60.89 ± 16.96 years), 57.89% of them were female. HCV RNA was tested in 50 (%52,63) of anti-HCV positive patients and it was found positive in 18 (36%) patients. In anti-HCV positive patients HCV RNA testing was requested most by infectious disease (100%) and gastroenterology (70.58%) clinics and least by surgery and other clinics (21% and 25% respectively). These differences were found to be statistically significant ( =33.65, p < 001).

CONCLUSIONS

Our study highlights the significant deficiencies existed in the referring patients with anti-HCV positivity for further examination and treatment by the attending physicians especially in surgical clinics. Performing HCV screening in the different steps of medical care and using electronic reminder systems directing physicians at appropriate diagnostic and treatment protocols can maximize the likelihood of the detection and treatment of HCV- infected patients.

HBV flare associated with immunosuppressive treatments: it is still dangerous in the third-generation antivirals era

BACKGROUND

There are limited data about the mortality and morbidity of patients with HBV flare related to immunosuppressive treatments (IST) in the third-generation antivirals era. Herein, we performed a multi-centric study in patients treated with entecavir (ETV) or tenofovir disoproxil fumarate (TDF) and evaluated their clinical course.

METHODS

The study group included patients who were referred to gastroenterology or infectious disease specialists at eight different hospitals in Turkey. HBV flare was defined as at least a threefold elevation in alanine aminotransferase (ALT) levels above the upper limit of normal range. The demographic data, IST protocol, virological markers, liver tests, international normalized ratio (INR), HBV DNA, reactivation risk profile according to AGA guideline, MELD and MELD-Na scores were retrospectively evaluated. The primary aim of the study was to determine the liver-related mortality, including transplantation, at 12 weeks and factors predicting it. Secondary aims were to compare ETV and TDF with respect to mortality and time to ALT, bilirubin normalization and HBV DNA undetectability.

RESULTS

The study group included 40 patients (29 males, mean age: 57 ±12 years). Twenty-five patients (62.5%) had a high risk of reactivation. Twenty-six patients received TDF and 14 patients received ETV treatment. Eight (20%) patients developed acute liver failure and one patient (2.5%) underwent living donor liver transplantation. Seven patients died due to liver-related complications, revealing a mortality rate of 17.5%. In multivariate analysis, total bilirubin levels at the onset, ALT levels and delta-MELD score at the first week were the independent risk factors for liver related mortality (HR: 1.222, 1.003, 1.253 and 95% CI: 1.096, 1.362; 1.001, 1.004 and 1.065, 1.470, respectively). There was no significant difference between the TDF and ETV groups with respect to time to normalize ALT and bilirubin levels, HBV DNA undetectability and mortality rates (16% and 21.4%, respectively).

CONCLUSIONS

HBV flare associated with IST has a high mortality in the third-generation antivirals era. High total bilirubin at the onset and high ALT and delta-MELD score at the first week predict poor prognosis.

Does microbial contamination influence the success of the hematopoietic cell transplantation outcomes?

INTRODUCTION

Microbial contamination can be a marker for faulty process and is assumed to play an important role in the collection of hematopoietic progenitor cell (HPC) and infusion procedure. We aimed to determine the microbial contamination rates and evaluate the success of hematopoietic cell transplantation (HCT) in patients who received contaminated products.

PATIENTS-METHODS

We analyzed microbial contamination records of HPC grafts between 2012 and 2015, retrospectively. Contamination rates of autologous donors were evaluated for at three steps: at the end of mobilization, following processing with dimethyl sulfoxide, and just before stem cell infusion. Grafts of allogeneic donors were assessed only before HCT.

RESULT

A total of 445 mobilization procedures were carried out on 333 (167 autologous and 166 allogeneic) donors. The microbiological contamination of peripheral blood (323/333 donations) and bone marrow (10/333 donations) products were analyzed. Bacterial contamination was detected in 18 of 1552 (1.15 %) culture bottles of 333 donors. During the study period 248 patients underwent HCT and among these patients microbial contamination rate on sample basis was 1.3 % (16/1212). Microbial contamination detected in nine patients (7 autologous; 2 allogeneic). In 8 of 9 patients, a febrile neutropenic attack was observed. The median day for the neutropenic fever was 4 days (0-9). None of the patients died within the post-transplant 30 days who received contaminated products.

CONCLUSION

The use of contaminated products with antibiotic prophylaxis may be safe in terms of the first day of fever, duration of fever, neutrophil, platelet engraftment and duration of hospitalization.